Laserfiche WebLink
ATTACHMENT C <br />CLAIMS ADMINISTRATION SERVICES <br />PERFORMANCE REVIEWS <br />The TPA and IRC agree that Performance Reviews will be conducted after the first year of <br />operations. Each Performance Review will involve Claim File Reviews and an overall Program <br />Management Review. Performance Reviews will be conducted by the Risk Manager, or the designee <br />thereof. <br />In the Claim File Review process, for each claim file that is reviewed, the reviewer will assign a <br />score from 0 to 100 based upon the criteria outlined in this Attachment B. At the conclusion of <br />reviewing all selected claim files, an average score for all claim files reviewed will be calculated. In <br />the Program Management Review process, a separate single score between 0 and 100 will calculated. <br />The average score for the Claim File Reviews will account for 90% of the overall scoring for the <br />Performance Review. The total score for the Program Management Review will account for 10% of <br />the overall scoring for the Performance Review. As an example, if the average WC Claim File <br />Review score is 86 points, and the average Third Party Liability Claim File Review score is 90 <br />points, and the Program Management Review score is 70 points, the total score will be calculated as <br />follows: <br />Third Party Liability Claim File Review <br />WC Claim File Review average <br />Program Management Review <br />Total Weighted Review Points <br />90 points times 40% weight = <br />86 points times 50% weight = <br />70 points times 10% weight = <br />The penalties will be based upon the Total Weighted Review Points. <br />36.0 points <br />43.0 points <br />7.0 points <br />86.0 points <br />IRC will perform one Performance Review for each annual period of the contract. The following <br />chart outlines the expected review schedule. IRC retains the right, at its sole discretion, to perform <br />such reviews at any time. <br />Performance <br />Review <br />Performance Period <br />Total Weighted <br />Review Points <br />Penalty <br />1 <br />Months 1 — 12 of Contract <br />80 <br />1% <br />2 <br />Months 13 — 24 of Contract <br />90 <br />1% <br />3 <br />Months 25 — 36 of Contract <br />95 <br />1% <br />4 * <br />Months 37 — 48 of Contract <br />95 <br />1% <br />5 * <br />Months 49 — 60 of Contract <br />95 <br />1% <br />* If agreement extension authorized by IRC. <br />Failure to perform at or above expected levels for the Performance Reviews will result in a financial <br />penalty of 1% of the amount that was charged by the TPA for the performance period. Any financial <br />Page 22 <br />