2022/08/31 Council Agenda Packet

SCHEDULE 3 Bill Audit, Review and Payment Services Terms and Conditions 1. DESCRIPTION OF SERVICES (a) CorVel's proprietary bill review program enables an application of the appropriate Standard Fee Schedules or usual and customary values, includes PPO, Technical and Clinical Review, and CERiS, applied to provider bills. 2. DEFINITIONS Bill (per Bill): Each transaction of a bill is considered a separate per bill count. CorVel is able to logically link transactions across logical sequences, but each is its own bill transaction. Clean/Prepared Bill: When the provider charges are deemed to be an accurate reflection of the services rendered based on the provider's documentation. Network Solutions savings such as Clinical Review and Technical Evaluation and other review types can be applied first to the bill for the bill to qualify for the Prepared Bill status. Once at the prepared bill state Standard Fee Schedule savings can be applied. Clinical Review: An additional level of review performed by nurses, system, or coding experts to evaluate appropriateness, relatedness of submitted charges with provided documentation. Implant Analysis: Review of implant charges submitted to a proprietary pricing database and documentation. Implant Analysis results are included as part of Clinical Review. Line Item Bill Review (LIBR): Out of Network Line Item Bill Review: Original charge data U&C review by zip code Fee re -bundling and error removal Separation of charges by diagnosis/procedure Facility to facility cost comparison Individual facility chargemaster analysis and price trending Fair and Reasonable - Universal Chargemaster: The Universal Chargemaster is a compilation of individual hospital line item descriptions from over 85% of the nation's hospitals. It is a virtual thesaurus of hospital billing terms, codes and abbreviations. Specific, unique line item descriptions are defined by the Universal Chargemaster and City of Everett, WA — CorVel EC Amendment 3 7-25-2022