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DocuSign Envelope ID:06CEAA47-F11F-421A-B8CE-390F42C61208 <br /> 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 /> departments. <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 />