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DocuSign Envelope ID:06CEAA47-F11 F-421A-B8CE-390F42C61208 <br /> SCHEDULE 3 <br /> Bill Audit, Review and Payment Services <br /> Terms and Conditions <br /> 1. DESCRIPTION OF SERVICES <br /> (a) CorVel's proprietary bill review program enables an application of the appropriate <br /> Standard Fee Schedules or usual and customary values, includes PPO, Technical and <br /> Clinical Review,and CERiS, applied to provider bills. <br /> 2. DEFINITIONS <br /> Bill(per Bill): Each transaction of a bill is considered a separate per bill count. CorVel <br /> is able to logically link transactions across logical sequences,but each is its own bill <br /> transaction. <br /> Clean/Prepared Bill: When the provider charges are deemed to be an accurate <br /> reflection of the services rendered based on the provider's documentation. Network <br /> Solutions savings such as Clinical Review and Technical Evaluation and other review <br /> types can be applied first to the bill for the bill to qualify for the Prepared Bill <br /> status. Once at the prepared bill state Standard Fee Schedule savings can be applied. <br /> Clinical Review: An additional level of review performed by nurses,system,or coding <br /> experts to evaluate appropriateness,relatedness of submitted charges with provided <br /> documentation. <br /> Implant Analysis: Review of implant charges submitted to a proprietary pricing <br /> database and documentation. Implant Analysis results are included as part of Clinical <br /> Review. <br /> Line Item Bill Review(LIBR): <br /> Out of Network Line Item Bill Review: <br /> • Original charge data <br /> U&C review by zip code <br /> • Fee re-bundling and error removal <br /> • Separation of charges by diagnosis/procedure <br /> Facility to facility cost comparison <br /> • Individual facility chargemaster analysis and price trending <br /> Fair and Reasonable-Universal Chargemaster: The Universal Chargemaster is a <br /> compilation of individual hospital line item descriptions from over 85%of the nation's <br /> hospitals. It is a virtual thesaurus of hospital billing terms, codes and abbreviations. <br /> Specific, unique line item descriptions are defined by the Universal Chargemaster and <br /> City of Everett,WA—CorVel EC Amendment 3 7-25-2022 <br />