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DocuSign Envelope ID:06CEAA47-F11 F-421A-B8CE-390F42C61208 <br /> In determining UCR prevailing rates,Payors,CorVel or their designees use either(a) <br /> CorVel's Enhanced Bill Review database or other nationally recognized databases to provide <br /> benchmarks for hospital charges in a hospital Health Care Provider's geographic area and(b) <br /> databases provided by FAIR Health, Inc. or other nationally recognized databases to provide <br /> benchmarks for charges by non-hospital Health Care Providers in the applicable geographic <br /> area. The UCR prevailing rate is the 80th percentile of the relevant database benchmark for <br /> the fees and charges in Provider's geographic area. <br /> 2. DELIVERY OF SERVICES <br /> (a) Customer's Obligations <br /> (i) During the term of this Agreement,unless agreed to otherwise by the parties in writing, <br /> Customer shall utilize CorVel exclusively(even as to Customer)for audit,review and <br /> repricing services for Bills related to workers' compensation claims. A breach of the <br /> foregoing obligation shall constitute a material breach under this Agreement. Without <br /> limiting any other remedies available under law, a breach of the foregoing obligation <br /> with respect to PPO(as defined in Schedule 7)Provider Bills will result in immediate <br /> termination of all PPO discounts provided by CorVel. <br /> (b) CorVel's Obligations <br /> (i) CorVel shall provide Bill Review Services described herein to Customer upon receipt <br /> of specific requests from Customer. In the absence of instructions from Customer to <br /> the contrary,which CorVel must approve,Bill Review Services shall be performed as <br /> described herein. <br /> (ii) Bill Review Services shall be completed within a reasonable period of time of CorVel's <br /> receipt by CorVel of all necessary billing information from Customer ("Complete <br /> Billing Information"). <br /> (iii)To facilitate timely processing CorVel shall process (A) each Provider Bill within a <br /> reasonable period of time and within industry standards after CorVel's receipt thereof, <br /> and(B)batches of Provider Bills on a daily basis or as volume dictates. <br /> (iv)CorVel shall process PPO Provider reimbursements on behalf of Customer industry <br /> standards from receipt of the corresponding Bill Review Audit analysis from CorVel. <br /> (v) CorVel will be responsible for monitoring, "flagging" and returning to Customer <br /> duplicate copies of a Bill("Duplicates"). <br /> (vi)Any conflicts or complaints from medical providers ("Complaints") concerning Bill <br /> Review Services completed by CorVel initially will be handled directly by CorVel. <br /> CorVel will provide an initial response to a Complaint and will send a written response <br /> to the complainant that summarizes the nature of the Complaint and the steps CorVel <br /> has taken to resolve it. Customer may be asked to interject itself into a Complaint <br /> between CorVel and a medical provider to resolve the Complaint in a manner <br /> acceptable to Customer and as needed by CorVel. Notwithstanding the foregoing, <br /> Customer shall retain full responsibility for payment of all benefits and any other <br /> expenses or services required to be paid or provided under applicable policies or state <br /> and federal workers' compensation laws. <br /> (vii) CorVel agrees to supply Customer in the CorVel's standard format a transmission <br /> reflecting the results of the Bill Review Services provided hereunder. <br /> (c) Savings for the Fee schedule or usual and customary service shall be: <br /> City of Everett,WA—CorVel EC Amendment 3 7-25-2022 <br />