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7.1.C. - Page 12 <br /> We recognize PRINCIPAL's stated desire to explore various vendor options to service its program; <br /> however, York's claims fees rely on fully integrated managed care services. <br /> York believes that for PRINCIPAL to realize an overall reduction in cost of risk, reduced leakage, <br /> and enhanced coordination and communication that a fully integrated service model is better <br /> suited for delivering on our promises. <br /> Managed Care Fees: <br /> DETAIL FEE <br /> MEDICAL BILL REVIEW <br /> Fee Per Bill $8.50 <br /> PPO Saving 26% <br /> CASE MANAGEMENT <br /> Telephonic Case Management $98.00 per Hour <br /> Field Case Management $98.00 per Hour, <br /> plus !RS Mileage Rate <br /> UTILIZATION REVIEW/CERTIFICATION <br /> Clinical Nurse Review <br /> $145.00 per case <br /> Physician Review $250.00 per case <br /> Peer Review $345.00 per case <br /> MEDICARE SECONDARY PAYER COMPLIANCE SERVICES <br /> MMSEA Reporting Waived with use of York MMSEA <br /> services <br /> Standard MSA includes Submission $2,575 flat rate <br /> Medical Cost Projection $1,545 flat rate <br /> Conditional Payment Requests $155 flat rate <br /> Rush Reports (Less than 10 days) No additional charge <br /> MEDICAL PROVIDER NETWORK(MPN) <br /> Application Fee $1,550 <br /> Access Fees $60.00 per claim access fee <br /> ATTY/AGR/2015.068/YQRK TPA REDWOOD CITY <br /> REV:04-20-15 MLG <br /> Page 8 of 17 <br />