Additional service fees (ABF) Zoe Center for Pediatric and Adolescent Health LLC
Effective June 1, 2025 through May 31, 2026
Additional service fees
Engagement on Claims Audits $150 per hour in situations where Anthem is asked to perform research on claim audit findings. Maximum of 250 claims will be reviewed by Anthem. Anthem shall provide up to one Monthly data feed to a supported outside vendor in Anthem’s standard format , not to exceed 12 feeds. The charge is $1,000 for each additional feed. Each time a report is sent to a supported vendor electronically, it is considered a feed, even if the same report is sent to the same vendor monthly. For example, if monthly feeds are sent to two supported vendors, 24 electronic data feeds will have been used on an annual basis. The charge for Weekly data feeds to a single supported vendor, not to exceed 52 feeds, is $15,000 annually. The charge for Daily data feeds to a single supported vendor, not to exceed 365 feeds, is $20,000 annually. Additional fees would be required for Stop Loss interfaces, Rx integration feeds and telemedicine. Independent Dispute Resolution Fee for Independent Dispute Resolution. Fees charged to Anthem as part of independent dispute resolution processes, including arbitrator fees, will be charged to Employer. The PPACA requires that ASO groups provide a process for external claims appeals to be available in situations where adverse benefit determinations have been made. Employer may contract with Anthem for this service or arrange to work directly with an external vendor. The fee will be $500 per external appeal for the service contracted with Anthem. Data Feeds A capitation fee will be charged for each Member seeking services from a Provider paid on a capitated basis for Anthem’s oversight and care coordination of designated Members. Such capitation fee shall be 20% of the monthly capitation rate paid to Providers. Capitation Fees BlueCard Fees The following BlueCard fees will be included in the paid claims amounts: ● The access fee is charged at a percentage no greater than 3.31% of the discount/differential subject to a maximum of $2,000 per claim. ● The AEA Fee is $5.00 per professional provider claim and $11.00 per institutional claim. ● Occasionally, Anthem and a Host Blue may contract for a lower fee by combining the Access Fee and the AEA fee. ● The Central Financial Agency fee is $0.35 per payment notice. The ITS transaction fee is $0.05 per claims transaction. ● BlueCard fees are not charged in Anthem states. For a complete description of these fees, please consult your ASO Agreement. Subrogation services The charge is 25% of gross subrogation recovery. External appeals
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