CCP 08-12-1996 - Laserfiche WebLink

Home Browse Search

.. ... CorCare, Inc. . Payor Agreement .. Page Two 1.3 "Peer Review" means the evaluation of the care provided to a worker by review of the pertinent I records and/or personal interview with the attending physician or consultant. Such evaluations shall be conducted by a group designated by CorCare, which must include, but is not limited to, members of the same healing art. I 1.4 "Health Care Provider" has the meaning given in Minnesota Statute Chapter 176. 1.5 "Report" means medical information transmitted in written form containing relevant subjective and I objective findings. Reports may take the form of brief or complete narrative reports, a treatment plan, a I closing examination report, progress notes from the worker's medical file, or any forms filed in accordance with the Provider Manual and/or as required by CorCare. 1.6 "In;ured Worker" means employee of the panicipating member using CorCare Managed Care I Services who is eligible to receive workers' compensation benefits from the PAYOR, and who is entitled to receive benefits under Minnesota Statute Chapter 176 for medical services. I 1.7 "Medically Necessary and/or Medical Necessity" means that any covered services the injured worker receives are consistent with physician's duty of care and applicable community standard of practice; .. appropriate by place and level of care in amount, duration, and frequency necessary for the diagnosis or treatment of an illness, disease, accidental bodily injury, or condition harmful or threatening to the injured worker's life or health; received in the most cost effective, medically appropriate setting that can reasonably 1 be utilized; not provided solely or primarily for the injured worker's or physician's convenience. 2. RELATIONSHIP OF THE PARTIES . 2.1 Particioation. CorCare has established a network of providers to deliver medical services to I workers throughout the State of Minnesota. Each Provider is an independent contractor, who will deliver medically necessary covered medical services, pursuant to that certain contract for such services with I CorCare, and according to the laws and administrative rules relative to workers' compensation in Minnesota. PAYOR has an obligation to pay for medically compensable injuries for its workers and desires to use CorCare Providers to deliver such medical services. I 2.2 Indeoendent Contractors. None of the provisions of this Agreement are intended to create, nor shall be deemed or construed to create, any relationship between the parties hereto, other than that of . independent contractors. Neither of the parties hereto, nor any of their respective officers, directors, or employees, shall act as, nor be construed to be, the agent, the employee, or representative of the other. 2.3 Dutv to Hold Harmless. PAYOR and CorCare each agree to indemnify, hold hannless, and defend . the other from all claims, liabilities, damages, losses, and expenses of third parties, as relates to their .. respective obligation under this Agreement. I