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A TRUE COPY CERTIFICATION ON LAST PAGE RYAN L. BUTLER, CLERK may retain interest earned on funds held in variance accounts. Members will not bear any portion of the cost of Value -Based Programs except when a Host Blue uses either average pricing or actual pricing to pay providers under Value -Based Programs. Care Coordinator Fees Host Blues may also bill BCBSF and/or its Designated Agent for care coordinator fees for provider services which we will pass on to Employer as follows: • PMPM billings; or Individual claim billings through applicable care coordination codes from the most current editions of either Current Procedural Terminology (CPT) published by the American Medical Association (AMA), or Healthcare Common Procedure Coding System (HCPCS) published by the U.S. Centers for Medicare and Medicaid Services (CMS). As part of this Agreement, BCBSF and Employer will not impose Member cost sharing for care coordinator fees. D. Prepayment Review & Return of Overpayments If a Host Blue conducts prepayment review activities including, but not limited to, data mining, itemized bill reviews, secondary claim code editing, and DRG audits, the Host Blue may bill BCBSF up to a maximum of 16 percent of the savings identified, unless an alternative reimbursement arrangement is agreed upon by BCBSF and the Host Blue, and these fees may be charged to Employer. If a Host Blue engages a third party to perform these activities on its behalf, the Host Blue may bill BCBSF the lesser of the full amount of the third -party fees or up to 16 percent of the savings identified, unless an alternative reimbursement arrangement is agreed upon by BCBSF and the Host Blue, and these fees may be charged to Employer. Recoveries of overpayments from a Host Blue or its participating and nonparticipating providers from post -payment review activities can arise in several ways, including, but not limited to, antifraud and abuse recoveries, audits, healthcare provider audits, hospital bill audits, credit balance audits, utilization review refunds and/or unsolicited refunds. Recoveries will be applied in general, on either a claim -by -claim or prospective basis. If recovery amounts are passed on a claim -by claim basis from a Host Blue to BCBSF they will be credited to Employer account. When a Host Blue identifies and collects these overpayments, the Host Blue may bill BCBSF up to a maximum of 16 percent of the savings identified, unless an alternative reimbursement arrangement is agreed upon by BCBSF and the Host Blue, and these fees may be charged to Employer. In some cases, the Host Blue will engage a third party to assist in identification or collection 14