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Only the initial claims based reimbursement to Network Providers will be subject to the Participant's copayment, <br /> coinsurance or deductible requirements. Customer will pay the Network Provider the full amount earned or <br /> attributable to its Participants, without a reduction for copayments or deductibles and agree that there will be no <br /> impact from these payments on the calculation of the Participant's satisfaction of their annual deductible amount. <br /> Section 4.3 Claim Recovery Services.United will provide recovery services for Overpayments,but United will not <br /> be responsible for recovery costs except as otherwise stated in this section. United will be responsible for recovery <br /> costs and reimbursement of any unrecovered Overpayment only to the extent the Overpayment was due to United's <br /> gross negligence. <br /> In some instances, United may be able to obtain Overpayment recoveries by applying (or offsetting) the <br /> Overpayment against future payments to the provider made by United. In effectuating Overpayment recoveries <br /> through offset, United will follow its established Overpayment recovery rules which include, among other things, <br /> the prioritization of Overpayment credits based on the age of the Overpayment in United's system and funding type. <br /> In United's application of Overpayment recovery through offset, timing differences may arise in the processing of <br /> claims payments, disbursement of provider checks,and the recovery of Overpayments. As a result,the Plan may in <br /> some instances receive the benefit of an Overpayment recovery before United actually receives the funds from the <br /> provider. Conversely,United may receive the funds before the Plan receives the credit for the Overpayment. It is <br /> hereby understood that the parties may retain any interest that accrues as a result of these timing differences. Details_ <br /> associated with Overpayment recoveries made through offset will be identified in the monthly reconciliation report <br /> provided to the designated representative for Customer's Plan. <br /> United will also provide services to recover Plan benefits that were paid and are recoverable by the Plan because <br /> payment was or should have been made by a third party for the same medical expense(other than in connection with <br /> coordination of benefits,Medicare, or other Overpayments). This is referred to as"Third Party Liability Recovery" <br /> (or "subrogation").Customer will not engage any entity except United to provide the services described herein <br /> without United's prior approval. <br /> Customer will be charged fees, as listed in Exhibit B, Fees, when any of the services described herein are provided <br /> by United through a subcontractor or affiliate. The fees are deducted from the actual recoveries. Customer will be <br /> credited with the net amount of the recovery. <br /> Customer delegates to United the discretion and authority to develop and use standards and procedures for any <br /> recovery, including but not limited to, whether or not to seek recovery, what steps to take if United decides to seek <br /> recovery,and the circumstances under which a claim may be compromised or settled for less than the full amount of <br /> the claim. Customer acknowledges that use of United's standards and procedures may not result in full or partial <br /> recovery for any particular case. United will not pursue any recovery if it is not permitted by any applicable law, or <br /> if recovery would be impractical. United may initiate litigation to recover payments,but United has no obligation to <br /> do so.If United initiates litigation,Customer will cooperate with United in the litigation. <br /> If this Agreement terminates, or, if United's recovery services terminate, United can continue to recover any <br /> payments United is in the process of recovering. The appropriate fees will continue to be deducted from the actual <br /> recovery,when and if a recovery is obtained. <br /> Section 4.4 Abuse and Fraud Management. United or its affiliate will provide services related to the detection, <br /> prevention,and recovery of abusive and fraudulent claims. <br /> United's Abuse and Fraud Management processes will be based upon United's proprietary and confidential <br /> procedures,modes of analysis and investigations. <br /> United will use these procedures and standards in delivering Abuse and Fraud Management services to Customer <br /> and United's other customers. These procedures and standards include,but are not limited to: whether or not to seek <br /> recovery, what steps to take if United decides to seek recovery, and under what circumstances to compromise a <br /> claim or settle for less than the full amount. <br /> Customer delegates to United the discretion and authority to use such procedures and standards, including the <br /> authority to undertake actions, including legal actions, which have the largest impact for the largest number of <br /> customers. <br /> 4 <br />