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HSI( <br />MR ".• MR SERVICES <br />FEE SCHEDULE <br />Per Employee per Month (PEPM) Fee $1.32 <br />Optional Services below (additional fees apply If selected): <br />• Additional languages for IVR: Add $800 for Spanish (other languages quoted) <br />• Customized IVR Scripts: $150/hour <br />• Updating & Script Revisions for IVR: $150/hour <br />• BASIC has the right to apply additional fees for any service outside the scope of its contracted <br />services. <br />• IT development for special processing, custom reports, and data formatting/cleansing- <br />$125/hour <br />• Intake script customization or mid -year changes - $125/ hour <br />• Second and Third Opinion on FMLA: $100 per event and cost of doctor visit <br />• EDI (,Electronic Data Interchange): <br />A. Monthly Fees (if applicable): Monthly fees will be assessed on a case by case basis for <br />each line of service (likely between $50 and $250 per month) for EDI files with the following <br />issues: <br />a. Files not provided in BASIC's format <br />b. Required data is missing/not provided <br />c. Data is inaccurate or conflicting data Is provided <br />d. Files transmitted in a non-standard manner <br />e. Other reasons as determined by BASIC <br />THE EMPLOYER TO INTIAL WITH ACCEPTANCE OF FEES HERE <br />Revised 5.25.17 <br />25A-12 <br />