HomeMy WebLinkAbout5.423 Amendment P'csr t An��l�s
R�ccrrd #5.423
AMENDMENT ONE TO WORKERS' COMPENSATION CLAIM
ADJUSTING AND ADMINISTRATION SERVICES
AGREEMENT EFFECTIVE JANUARY 1,2010
This first(1st) Amendment to that certain Claims Service Agreement (collectively referred to as
the"Agreement") dated as of July 1, 2002 and as subsequently amended by exhibit or otherwise,
by and between CITY OF PORT ANGELES, WASHINGTON ("CLIENT") an Ohio
Corporation,with its principle place of business located at 5000 Bradenton Avenue, , Dublin,
Ohio 43017 and YORK RISK SERVICES COMPANY, INC. (parent and affiliate of The Frank
Gates Service Company, d/b/a Avizent) ("YORK");
WITNESSETH
WHEREAS, the parties wish to extend the Term of this Agreement as set forth herein; and
WHEREAS, the parties wish to amend the Claims Administration Service Fees of this
Agreement as set forth herein;
WHEREAS,the parties wish to amend the name of The Frank Gates Service Company d/b/a/
Avizent as reflected below,
NOW THEREFORE
The parties hereby agree as follows:
1. The Term of this Agreement shall be extended to include: January 1, 2014 through
December 31, 2014.
2. The Parties agree to the following in place and stead of the former Exhibit A as applicable.
ELAT ANNUAL FEE PRICING
Service Fee: CLIENT agrees to pay YORK a flat annual fee of$17,500.00,payable at $4,375.00 per
quarter in advance.
* The fees set forth above are contingent upon CLIENT using YORK's bundled bill review and
managed care services.
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following fees and expenses Mal be billed and paid through each individual claim file Masan
allocated expense.
Medical Fee Bill Review Services and PPO Network Access — CLIENT agrees to pay
YORK a fee rate of$8.50 per line per medical and pharmacy bill processed. Medical fee bill
review includes review and reduction of medical charges to state fee schedule levels and
review for duplicate charges. CLIENT further agrees to participate in YORK's nationwide
PPO network offering including pharmacy network and out of network negotiation services with
any savings/reductions below state fee schedules or other enhanced savings subject to a fee rate
of thirty percent(30%) of any such savings.
Enhanced Savings — YORK, at its sole discretion, may review bills for enhanced savings to
include reductions for unbundling, fragmentation, up-coding, correct coding initiatives, and/or
may refer bills for physician or nurse review and audit. All enhanced reductions achieved are
subject to a fee rate of thirty percent(30%) of the net savings below state fee schedule.
State Medical EDI Reporting - CLIENT agrees to pay YORK a fee equal to the lesser of an
additional (1) line header or $1.30 per bill in jurisdictions that require Medical Electronic Data
Interchange(EDI) reporting.
Electronic Billing (E-Bill) — CLIENT agrees to pay YORK an additional fee equal to the
lesser of an additional (1) line header or$1.30 per bill in jurisdictions requiring EDI reporting.
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CLIENT agrees to an automatic 3% annual increase to the Service Fee for any automatically renewed
1-year terms of the Agreement.
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1. A telephone and/or facsimile claim/incident reporting system at$25.00 per call or reported
incident,and$9.00 per non-report calls.Reporting claims through YORK's web-based intake
system is$0.00.
The following represents services that may be obtained on behalf of CLIENT and are billed and
paid for through each individual claim as an allocated expense (Expense Column). YORK shall
not proceed with these services without prior discussion with and authorization from CLIENT.
(a) Fees to attorneys for litigated and potentially litigated claims and for attorney
representation at hearings, pretrial conferences or similar proceedings;
(b) Fees to court reporters;
(c) All court costs, court fees and coud-cxyeomca;
(d) pre-and post-judgment interest paid asa result ofjudgments;
(e) Fees for service 0fprocess;
AM Costs of undercover operative and detective services;
~, Costs for employing experts for the preparation of maps,professional photographs,
accounting services or records,chemical or physical analysis, diagrams, appraisals, or similar
documents;
(6) Costs for employing experts for their advice, opinions or testimony concerning claims
under investigation or in litigation or for which a declaratory judgment is sought;
(i) Costs for obtaining independent medical examination and/or evaluation for
rehabilitation and/or to determine the extent nfCL.IINT`o liability;
6) Costs of legal transcripts oftcatiouonyCakcou1cornuer'oiogucuto`odooivalmcoivil
proceedings;
(k) Costs for legal transcripts orcopicaofpub[iuceuordmaud/oc000dical.-nocordm;
(|) Costs nf depositions and court reported and/or recorded statements;
`—') (�oa1uand expenses related to the purxu�of subrogation and recovery rights;
_)' Costs of engineers, handwriting experts and/or any other type of expert used in the
preparation time
n) Managed Care Services including, but not limited to, the following services:
l. Utilization Review Services
2. Light Duty and BLotucu-to-VVock Programs
3. Medical and Hospital Bill Audit Services
4. Medical Case Management and Vocational Case Management
Services, including nurse case management
5. Pharmacy Benefit Management Services
( ) Costs for the reporting of claims (First Report of Injury)bytn}onhnuo([ol<Fceo)or
transmitted through the Internet;
k^A Costs associated with claims indexing aud-OF/ Creporting;
State-mandated B[)I Reporting on o per transaction cost to the o}u� file for all states
``which mandate the 2IJI reporting of either the First Report of Injury (Fl{O0 and/or the Subsequent
Report of Injury(SQ )A; and
(e) Any other 'similar o
oot, fee or cxycuuo reasonably chargeable to the investigation,
negotiation, settlement or defense of o|claim ocloss to protect or perfect the subrogation
rights ofCLIENT.
For the purpose ofthis Agreement, the fb\lVvviug definitions apply to the type of claims
processed and fee structure options.
Medical Only Claim: /\ Medical Only C|u|cu is defined as any c{oion resulting from oziuoc
injury'n[y thnt requires routine medical treatment where total medical payments do not ogun/ or
exceed$2,j0A.0O and oo payments-of indemnity(fiaubi1ity)houcfiis are made.
Indemnity CKoin ; An Indemnity Claim is defined an any claim, resulting in the payment of
uonDeumioo (any type of disability)
benefits, any o\oinu that requires investigation for
subrogation, any contested claim involving disputed or questionable issues, any claim requiring
intensive medical management regardless of lost time days, any claim that requires settlement
negotiations, or any claim that equals or exceeds $2,500.00 in medical payments.
Record Only Claim: A Record Only Claim is defined as any claim resulting from an accident
with no apparent injury and no medical treatment, excluding first aid. There are no billings for
payment of medical services by a physician, hospital, or any other provider that submits medical
bills for treatment.
3. York represents that is the parent company of The Frank Gates Service Company d/b/a/
Avizent,that that The Frank Gates Service Company d/b/a Avizent has assigned its rights
and obligations under the Agreement to York. York further represents that it is
unconditionally assumes all obligations of its subsidiary company under this Agreement
and that York agrees to remain liable for all obligations of The Frank Gates Service
Company d/b/a/Avizent under this Agreement.
4. Except as noted above,the Agreement shall remain unchanged.
In witness thereof,the parties have executed this Amendment as dated below with an effective
contract date of January 1, 2014.
CITY OF PORT ANGELES, WASHINGTON THE FRANK GATE COMPANY dba Avizent,
YORK RISK SERVICES COMPANY, INC.
B
BY: Y:
Printed Name: 40 taeltzj- Jody A. Gray
4417 1C-J?S061J1'e, Yt-
Title: /�'-e-kdfel Senior Vice President
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D ate:- Date: