AgdaPkt 2002-01-28 - Laserfiche WebLink

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7. In the event of a questionable claim, CMl will coordinate all actions with theClient, keeping them informed of all developments. 8. Upon approval, defend the Client's interest, gathering evidence for prosecution of fraud or abuse where appropriate. 9. Establish and maintain complete, detailed, accurate claim files and review all claims on a thirty (30) day diary system. 10. Safeguard all files and store them appropriately in CMI's office or archive facility. All records remain the property of the Client and will be delivered upon reasonable notice in good order and condition. 11. Meet regularly with the Client's staff as scheduled to review specific files and general program status. 12. Provide copies of all pertinent medica, settlement, hearing, legal and investigative reports to keep the Client current on claims development. 13. Provide monthly, quarterly and annual loss information to the Client as agreed in the contract and on an ad hoc basis through their electronic access to all claim files. 14. Pursue all subrogation and other recovery opportunities. 15. Cooperate with all periodic claims handling audits and independent actuarial consultants as required by the Client. 16. Accept full responsibility for penalties resulting from our failure to comply with workers' compensation laws and regulations. 17. Use the Client's selected defense counsel, medical panel, investigators, counselors, and other contracted vendors as directed. Medical Cost Management With the Client's authorization, CMl will control medical costs by utilizing a full array of medical managed care services from Horizon Managed Care, LLC (HMC), and other vendors, including: 1. Bill Review 2. Case Management (Where Appropriate) 3. PPO Network 4. Durable Goods and Pharmacy Discounts 5. Medical Peer Review of Treatment Plans 6. Utilization Review of Medical, Chiropractic and Physical Therapy Treatment Plans CI~A~$ MA~AGF~FJ~, INC.