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letter allows the claim specialist to expedite medically necessary care, meet California <br />Division of Workers' Compensation (DWC) regulations and Senate Bill 1160 that <br />requires all treatment determinations are included in a database reportable to the DWC. <br />This process is completed by CorVel's California Utilization Management <br />depai tiuents. <br />(iii) CorVel nurses make recommendations to the claims adjuster based on nationally <br />accepted medical guidelines, including Optimed Managed Care System, a clinical <br />protocol software; the American College of Occupational and Environmental Medicine <br />(ACOEM) Occupational Medicine Practice Guidelines: Evaluation and Management <br />of Common Health Problems and Functional Recovery in Workers; other nationally <br />accepted treatment practice guidelines, as well as any state mandated treatment <br />guidelines. <br />(iv) Any nurse recommendations for limitation or denial of care based on lack of medical <br />necessity are reviewed by a CorVel Physician Advisor. The Physician Advisor makes <br />a final recommendation to the claims adjuster to approve or deny. If a final <br />recommendation is made to deny treatment, the treating physician is notified in writing <br />of the decision and the appeals process. <br />(f) Pre-Hab (Surgery Preparation) and Rehabilitation (Recovery) Services: <br />CorVel provides Case Management Pre-Hab (Surgery Preparation) and <br />Rehabilitation (Recovery) Services through a platform provided by CorVel's vendor <br />PeerWell utilizing a smart phone based application (the "Platform") providing injured <br />claimant(s) requiring a digital PreHab (surgery preparation) and Rehab (recovery) <br />program to be used for specific musculoskeletal conditions. Customer's injured claimant <br />will need to have a smartphone, Ipad or tablet to download and accept the app's terms <br />and conditions. Such service shall be used in conjunction with CorVel's telephonic or <br />field case management services. If Customer's injured claimant does not activate the <br />Platform app, there will be no fee billed to Customer. CorVel's Pre-Hab (Surgery <br />Preparation) and Rehabilitation (Recovery) Services will be made available to injured <br />claimants with an existing claim in conjunction with any medical care, where the injured <br />worker requests such care. <br />3. PROFESSIONAL FEE <br />(a) CorVel's case management nurses and vocational rehabilitation counselors are required <br />to be licensed in the jurisdictions they provide patient care or counseling. CorVel's case <br />managers may provide care in multiple jurisdictions. Such case managers are required to <br />maintain multiple state licenses and corresponding continuing education credits in <br />maintaining these licenses. Additionally, CorVel's case managers are required to utilize <br />up to date nationally recognized treatment guidelines, including American College of <br />Occupational and Environmental Medicine (ACOEM), Official Disability Guidelines <br />(ODG) and the MDGuidelines. An incremental professional fee as described hereunder <br />in Exhibit B ("Fees") shall be invoiced to Customer for the substantial costs associated <br />with obtaining and maintaining the national guidelines for CorVel's case management <br />nurses. Such professional fee allows CorVel to maintain the applicable licenses and <br />certifications for CorVel's case managers as well as keeping appropriate treatment <br />guidelines up to date. <br />City of Everett, WA — CorVel EC Amendment 3 7-25-2022 <br />