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2009_0921_Packet
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2009_0921_Packet
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1/9/2012 3:13:41 PM
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10/13/2009 9:30:05 AM
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health care providers and patients with information about treatment <br />alternatives and related functions; <br />iii. Rating provider and plan performance, including <br />accreditation, certification, licensing or credentialing activities; <br />iv. Underwriting, premium rating and other activities related to <br />the creations, renewal or replacement of a contract of health insurance or <br />health benefits, and ceding, securing or placing a contract for reinsurance <br />of risk relating to health care claims including stop-loss insurance and <br />excess of loss insurance; <br />v. Conducting or arranging for medical review, legal services, <br />and auditing functions, including fraud and abuse detection and <br />compliance programs; <br />vi. Business planning and development, such as conducting <br />cost-management and planning-related analyses related to management <br />and operating the plan, including formulary development and <br />administration, development or improvement of payment or coverage <br />policies; <br />vii. Business management and general administrative activities <br />of the plan, including, but not limited to: <br />a. Management activities relating to the <br />implementation of and compliance with HIPAA privacy <br />rules and Administrative Simplification requirements, or <br />7 City of Roseville MPD <br />
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