Prior Authorization Service Types Addendum

BY ENTERING INTO AN ORDER UNDER WHICH CUSTOMER WILL BE PROVIDED PRIOR AUTHORIZATION SERVICES WHICH ARE PRICED BY SERVICE TYPE, CUSTOMER HEREBY ENTERS INTO THIS PRIOR AUTHORIZATION SERVICE TYPES ADDENDUM (THIS “ADDENDUM”) AND IS LEGALLY BOUND THEREBY. FOR THE AVOIDANCE OF DOUBT, THIS ADDENDUM DOES NOT APPLY TO THE PROVISION OF ANY PRIOR AUTHORIZATION OR OTHER SERVICES NOT PRICED BY SERVICE TYPE. THIS ADDENDUM IS HEREBY ATTACHED TO AND MADE A PART OF THE GENERAL TERMS AND CONDITIONS (“GENERAL TERMS”) SET FORTH AT HTTPS://WWW.INFINX.COM/TERMS-AND-CONDITIONS-FOR-CUSTOMER-AGREEMENTS BY AND BETWEEN THE CONTRACTING INFINX ENTITY PROVIDER DESIGNATED IN THE APPLICABLE ORDER(S) ON BEHALF OF ITSELF AND ITS AFFILIATES (INCLUDING WITHOUT LIMITATION, ITS OFF-SHORE AFFILIATES WHICH INCLUDE INFINX SERVICES PVT. LTD., LOCATED IN INDIA AND INFINX HEALTHCARE PHILIPPINES, INC., LOCATED IN THE PHILIPPINES) (COLLECTIVELY, “INFINX”), AND THE PURCHASING BUSINESS OR OTHER ENTITY WHO IS ENTERING INTO THE ORDER(S) (“CUSTOMER”), REGARDING THE PROVISION AND USE OF PRIOR AUTHORIZATION SERVICES PRICED BY SERVICE TYPE. THE PERSON EXECUTING THE ORDER(S) ON BEHALF OF CUSTOMER REPRESENTS AND WARRANTS TO INFINX THAT THEY HAVE FULL LEGAL AUTHORITY TO ACCEPT THE TERMS OF THIS ADDENDUM AND THAT THEY AND CUSTOMER ARE NOT BANNED FROM USING THE PROVIDED SERVICES UNDER THE LAWS OF THE UNITED STATES OR ANY OTHER COUNTRY. ALL CAPITALIZED TERMS USED IN THIS ADDENDUM BUT NOT DEFINED WILL HAVE THE SAME MEANINGS GIVEN IN THE GENERAL TERMS OR APPLICABLE ORDER. IN THE EVENT OF A CONFLICT BETWEEN THE TERMS OF THIS ADDENDUM, THE GENERAL TERMS AND THE ORDER, THE FOLLOWING DESCENDING ORDER OF PRECEDENCE WILL CONTROL: THE ORDER, THIS ADDENDUM AND THE GENERAL TERMS.

Prior Authorization Service Types: The Prior Authorization service types are as follows:

Service Type PA Type
Surgical (includes Urology, Vascular and Vein Surgery) PA II
Diagnostic X-Ray PA I
Diagnostic Lab PA II
Radiation Therapy PA II
MRI Scan PA I
Pathology PA II
Chemotherapy PA II
Allergy Testing PA I
Podiatry PA II
Occupational Therapy PA I
Speech Therapy PA I
Skilled Nursing Care (Home Health) PA II
Orthopedic PA I
Cardiac – Mobile Cardiac Telemetry PA I
Cardiac – Event Monitor PA I
Cardiac – Extended Holter PA I
Cardiac – Holter PA I
Cardiac – all not listed above PA II
Gastrointestinal PA II
Neurology PA II
Coronary Care PA II
Mammogram, High Risk Patient PA I
Durable Medical Equipment PA II
CAT Scan PA I
Ophthalmology PA II
Allergy PA II
Oncology PA II
Positron Emission Tomography (PET) Scan PA I
Physical Therapy PA I
Pediatric PA II
Specialty Pharmacy PA II
Other (any service type or specialty not listed) PA II

Prior Authorization Service Types Addendum to General Terms and Conditions, Version 1.0, Promulgated February 5, 2025.