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Corvel Enterprise Comp, Inc. 9/6/2022 Amendment 3
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Corvel Enterprise Comp, Inc. 9/6/2022 Amendment 3
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Entry Properties
Last modified
10/7/2022 2:22:51 PM
Creation date
10/7/2022 2:21:41 PM
Metadata
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Template:
Contracts
Contractor's Name
Corvel Enterprise Comp, Inc.
Approval Date
9/6/2022
Council Approval Date
8/31/2022
End Date
7/31/2025
Department
Human Resources
Department Project Manager
Marcy Hammer
Subject / Project Title
Worker's Comp Third Party Administrative Svcs
Amendment/Change Order
Amendment
Amendment/Change Order Number
3
Tracking Number
0001282
Total Compensation
$0.00
Contract Type
Agreement
Contract Subtype
Professional Services
Retention Period
6 Years Then Destroy
Document Relationships
Corvel Enterprise Comp Inc 6/13/2018
(Amendment)
Path:
\Documents\City Clerk\Contracts\Agreement\Professional Services (PSA)
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DocuSign Envelope ID:06CEAA47-F11 F-421A-B8CE-390F42C61208 <br /> appropriately compared to the same service or supply for other hospitals in the same <br /> geographical area. <br /> Minimum Transaction Fee(MTF): For each bill transaction if the fees on a bill <br /> transaction instance do not meet the minimum transaction fee amount,the difference <br /> between the fees and the min transaction fee will be automatically added to the fees. <br /> Negotiations: A one time or ongoing agreement with the provider to accept a specific <br /> payment amount. <br /> PPO Network Access: A preferred provider organization(PPO)is a medical care <br /> arrangement in which medical professionals and facilities provide services at a <br /> negotiated/contracted rate. PPO medical and healthcare providers are called preferred <br /> providers. <br /> Provider Sendback: Sendbacks occuring when a bill instance does not have enough <br /> supporting information from the provider to be a Prepared Bill.The bill is sent back to <br /> the provider requesting further information. <br /> Standard Fee Schedule: Savings defined as the amount reduced from the Prepared Bill <br /> status to the jurisdictional state fee schedule amounts when those amounts are expressly <br /> assigned a specific value,not through reference methodologies developed by a third party <br /> or federal agency. <br /> Substantive Denials: Sendbacks occur when a bill instance does not have enough <br /> supporting information from the provider to be a Prepared Bill. The bill is sent back to <br /> the provider requesting further information. If the provider does not provide the <br /> necessary supporting information after 90 days of the sendback status all bill savings will <br /> be considered Substantive Denial Savings and charged accordingly through an automatic <br /> bill instance. If the bill is later submitted through another bill instance with further <br /> information from the provider,another review will occur which may reverse all or part of <br /> the Substantive Denial savings and fees. <br /> Technical Evaluation: Applicable to bills when reimbursement is not fully addressed in <br /> the jurisdictional fee schedule. State regulations may require payment to be made in <br /> accordance with payment methodologies developed by a third party(typically the Centers <br /> for Medicare and Medicaid Services(CMS)),often with exceptions or special exemptions <br /> added by the state. <br /> UCR: "UCR" is defined as: <br /> • Usual—A charge is considered"Usual"if it is the fee that most providers in the area <br /> charge for the same service. <br /> • Customary—A charge is considered"Customary"if it is within the range of fees <br /> that most providers who practice in the area charge. <br /> • Reasonable—A charge is considered"Reasonable"if it is both usual and customary <br /> or if it is justified by the Payor because of complexity. Payor, CorVel or its designees <br /> use a nationally recognized third party database for UCR charges. <br /> City of Everett,WA—CorVel EC Amendment 3 7-25-2022 <br />
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