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01
City of Pleasanton
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CITY CLERK
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AGENDA PACKETS
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2011
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062111
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01
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6/17/2011 3:20:33 PM
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6/16/2011 3:20:55 PM
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CITY CLERK
CITY CLERK - TYPE
AGENDA REPORT
DOCUMENT DATE
6/21/2011
DESTRUCT DATE
15Y
DOCUMENT NO
01
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1. Refer litigated cases, when needed, to attorneys recommended by ICS and <br /> approved by CLIENT for purposes of defending CLIENT's interests before <br /> Workers' Compensation Appeals Board and the court. <br /> 2. Work closely with counsel in preparing defense of litigated cases. <br /> 3. Obtain CLIENT's authorization on all settlements or stipulations when required. <br /> 4. Work closely with applicant's attorney and legal counsel in informal dispositions of <br /> litigated cases. <br /> 5. Attend, when required, Workers' Compensation Appeals Board hearings. <br /> 6. Discharge on behalf of CLIENT, all legal obligations to its injured employees <br /> imposed by Workers' Compensation Appeals Board and higher courts. <br /> 7. Protect and preserve CLIENT's interests in all potential subrogation cases. <br /> D. Medical Cost Containment Services. ICS shall adhere to the following <br /> medical cost containment services standards: <br /> 1. ICS shall use and cooperate fully with the designated medical cost containment <br /> vendor (bill review and utilization review service provider) to review the medical <br /> bills for the CLIENT and other medical charges and provide necessary utilization <br /> review services relating to treatment requests on all claims of industrial injury or <br /> illness. <br /> 2. Unless otherwise directed, ICS will select the service provider to be utilized and <br /> CLIENT will pay for such services. The rate of services for bill review will be <br /> charged at $3.00 per header, $1.00 per line, 20% of savings for all PPO savings, <br /> 20% of savings on all non PPO inpatient hospital bill savings and 16% of all non <br /> PPO outpatient bill savings, unless otherwise negotiated. The rate for utilization <br /> review services will be charged at $100 per RN determination, $220 per hour <br /> (billed in '/ hour increments) for all Physician Adviser Reviews, $310 per hour <br /> (billed in ''A hour increments) for all Specialty Physician Reviews on appeal and <br /> all PEER Reviews. <br /> E. Information Systems. ICS will provide a computer system with appropriate <br /> data base management capabilities to maintain records related to the administration of the <br /> Client's workers' compensation program. ICS shall coordinate data entry for employees in <br /> the program and for services supplied by ICS. The CLIENT shall have access to the <br /> computer system during normal working hours and access to the database through its own <br /> computers at its own expense. ICS shall provide computer-generated reports that are <br /> reasonably requested on a regular basis as detailed in section F below. <br />
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