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tlifP7= <br /> PRICING BEST& FINAL <br /> Workers'Compensation Claims Administration <br /> OPTION#2 <br /> {7 � .r <br /> Data Conversion&Implementation Fee $5,000 <br /> Claim Intake $30 per claim <br /> Incident Only Reporting ( $30 per claim <br /> 24/7 Nurse Triage $85 per claim <br /> Option 1: Life of Contract Claims Handling Fee <br /> Medical-Only $150 <br /> Indemnity $1,100 <br /> Option 2:Life of Contract Flat Annual Fee <br /> Up to 90 new IND 100 new MO claims annually $100,650 <br /> 54 MO claims 76 IND tail claims(one-time fee) $46,930 <br /> Per claim Fee after maximum number of claims: <br /> Medical-Only $150 <br /> Indemnity $1,100 <br /> Annual Administration Fee: <br /> • Designated Account Manager <br /> • Preparation and participation in quarterly <br /> claim reviews <br /> • Annual stewardship meeting <br /> • Monthly standard reporting <br /> • L&I Reporting: <br /> • SIRAS reporting <br /> • SIEDERS reporting <br /> • Annual SIF-7 report <br /> • Quarterly F207 report <br /> • Scanning/OCR $12,000 <br /> • Technical support <br /> • Maintenance of the loss fund account and <br /> all Wells Fargo bank fees <br /> • Filing of all required state forms <br /> • Reporting to excess/fronting carrier <br /> • File Storage <br /> • Includes all RMIS Fees <br /> • All OHSA Reporting <br /> • Additional Nurse Triage(first call from nurse <br /> after claim filing) <br /> • Section 111 Mandatory Medicare Report Filing <br /> January 26,2018 Page 2 <br /> cCORVEL <br /> 28 <br />