If you use United Resources Network (URN) through Summit Re to manage your transplant cases, the access fee can be submitted and considered as a claims expense if the claim exceeds the annual retention. Also, URN network claims will be considered at a higher coinsurance level and the average daily maximum limitation (ADM) will not be applied to case rates (Base Payment Rate or BPR). Should a URN arrangement go into an outlier arrangement, the BPR, or case rate portion, is still not subject to the ADM. Only the outlier portion will be subject to the ADM. This provides for higher reinsurance recoveries to the plan, and it is handled via claim administration guidelines rather than by policy amendment.
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