The document provides an overview of Integrated Claims Strategies' (ICS) innovative medical claims management program. ICS offers a full suite of integrated medical management services including call center services, early intervention case management, pre-certification and utilization review, medical bill review with PPO networks and out-of-network negotiations, and retrospective utilization review. ICS prides itself on customized, flexible programs and proprietary technology to achieve outstanding outcomes and savings for clients.

1. Innovative Claims Strategies
Integrated Medical Claims Management
Program Overview Prepared for:
September 1, 2011

2. Corporate Overview
 Genesis of ICS
 Disability and medical care management services
 Leader in technology-driven, early intervention case management services
 Extensive experience within both public and private sector, risk pools, carriers,
third party administrators, self insured/administered, and transportation industry
 Comprehensive and innovative technology solutions, including extensive
interface capabilities
 Documented savings and results
 Flexibility to customize all aspects of service to ensure programs meet unique
needs of each client
 Our principle objective is to deliver innovative, integrated, and technical
strategic services to our clients that result in outstanding program outcomes
 We create our services as a branded business model, not a commodity
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3. Capabilities Overview
Covered Lines of Business:
 Workers’ Compensation  Longshore/Jones Act
 Auto  Liability
 FELA  Group Health
Our Branded Service Product Lines:
3

4. Our Service Capabilities Overview
 24/7 Case Initiation & Absence Management  Medical File & Demand Package Reviews
Call Center  Independent Medical Evaluations
 Early Intervention Telephonic Case  Physician Advisor (PHAD) and Peer Reviews
Management - Concurrent UM  Pharmacy & Durable Medical Equipment
 Catastrophic & Task Based Field Case Programs
Management  Medical Record Retrieval
 Pre-Certification/Prior Authorization –  Arbitration & Litigation Support
Prospective UM  Investigative & Surveillance
 Online Medical Bill Review with Fusion  Subrogation & Third Party Recovery
 PPO-ICING  Transportation & Translation & Transcription
 Out of Network IRON Signed Agreements  Technology Suite
 Specialty Bill Review – Retrospective UM  Program benchmarking, data collection, &
 Medicare Set Aside – Comprehensive Solutions analysis
4

5. Competitive Advantages
 Extensive managed care industry knowledge
 Integrated managed care model with demonstrated results
 Customized, flexible programs helping clients meet objectives
 Complete transparency in all service component
 PPO ICING combines disparate networks
 Proprietary, integrated technology solutions
 Dedicated implementation and customer service team
5

6. Our Integrated Service Business Model
 iCORE (Integrated Circle of Excellence)
 PPO Management
 Fraud Abatement
 Record Retrieval
 Field Case Management
 Transportation
 Translation (Telephonic, Traditional, On Demand)
 Vocational Rehabilitation
 Subrogation
 Impairment & Disability Ratings
 Pharmacy Benefit Management Programs
 Wellness & Recovery
 iSYS (Integrated Systems)
 Data & Image Repository
 iBOSS (Integrated Back Office Service Solutions)
6

7. Integrated Medical Claim Management – Our Approach
 Our primary approach is to deliver innovative, integrated, and technical strategic services
to our clients that result in outstanding program outcomes fused with stakeholder
satisfaction creating a branded business model, not a commodity
 Our claims management approach includes Medical and Disability services to manage
each dimension of a claim that affect overall costs to achieve program efficacy
 We adapt our technology and processes within the program to match the specific and
unique characteristics of our clients and any jurisdictional or legislative requirements,
along with the endorsed case management techniques typical of a given state
 Our services within the program are scaled to match our client’s desired distribution of
process between its internal staff and the ICS professional staff
 Our model is composed of services that begin with the first notice of injury and
encompass prospective, concurrent, and retrospective care management industry best
practice techniques
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8. Integrated Medical Claim Management – Our Approach
8

9. Call Center Services
9

10. Call Center Services - Component Benefit
 Promotes Early Intervention with prompt notification of injury, illness, accident
and/or absence
 Dedicated Toll-free number available 24 hours a day/7 days a week
 Designed to complete all mandatory and client specific reporting forms
 Allows for immediate verification and access of information via Auto Email
Alert process and WebOPUS Browser technology
 Designed to eliminate paper & labor intensive processes
 Improves timeliness of reporting of injury, illness, accident and/or absence,
allowing for Care Management to begin immediately
 Provides for Mandatory and/or “Soft” channeling to appropriate PPO/EPO
Network provider
 Provides for “Call ahead” process to the appropriate facility
 Provides for Flagging between various payment systems
10

11. Impact of Early Intervention - Average Medical Cost by Lag Time Category
For Client A, new injuries that are reported 8 Days of Greater incurred roughly 140% more in medical costs than
those cases that are reported the Same Day.
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12. Early Intervention Case
Management
12

13. Early Intervention/Telephonic Case Management
 The control process in the Integrated Medical Management Program is the
Telephonic Case Management component
 Prompt and concurrent review and management of the medical care of injured
employees ensuring the utilization of the best and most appropriate medical
care
 Timely and continuous contacts with injured employee, work site coordinator,
medical provider, and claims adjustor until claim resolution promoting
effective communication
 Focused return to work coordination by managing the disability duration of
injured employees compared to national best practice guideline
 Promote employee advocacy and goodwill
 Forum for Program Introduction & Expectations
13

14. Early Intervention/Telephonic Case Management
 Upon completion of an Initial Assessment, Nurse Case Manager will
evaluate:
 Medical Management • Treatment Plan • Disability
Duration
 Return to Work Plan • Pre-Authorization/Utilization
Review
 Necessity for Peer Review, Independent Medical Evaluation or
Field Case Management
 Continuously update work site coordinator, claims adjustor or any
other interested stakeholders with care management milestones via:
 EDI to Claims System
 Email Alerts to all interested parties
 WebOPUS Browser accessibility
14

15. Promoting Early Intervention - The ICS Health Ticket
 Transparent claimant, provider, and employer tool, customizable
by client
 Consolidates all prospective services (pharmacy, PT, imaging,
DME) into an ID card
 Created through a claim file feed or in real time through a
customized web-site
 Incorporates panels to improve compliance and direction of care
 Increases utilization of prospective programs and PPO penetration,
reduces out-of-network management cost
 Enhances quality of care and improve claim outcomes
15

16. Average Lost Time Days by Closed Lost Time Claim
CY 1999 was the year prior to implementation of current ICS program. Over the past 11 full calendar years, the
Average Lost Time Days on Closed Lost Time Claims is 27.5, 53% improvement measured against CY99 results.
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17. Pre Certification/Utilization
Review Services
17

18. Prospective Utilization Review Overview
 Detailed determination reporting with complete clinical rationale and treatment
guidelines used for decision making
 Our Technology allows for a seamless and fully integrated data exchange ensuring
Authorization outcomes are embedded automatically for future reimbursement activity
 Pre-certification Model
 Medical Necessity Review
 Full utilization management including concurrent review
 Physician Review Model
 Criteria based referral
 Peer to peer board certified specialties
 Independent Medical Evaluations
 Case Management Model
 Early Intervention
 Field Case Management as necessary
 Cost Projection 18

19. Medical Bill Review &
PPO ICING &
Out of Network IRON
19

20. Medical Bill Review Services
 ICS has emerged as a unique national medical bill review alternative for Insurance
Carriers, Third Party Administrators, State Funds, and Self Insured Employers by
providing flexible service delivery through our innovative technology, business model
and offering access to national and specialty PPO Networks
 ICS utilizes an internally developed and proprietary medical bill review software, that
utilizes highly flexible technologies as the basis for an extremely powerful and robust
pricing engine
 Carefully balancing the efficiency of automated pricing functions with the opportunity
for intervention, control, and customization as required, ICS is able to meet the diverse
needs of the Workers’ Compensation, Auto, Liability, FELA, FECA, and
Longshoreman & Maritime Industries
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21. Medical Bill Review Services
 Mail Room & Claim Indexing  Out of Network IRON (Increased
 Document Management, Storage, Results On Negotiations)
and Retrieval – Paperless Solutions  Rules Based Technology creating
 Operational Throughput (iSTEP Client specific Exception based
Environment) workflows
 e-BRIDGE(Adjuster Online Bill  Customized Adjudication Protocols
Approval Dashboard)  Real Time Integration between all
 Real time interface that feeds stakeholder applications
outcomes from Prospective Pre  Real time, web based management
Cert to apply Retrospective Bill reporting
Review Pre Cert Flags  Custom/Ad hoc/State Reporting
 Fee Schedule/UCR adjudication  Provider Assistance Hotline
 PPO ICING with Fusion  Automated Check Writing
 Nurse Audit & Code Review
21

22. Rules-Based Process
 ICS performs bill review services using a rules based software application that
sequentially applies a list of repricing considerations, as shown below, to each
set of submitted charges that constitute a medical bill
 User-configurable rules engine  ICD/CPT Procedure Code
Matching/Crosswalk
 Redundant or Duplicate
Charges  PPO Network ICING
Application
 Improper Coding
 Out of Network IRON
 Jurisdictional Rules
Application
 Utilization Guidelines
 Automated Medicare CCI / OCE
 Pre Certified Treatment Plans / MUE
 Case Specific Denials  Reserve Limits
 Fee Schedule/UCR Calculation  Client Defined Flags
22

23. Network Solutions – PPO ICING
 PPO application performed on proprietary software platforms
 Setup customized per State for maximum penetration / savings
 Network types: National / Regional / Specialty
 “ICING” with Fusion technology - Competitive Advantage
 Increased savings through multiple network Tiers – Best in Class
 Immediate network application reduces “lag time”
 Increased penetration levels drive additional savings
 Client specific network solutions on a state-by-state basis through
historical data analysis
 Quarterly Reviews of PPO Penetration and Trending Analysis to ensure PPO
Tier is appropriate and applicable to current outcomes
23

24. PPO ICING – Sample Listing of Network Partners
 National
 Prime Health Services
 Coventry (First Health, Focus, Aetna)
 Rockport Healthcare
 Healthcare Solutions
 Interplan
 Regional
 MagnaCare
 HFN
 Sagamore/CIGNA
 Wellpoint
 Specialty
 Physical Therapy – Universal SmartComp, Align, MedRisk
 Radiology - Core Choice, One Call Medical, ADIN
 Pharmacy – myMatrixx, Express Scripts, Progressive Medical, PMOA
 DME – myMatrixx, TechHealth, PMSI, MSC
24

25. Incremental PPO/Specialty Savings& Penetration Breakdown
PPO Savings PPO Penetration
Tier 1 % of Total Savings: 29% Tier 1 PPO Bill Penetration: 21%
Tier 2 % of Total Savings: 8% Tier 2 PPO Bill Penetration: 13%
Tier 3 % of Total Savings: 8% Tier 3 PPO Bill Penetration: 9%
Specialty Network % of Total Savings: 22% Specialty Network Penetration: 23%
Specialty Review % of Total Savings: 33% Specialty Review Bill Penetration: 1%
*Specialty Networks include PT, MRI, DME Total Bill Penetration: 67%
Case study: National retail client with warehousing and distribution centers
2010 New Jersey Results: 75% PPO Penetration resulting in 50% Gross Savings
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26. PPO ICING & Out of Network IRON Services
 PPO ICING – Identifying Incremental Network Penetration
 Business Model is structured to identify and increase PPO network penetration and savings
without ICS being the “primary” bill review vendor
 PPO-ICING has the ability to provide additional and comprehensive layers of PPO Networks to
augment and enhance existing PPO Networks, creating savings where none existed
 Leveraging our proprietary technology and operational methodology, PPO-ICING can
immediately identify if a medical bill “hits” a given PPO partner, assuring turnaround times are
not compromised
 Risk Free – ICS does not charge for processing the medical bill, only if PPO savings are
achieved
 Out of Network Signed Agreements – IRON
 Recommended referral criteria: Any medical bill that comes back without a PPO hit and over
$2,500.00 in Allowance Amount should be flagged for consideration
 Utilize proprietary application to identify past payment trends to establish appropriate
negotiation baselines
 All negotiations are tied to a signed agreement by medical provider to ensure 0%
reconsiderations
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27. Retrospective Utilization Management
 Augmenting the traditional Medical Bill Review adjudication process of securing
savings via Contractual PPO discounts, Fee Schedule/UCR reductions, or Out of
Network IRON Signed Agreements, ICS has created comprehensive Retrospective
Review Programs that are typically part of our overall Integrated Medical Management
Program:
 RN/Certified Coder review of coding and supporting documentation identifying
unbundling, upcoding, and correct modifier utilization
 Nurses review the services for appropriateness and medical necessity
 RN Desk Audit focusing on a review of the itemized billing statement for medical
necessity, treatment crosswalk, appropriateness of charges, length of stay, and proper
documentation to support charges
 Automated Flagging of Services matched with integrated Treatment Plans and Pre-
Certification decision points/outcomes
 RN/Physician Medical File Reviews
27

28. Sample Medical Bill Review Process & Procedure –
Administrative Phase
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29. Sample Medical Bill Review Process & Procedure –
Decision Phase
29

30. Sample Medical Bill Review Process & Procedure –
Incremental Savings & Completion Phase
30

31. PPO Network Management
services managed by:
31

32. Prime Health Services History – Business Model
 Direct contract with providers using comparison methodology
 Obtain provider partnerships with “Best in Class” regional provider systems
in country
 Acquire regional networks that fit Prime Health’s business goals
 Create local customizable networks where possible
 Innovative and proprietary technology solutions
32

33. Prime Health Philosophy of Customizing
 Prime Health has seen a growing lack of concern by other
National PPOs to provide custom contracting for their clients.
 Thus, Prime Health has developed a core philosophy of giving
our clients access to the providers of their choice instead of
forcing them into a pre-established network.
33

34. Prime Health Philosophy of Customizing
Customizing through Queball™
 QueBall™ drives the nomination and recruitment process and
is an internal operation that is unique to Prime Health.
 No other network offers the rapid turnaround in customizing
it’s network offering to meet the needs of our clients.
 Review of Non-Par data on a concurrent basis
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35. Prime Health Philosophy of Customizing
35

36. A Case Study on Customization – State of Connecticut
 QueBall impact on customizing and enhancing the State of Connecticut’s PPO Network
include the following results:
 First 90 Days post the implementation of our Network Services:
 70% increase in the number of Physicians
 26% increase in the number of Facilities
 56% increase in the number of Hospitals
 Overall impact QueBall has had on the State of Connecticut PPO network since Program
Implementation
 200% increase in the number of Physicians
 158% increase in the number of Facilities
 161% increase in the number of Hospitals
Provider Counts
Month Physicians Facilities Hospitals
July 2009 3,751 683 18
October 2009 6,373 860 28
January 2010 7,538 999 33
June 2010 9,220 1,474 34
June 2011 11,226 1,765 47
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37. A Case Study on Customization – State of Connecticut
 QueBall financial impact on customizing and enhancing the State of Connecticut’s PPO
Network include the following results:
 The State of Connecticut has seen their PPO Network Penetration increase nearly 63% from October
2009 (56%) to April 2011 ((91%)
 Overall Network Savings below the State Fee Schedule has improved even with the larger influx of
contracted providers
Network Penetration – By Medical Bill Adjudicated
Month October 2009 January 2010 April 2010 July 2010 October 2010 January 2011 April 2011
Total Bills 9,540 5,975 9,994 5,682 5,025 4,708 7,833
In Network Bills 5,331 4,499 8,380 5,021 4,498 3,670 7,148
PPO Penetration 56% 75% 84% 88% 90% 78% 91%
Network Savings
State Physician Hospital Facility
CT 16% 14% 16%
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38. Exclusive Occupational Health Network Overview
 Specially designed network of occupational health providers that are trained to
understand and treat a work-related injury
 Occupational Health facilities that are in close proximity to employer locations
 Utilization of Occupational Health facilities that have gone through and met
extensive credentialing criteria
 Utilization of Occupational Health facilities that have gone through and
successfully met rigorous Site Visits
38

39. PBM Network Management
services managed by:
39

40. Pharmacy Benefit Management
 Electronic Interface with Pharmacy vendor partner to establish eligibility
information
 First Fill Process
 Aggressive third party paper bill conversion
 Directly contracted Nationwide network
 Comprehensive Trend Reporting
 Determine Correct Formularies
 Retrospective Drug Utilization Review
 Predictive Modeling Program
 Reduces or Eliminates “Out of Pocket” Expense
 Mail Order or Non-Mail Services
 Physician Dispensing Solutions
 Significant Cost Savings coupled with low implementation requirements
40

41. Pharmacy Benefit Management – Clinical Management
Our Programs drive a lower cost per claim by managing the mix of drugs.
Average Cost Per Claim/Year
$2,500.00
$2,000.00 Savings Per Claim/Year
$2,270.75
$571.67
$1,500.00 $1,699.08
$1,000.00
$500.00
$-
Other WC PBM myMatrixx
41

42. Pharmacy Benefit Management – Use of Generics
myMatrixx converts 98.3% of all multisource brands to generic
where it is appropriate
AVG Generic Substitution 82.26%
Generic Efficiency 98.3%
Generic
16.04%
82.26% 17.74% Single Source
Brand
Multisource
Brand
1.70%
42

43. Pharmacy Benefit Management –
Network Penetration & Savings Results
myMatrixx Claims Data vs. pre-myMatrixx Claims Data
Client Type Percentage Generic Penetration Average Per Script
Savings Differential Savings
Auto Clients 15.24% 8.27% $27.94
Larger State 19.59% 9.85% $30.84
Managed Care and TPA 18.04% 10.55% $36.95
Insurance Carriers 23.09% 11.24% $39.43
43

44. Independent Medical Evaluation
& Physician Review Services
44

45. IME Services – Introduction
 National Provider of Independent Medical Examination services
 Current Service footprint covers 40 states throughout the continental US
 Multi-disciplinary network of Board-Certified physicians
 Providers that maintain an active treating practice with no restrictions
 IME referrals via the internet
 Timely appointments and subsequent appointment management
 Timely receipt of initial and final IME reports
 Thorough quality assurance program to ensure client specific parameters are
being met
 Centralized management of referral from start to finish is accomplished via
proprietary Internet based application
 Web Portal available to access real time information, reports, and
communications
45

46. IME Services Overview
 Multi-disciplinary network of Board-Certified physicians
 Providers that maintain an active treating practice with no restrictions
 Medical Evaluation referrals via the internet
 Timely appointments and subsequent appointment management
 Timely receipt of initial and final Medical Evaluation reports
 Thorough quality assurance program to ensure client specific
parameters are being met
 Centralized management of referral from start to finish is
accomplished via WebOPUS
 WebOPUS Browser available to access real time
information, reports, and communications
46

47. IME Services –Advantages
 Advantages include:
 Documented Return on Investment Savings
 Industry Leading Service & Technology
 Customized HIPAA compliant proprietary software
 Real Time Online Tracking of IME Referral
 Robust Document Management interface for document viewing
 Complete Document Reproduction into a single source PDF using “One Click”
 Link with USPS for mailing requirement compliance
 Ease of Doing Business
 Online Referral Sheet
 Ability to refer multiple EIP for multiple specialties
 Confirmation page can be easily exported to your claims system
 Turnaround Time - TAT
 Industry Average for TAT is 21-30 Business Days, our Average TAT is 15 Business Days
 TAT from Date of Examination to Adjuster Receipt averages less than 3 Business Days
47

48. IME Services – Quality Assurance
48

49. IME Services – Ease of Doing Business
 Online Referral Sheet
 Can refer multiple
claimants for multiple
specialties
 Confirmation page can
be easily downloaded
(exported) to your claims
system
49

50. IME Services – Online Tracking
 Demographic
information
 Document viewing
and/or reproduction
(in PDF or DOC
format)
 Link with USPS for
proof of mailing
50

51. Independent Peer Review
National Reviewer Panel
 Over 1,100 reviewer
 All ABMS specialties and subspecialties
 Board-certified
 Active clinical practice
 Current, unrestricted state license(s)
 TAT to meet your business needs
 Dedicated customer service teams
 HIPAA compliant technology
 SAS 70 Type II certified
 Web referrals
 Re-credentialed every three years
51

52. Comprehensive MSA Services:
Medicare Set Aside
Medicare Legal Submission
Medicare Reporting
Post Settlement Fund Management
52

53. Medicare Set Aside Services
 Medical Services
 Comprehensive overview of future care recommendations related to the compensable
injuries of a claim conducted by experienced Nurse Case Managers certified in Life
Care Planning
 Social Security & Rated Age verification
 Appropriateness of past treatment/medication use based on clinical practice
guidelines and/or ODG
 Compliance with treatment, response to past treatment and recommendations for
future treatment
 Prepare Medical Cost Projection Allocation Report
 Evidenced Based Drug Utilization Review
 Claim Settlement Allocation – Non Threshold MSA
53

54. Medicare Set Aside Services
 Legal Services
 Verify claimant’s eligibility status for Social Security and Medicare Benefits
 Provide professional legal opinion determining whether CMS approval is
necessary and support that opinion with professional liability coverage
 Provide appropriate settlement language
 The assembly of a MSA Arrangement and the submission to Medicare for
review and approval
 Advise on method of funding and administering MSA
 Provide Settlement Allocation language
 Obtain quotes and arrange purchase of Structured Settlement Annuities
 Medicare Lien Verification &Negotiation
 Reversionary Trust & Settlement Assistance
 Post Settlement Compliance Services
 Creating a simple all-in-one solution for administering the post settlement
funds ensuring proper coordination of benefits and protection for all parties
54

55. Fraud Abatement/SIU &
Medical Record Retrieval
services managed by
a division of
55

56. Fraud Abatement Services - Surveillance
 Largest provider of surveillance services in the industry
 National Coverage
 Over 270 Employee Investigators
 Dedicated experienced staff that focus exclusively on this service component
 Highest ethical standards
 Direct Management of all Files
 Defined Quality Control Program
 Ongoing Training Programs
 Accountability
 Monthly Reports
 Communication
56

57. Fraud Abatement Services – eSearch
 eSearch Investigation can cover wide ranges of inquiries, as well as a focus on
specific leads or known relevant areas
 Common examples of available record information:
Police Reports Criminal Records
Suits and Judgments Bankruptcy Records
Property Ownership, Motor Vehicle, Recreational Licenses
Education Employment
 Detailed research report that can access:
Various Internet Search Engines Social Networks Satellite Shots of Pertinent areas
Press Releases News Articles Canvassing Activities
 This research can provide extensive information to facilitate focus of
surveillances and other field inquires
57

58. Fraud Abatement – International
 Experienced provider of claim investigations in over 200 countries
 Established relationships with reputable network of resources in each nation
 Cost effective service with specific quotes for an investigation before it is handled
– no surprises
 Management of the entire process from start to finish out of our Dallas TX office
 Types of reports include:
 Death Related Investigations
 Death Verifications
 Interviews
 Surveillance
 Background Checks
 SIU Investigations
 Translation Services
58

59. SIU Services
 Specific SIU Division within ICS Merrill
 48 Investigators with over 20 years average experience
 Complete national coverage by locally based investigators
 Proficiency in all lines of property and casualty coverage’s
 Full of supplemental service functions per client needs
 Fraud reporting to State Fraud Bureaus and State Department’s of Insurance
 Fraud training programs for clients
 Ease of communication – single point of contact service
59

60. Fraud Abatement & SIU Services - Technology
 SmartPartner Case Management System
 Access with password through secure website
 Submit work requests
 Track case progress
 Receive email alerts on the referral
 Review actual reports
 See video clips or entire video
 Access to all historical data and video
 Digital Video Library Link
 Access actual reports, documents, invoices
 Electronic link may be forwarded to client for ease of access
 Transfer the link to other parties within your organization
 Client designates life span of the link
60

61. Medical Record Retrieval Services
 Parent company of ICS Merrill provides services directly– EMSI
 EMSI is the largest and most experienced provider of medical record retrieval
services to the insurance industry
 EMSI has existing relationship with many Carriers for underwriting, medical
records, and paramedical
 Average 3,700 Medical Records retrieved per month
 Average 12 Days to complete Service Referral
61

62. Our Technology Suite
“The ICS Web Portals provide visibility into the progress of a case under
management for the adjuster and other stakeholders, as well as provides an
entirely electronic internal workflow for addressing all service requirements of an
Integrated Medical Claim Management Program as well as creating a “Paperless”
medical file as all medical documentation associated with the claim will be
available electronically”
62

63. WebOPUS - Browser Tool
 Facilitates communication with real-time access to user friendly, web-based
care management software
 Provides browsers the ability to:
 Follow the medical & disability aspects of cases online
 Review disability guidelines by diagnosis code
 Communicate with nurse case manager online
 Locate medical providers by location/specialty
 Receive auto email alerts of new First Reports of Injuries & Case
Management Episodes of Care
 Retrieve Case Management Reports online
 Review the medical payment history on a claim
 Retrieve & Review medical documents attached to a claim
 Generate Management Reports on demand
63

64. Adjuster Web Portal Tools
 eBRIDGE Adjuster Production Worklist Web Portal
 Access to Pre-PPO EOR/Bill Images
 Line Level Approval Denial
 Customizable Denial Reasons
 Free Form Text Denial Comments
 Automated Throughput
 WebOPUS Real Time Browser Web Portal
 Access to all completed historical bill data and images
 Access to all completed Utilization Review records and medical documentation
 Access to all Case Management information, including return to work documentation, Nurse
Notes, and Treatment Plan management
 Receive auto email alerts predicated on Case Event Milestones
 Follow the medical & disability aspects of cases online
 If applicable, ability to interact directly with assigned Nurse Case Manager, Utilization Review
Nurse, and/or Hospital Bill Audit Nurse.
64

65. Case Management / Bill Review Seamless Integration
 Claim Data
 Claims created from Client Claim Feeds
 Claims created from ICS FROI Services
 Claim updates received from any Third Party Source
 Pre-Authorization / Pre-Cert Header & Line Detail outcomes
with notes
 Claim Flags created from Pre Cert and Claim Update process
 Pre Cert Data – Fee Schedule data creates cost and savings reports
 Online Bill Approval / Denial Portal – Status and Outcomes
 Case Management Billing Screen – Comprehensive Service History
 Automatic Claim Reopening & Nurse Intervention
65

66. EDI Capabilities
 Incoming
 Claim/Eligibility
 Provider/Vendor Files
 e-billing
 UR/CM notes/data
 PPO data
 Check Number/Date
 Outgoing
 provider payment for ease of generating reimbursement checks
 EOR Header and Line Detail data (including CPT codes)
 review fees
 PPO data
 Regulatory (TX & CA EDI mandates)
 Systems flexibility to match and re-create existing EDI processes
 Transfer of files can take place using SFTP, VPN, electronic mailbox, e-mail etc.
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67. Comprehensive Reporting Dashboard Capabilities &
Sample Stewardship Report & Outcomes
 Standard report package
designed to meet client
needs
 Web based reports are
concurrent with Real Time
Data
 Customized Stewardship &
Ad Hoc Reporting
 Auto Reporting Triggers
 Demonstrates program
effectiveness
 State Reporting
 Identifies safety & loss
control interventions
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68. Implementation & Account Management Philosophy
 Implementation is the Key to Program success
 Dedicated Implementation and Operational Team
 Senior Level Account Management
 Detailed knowledge gathering round table meetings
 Customized service programs and reporting
 Ad Hoc Status Calls
 Monthly Program Updates
 Quarterly Stewardship Meetings and Efficacy Outcomes
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69. ICS offers a Unique Partnership
 Comprehensive service and processing solutions
 Bundled or unbundled program management
 Customized medical processing and flexible network options
 Program designed to address your claims population needs
 Lower cost solution due to proprietary components
 Complete transparency with no conflict of interest
 Key Attributes: Integrity, Innovation, Service, Flexibility, Technology, Results
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70. Our Vision
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