2009_0112_Packet - Laserfiche WebLink

Home

Page 5 Section V — Fees New Clairns - Per Cfaim Fees Incide�f/Report Only Glaims Medical Only Clairns Lost Time Claims Reopened Los9 Time Claims Reopened Medical Only Claims Year One $D.00 $150.00 $90Q.Q0 $450.60 $50.00 Subseauent, Year $0.00 $i �a.00 $456.00 $450.00 $50.00 ALAE (Expense) Fees Ser�ice Fee Index Bureau Re ortin $9.00 er re ort State Fee 5chedule $9.00 er bilf Bill Aeview Re- ricin 30% of savin s PPQ & Pharmac Network 30% of savin s Non-liti ated subro ation ursuit b ad�uster 15% of recove RMISIRe ort S stem Access $500.D0 er user eo ear En-hause Ph sician Review $200 er review Tele hanic Nurse Case Mana ement No additional char e Attend hearin s b ad�uster No additional char e Quarterl Claim �eviews No additional cF�ar e Wab re ortin No additional char e Fax re artin No additiona! char e Tele hanic Re ortin No additiona.l char e Ad hoc Fieports Sorting and filtering op3ions available thro�gh Com Qnline Efectronic Data Transfer '$125 er hour Account Man.a emenf 7.5% of claims mana ernent fee 5FM Risk has agreed to handle 22 existing open claims originally reported to Employer's previaus claims administratar for a period of one year effecti�e January 1, 20�9 through December 31, 20a9 at no additional charge. Medical Only claims that exceecf $2,500 in medical costs during the first contraci year will be billed the difference betwe�n the Indemnity Claim fee a�d the Medical Only #ee.. Medical Only claims that exceed $2,500 in medical costs in the aggregate anytime after the first year will be charged at the Inder�niiy subsequent year fee. Medical Only claims that do noi reach the $2,5�0 threshold in th� aggregate will be charged at the first year Medical Only fe� and 50% of the first year fee for subsequent years. �� The Work Corr�p Experts F��sk Solutions