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Medicare status of injured party is unknown or unclear, a request for Medicare status will <br />be submitted to the Social Security Administration. Once the Medicare status is known, <br />the Coordination of Benefits Contractor will be notified and conditional payments <br />requested. <br />e. Upon Customer's request, CorVel Medicare Set -Aside Hub office will submit through <br />the web -portal all required documents to enable CMS to review and approve the <br />proposal. Items submitted include the Medicare Set -Aside report, the tentative settlement <br />amount, along with other required documentation, to the Centers for Medicare & <br />Medicaid Services (CMS). Upon receipt, CorVel Medicare Set -Aside Hub office will <br />forward the CMS Determination letter to the Customer. Final executed settlement <br />documents (reflecting CMS recommended Medicare Set -Aside amount) will be provided <br />to CorVel Medicare Set -Aside Hub by the Customer/counsel and then forwarded by <br />CorVel to CMS through the web -portal. <br />f. Upon request from Customer, CorVel shall provide Customer quarterly activity report <br />within twenty (20) business days following the applicable quarter. <br />III. DELIVERY OF SERVICES OF LIFE CARE PLANS/FUTURE COST <br />PROJECTIONS <br />i.Customer shall provide all available medical records and billing to CorVel Medicare Set - <br />Aside Hub office as well as any other pertinent records for initial review. <br />ii.For a Life Care Plan, a visit to the residence of the Customer's employee or injured <br />individual with interview of claimant and family will be conducted after permission is <br />acquired by the Customer. The interview will include evaluation of the home setting, <br />extensive information gathering, and pictures of the various equipment and housing <br />structures. <br />iii.Letters will be sent to all treating physicians to obtain their opinions on future medical <br />treatments including medications and therapies for the claimant. The physician's <br />opinions will be included as recommendations within the Life Care Plan summaries. <br />iv.Future cost projections are utilized to immediately set reserves for future medical needs <br />regarding catastrophic or major injuries. Home visits are not conducted for a future cost <br />projection. <br />v.Customer may submit a request for a life care plan or future cost projection via email, <br />phone, fax, or electronically via CorVel's CareMC website, if applicable. <br />City of Everett, WA — CorVel EC Amendment 3 7-25-2022 <br />