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2025-126D
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2025-126D
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Last modified
9/18/2025 10:43:54 AM
Creation date
9/8/2025 1:42:16 PM
Metadata
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Template:
Official Documents
Official Document Type
Agreement
Approved Date
06/03/2025
Control Number
2025-126D
Agenda Item Number
13.D.1.
Entity Name
Rightway Healthcare, Inc.
Subject
Pharmacy Benefit Management Services Agreement
Document Relationships
2025-126
(Cover Page)
Path:
\Official Documents\2020's\2025
2025-126A
(Cover Page)
Path:
\Official Documents\2020's\2025
2025-126B
(Cover Page)
Path:
\Official Documents\2020's\2025
2025-126C
(Cover Page)
Path:
\Official Documents\2020's\2025
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Docusign Envelope ID: 921 F7A24-D5CE-4BCC-9F3C-5E7844661266 <br />Section 13. Pharmacy Navigation Services. RIGHTWAY will make Pharmacy Navigation <br />Services available to Eligible Persons including access to RIGHTWAY'S technology portal and patient <br />navigator, which are designed to help Eligible Persons to navigate to the optimal cost and quality option <br />for their condition, and the following services: <br />• Patient Education & Management <br />• Consumer Savings Recommendations (Digital) <br />• Site of Service Optimization <br />• Therapy Optimization <br />Section 14. Care Navigation Services. RIGHTWAY will make Care Navigation Services avail- <br />able to Client beginning on the Effective Date of the Agreement and continuing for the Initial Term and <br />Renewal Term(s). "Care Navigation Services" means access to RIGHTWAY's technology portal and live <br />care team (via call or chat), which are designed to help Authorized Users manage their health and <br />healthcare through the provision of the following services: <br />• Benefit navigation, education, and guidance <br />• Finding and accessing care (e.g. provider search and cost transparency) <br />• Appointment scheduling <br />• Billing advocacy <br />• Clinical guidance: <br />o Triage and assessment; education, care decision support, care coordination, and <br />proactive outreach <br />14.1 Minimum Requirements for Care Navigation Services. Client's execution of <br />the Agreement shall be deemed as consent of Client for delivery of the following information to RIGHT - <br />WAY in connection with the delivery and invoicing for the Care Navigation Services. <br />14.1.1 Eligibility Feed In connection with the delivery of the Care Navigation Services, <br />Client must provide RIGHTWAY with a monthly census file during the Initial Term and Renewal <br />Terms(s) of the Agreement. If Client is adding RIGHTWAY's Care Navigation Services for the first time, <br />Client must also provide RIGHTWAY at least one initial census file for the period prior to the Effective <br />Date of the Agreement. The census file to be provided shall include Authorized Users of RIGHTWAY's <br />Care Navigation Services. Client is responsible for ensuring the accuracy of initial and monthly census <br />files ("Eligibility Feed"). The Eligibility Feed shall serve as the basis for billing for RIGHTWAY's Care <br />Navigation Services. If a current monthly file is not received from Client, RIGHTWAY will reference the <br />most recent census file for billing and determination of Authorized Users who have access to RIGHT- <br />WAY's Care Navigation Services. The Eligibility Feed shall include at least the following, and RIGHT - <br />WAY reserves the right to modify or update the following as needed during the Initial Term and Renewal <br />Term(s) of the Agreement (and as necessary to comply with Client's approved insurance carrier require- <br />ments): <br />• Census eligibility file — employee and dependent demographic and personal identi- <br />fier information <br />• Plan election for medical, dental, vision. <br />14.1.2 Plan Asset Information In addition to the Eligibility Feed, Client must provide <br />RIGHTWAY with the following plan information prior to the Effective Date of the Agreement <br />35 <br />This document is CONFIDENTIAL AND PROPRIETARY to RIGHTWAY Healthcare, Inc. and may not be reproduced, <br />transmitted, published, or disclosed to others without the prior written authorization of RIGHTWAY Healthcare, Inc. <br />
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