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2011-205
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Last modified
5/9/2018 1:38:36 PM
Creation date
10/1/2015 2:52:35 AM
Metadata
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Template:
Official Documents
Official Document Type
Addendum
Approved Date
09/20/2011
Control Number
2011-205
Agenda Item Number
8.B.
Entity Name
Johns Eastern Company
Subject
Claims Administration Agreement Third Party
Supplemental fields
SmeadsoftID
10236
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recoverability, claimant control, attendance at mediations, hearings and depositions, attendance at <br />management meetings, attendance at medical consultations or hearings, appraisals, case <br />management, recorded statements, <br />f. Fees for any field investigation will be $105.00, $0.55 a mile and $1.00 per photograph, <br />and administrative expenses. We will bill at these rates all activities involving, handling, <br />controlling, or settling a client's liability on claim <br />g. Fees for over -night or special mail service for various documents, <br />h. Fees for examining and reducing hospital and medical bills as appropriate <br />Photocopying and/or CD-ROM copies, review of relevant documentation. <br />j. Pre -Certification of Hospital Admissions, On -Site Case Management, Peer Review, Medical Care Audits, <br />and Hospital Bill Audits. <br />k. Medical Management—Telephonic case management would be provided on all cases at <br />a rate of: <br />• $525.00 per lost time exposure <br />• $125.00 per medical only exposure <br />Provider Bill Review/Cost Containment Services —Fees for these services are: <br />• $5.95 per bill <br />• 30% of all savings over and above Fee Schedule reductions <br />• 35% out -of -network <br />and hospital audits <br />m. Medicare Set -Aside (MSA) services to include; recommendation for MSA submission, MSA cost <br />projection, MSA submission, liability MSA services, comprehensive drug utilization review, lien search, <br />conditional lien dispute, projection update. <br />5. Compensation for the Service Agent: For performing its services under this Agreement, the Service Agent shall be <br />entitled to the following compensation: <br />a. Fees for handling the CLIENT'S workers' compensation exposures whose dates of loss fall between <br />October 1, 2011 and September 30, 2012 will be a minimum and deposit of $64,844.00 <br />This fee contemplates handling 150 workers' compensation exposures. If the number of exposures <br />Exceeds 150, then the fees will be increased proportionately. All years subject to audit. <br />b. Fees for non -workers' compensation exposures whose dates of loss fall between October 1, 2011 and <br />September 30, 2012 will be a minimum and deposit of $13,400.00. <br />This fee contemplates handling 22 non -workers' compensation exposures. If the number of exposures <br />Exceeds 22, then the fees will be increased proportionately. All years subject to audit. <br />All other terms of the original contract remain unchanged. <br />
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