ICS - Integrated Services Total Service Solution Overview Prepared for :

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Overview of Integrated ServicesLines of Business: WC / Auto / FELA / Liability/ Group Health 24/7 Claim Reporting/First Report of Injury/Absence Mgmt Call Center Early Intervention Telephonic Case Management / Utilization Management EPO Network Management Pre-Authorization / Utilization Review Medical Bill Review – Online & Paperless PPO Fusion Specialty Nurse Audit & Out of Network Signed Agreements Independent Medical Evaluations Independent Physician Reviews Pharmacy Benefit Management & Durable Medical Equipment Programs Medicare Set Aside Medical Record Litigation Support Fraud & Investigative Services Proprietary web-based technology solutions

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ICS - Integrated Services Overview Genesis of ICS Strategic Partnership with MCMC 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

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Call Center Services

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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

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Call Center Utilization

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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.

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.

Average Medical Cost by Lag Time Category

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Early Intervention Nurse Case Management/EPO Network

Services

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Early Intervention/Telephonic Case Management Component Overview & Benefits

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 guidelines

Communication of Care Management Episodes to all interested parties via EDI with Claims System, Auto Email Alerts, WebOPUS® Internet Browser, and Auto Fax Server

Promote employee advocacy and goodwill

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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, Medical Evaluation or Field Case

Management

Continuously update work site coordinator, claims adjustor or any other interested party with care management milestones via:

EDI to Claims System Email Alerts to all interested parties WebOPUS® Browser accessibility

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Monthly Saved Days Analysis - Comparison to National Benchmark

For this national client, the average monthly “saved” lost time days has increased by nearly 200% over the past 2 full calendar years. The “saved” days is measured on closed Lost Time cases and the number of lost time days

incurred measured against the expected disability duration using national best practice benchmarks

For this national client, the average monthly “saved” lost time days has increased by nearly 200% over the past 2 full calendar years. The “saved” days is measured on closed Lost Time cases and the number of lost time days

incurred measured against the expected disability duration using national best practice benchmarks

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Transitional Duty Outcomes - New Employees Entering Program

For this national client, since FY02, there have been over 1,700 new employees who have benefited from the Transitional Duty Program.

For this national client, since FY02, there have been over 1,700 new employees who have benefited from the Transitional Duty Program.

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Average Lost Time Days by Lost Time Claim

CY 1999 was full year prior to implementation of current TCM ProgramCY 1999 was full year prior to implementation of current TCM Program

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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

Ongoing Site Visits are completed to ensure compliance.

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Exclusive Occupational Health Network Overview Establishment of “Service Level Agreements” to provide an injured employee

with the following “Expectations”: Expect to receive medical care within 30 minutes of arrival. (Remember: Emergencies

should always go to the nearest ER) Expect that the facility be near the worksite, be clean and have the equipment necessary

to treat their injury appropriately Expect that the treating medical provider should be able to answer your questions and

provide you with information about your injury. Expect that the medical provider is communicating with your Nurse Case Manager to

ensure you are receiving the best and most appropriate medical care Expect that the Occupational Health facility that treated your work related injury is also

certified by Health Services to complete a Return To Work Physical. (If necessary, this ensures your Physical will be completed by a facility that knows you and your injury.)

Expect to find a contracted Occupational Health facility via Intranet site or by calling the Call Center.

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Pre Certification/Utilization Review Services

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Utilization Review - Component Benefits Detailed determination reporting with complete clinical rationale and treatment

guidelines used for decision making Seamless integration with Telephonic Case Management and Medical Bill

Review 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

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Medical Bill Review & PPO Fusion Services

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Medical Bill Review Services

Application of all state fee schedule/UCR values, jurisdictional rules, and CCI/OCE edits

Access to multiple network/out of network fee discounts Specialty review services for additional savings Guaranteed turnaround times Real Time interface to share data with UR and case

management services Dedicated toll-free provider assistance hotline Automated check writing

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Medical Bill Review ComponentsClaim Handling/Intake

Mailroom Claim Indexing Document Management

Adjudication Fee Schedule & UCR Application Nurse Code Review Nurse Desk Audit PPO Fusion Application Out of Network Bill Signed Negotiations Online Medical Bill Review & Approval Operational Throughput

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Medical Bill Review – Service Overview Automated Client specific utilization management parameters Customizable claim edits for exception processing Access to multiple network fee discounts Application of State Fee Schedule/UCR values, State rules and CCI Edits Guaranteed turnaround time to enhance provider relations Comprehensive status & outcome reports including provider profiling Linked to WebOPUS case management software Electronic interface in sharing Closed/Denied information to prevent improper payments Electronic link with Group Health carriers to prevent “double dipping” Automated check writing capabilities Dedicated toll free Provider Assistance Hotline Mail Room outsource/claim indexing services Ability to offer an online Approval/Denial portal for Adjusters to make a decision on a

scanned medical bill. Creating the “paperless” medical file.

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PPO application performed on proprietary software platforms Setup customized per State for maximum penetration / savings Network types: National / Regional / Specialty No conflict of interest

“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 A has experienced a 58% improvement in PPO Savings Client B has experienced a 150% improvement in PPO 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

Network Solutions – The ICS Fusion

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PPO/Specialty Savings & Penetration Breakdown

Tier 1 % of Total Savings: 29%

Tier 2 % of Total Savings: 8%

Tier 3 % of Total Savings: 8%

Specialty Network % of Total Savings: 22%

Specialty Review % of Total Savings: 33%

*Specialty Networks include PT, MRI, DME

PPO Penetration

Tier 1 PPO Bill Penetration: 21%

Tier 2 PPO Bill Penetration: 13%

Tier 3 PPO Bill Penetration: 9%

Specialty Network Penetration: 23%

Specialty Review Bill Penetration: 1%

Total Bill Penetration: 67%

PPO Savings

Case study: National retail client with warehousing and distribution centers2009 New Jersey Results: 75% PPO Penetration resulting in 50% Gross Savings

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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

The ICS Health Ticket

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IC_Solutions – Specialty Bill Review Services

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IC_Solutions offers a suite of services to address the specialty bill review needs of Workers’ Compensation, Auto, Liability, Federal, Longshoreman, and Maritime payers

These services, supported by innovative and proprietary technology, result in accurate outcomes for Code Review, Desk Audits, and Out of Network Negotiations with Signed Agreements that deliver significant savings to our clients.

IC_Solution’s experienced subject matter experts have firsthand knowledge of provider billing practices and techniques.

IC_Solutions Nurse Auditors and Certified Coders prevent overpayment of medical charges

IC_Solutions – Specialty Bill Review Services

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Code Review - Over $7,750,000 in Savings for CY 2009 RN review of coding and supporting documentation Review for linkage of Diagnosis Codes to Procedure Codes, along with confirming

correct modifier usage Desk Audit - Over $3,500,000 in Savings for CY 2009

Focused Inpatient Hospital Bill Auditing by experienced Nurse Auditor Review for causal relatedness of charges to compensable injury, appropriate length

of stay, and appropriate coding Out of Network Signed Agreements – Over $3,000,000 in Savings in CY 2009

Recommended referral criteria: Any medical bill that comes back without a PPO hit and over $2,500.00 in Charge 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

Specialty Review/Negotiated Savings

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HIPPO contains information on millions of medical transactions, including costs, charges, PPO hits, and prevailing payments. Queries can be based on

individual bills or more globally by using Provider Tax ID Numbers

IC_Solutions – Specialty Bill Review Services

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Referrals to IC_Solutions for anyone of our services is the model of flexibility, including:

*Secure E Fax *Secure FTP *EDI *Hardcopy *Email The entire body of work for all IC_Solutions services is managed and

completed through proprietary web-based case management portal, WebOPUS. WebOPUS allows you real-time access to all medical and clinical

information associated with a referral. WebOPUS allows for secure ongoing communication with the ICS

Nurse Auditor and/or Certified Coder on the status and final resolution of a referral

WebOPUS generates and stores all correspondence, letters, and agreements associated with a referral, easily accessible at anytime.

IC_Solutions – How To Refer, Manage, Save

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Independent Medical Evaluation & Physician Review Services

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Medical Evaluation Services 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

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Independent Peer Review 25+ years 45,000+ reviews performed in 2009 National Panel of Reviewers URAC IRO accredited All lines of business and levels of review TAT to meet your business needs Dedicated customer service teams HIPAA compliant technology SAS 70 Type II certified Web referrals

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National Reviewer Panel Over 1,100 reviewers

All ABMS specialties and subspecialtiesBoard-certifiedActive clinical practiceCurrent, unrestricted state license(s)Well established credentialing committee

Oversight by MCMC’s Medical DirectorRe-credentialed every three yearsVerification of key credentials

Independent Peer Review

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Medicare Set Aside

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Medicare Set Aside Services Experienced nurses certified in life care planning available to review medical

records for: Compensable body parts/conditions Potential for rated age 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 Pharmacy Benefit Reviews

Rated age vs. chronological age determines life expectancy on which future costs are based

Partner with leading law firm to provide legal opinion letter, handle interface with CMS, provide legal support

Ten Day Turnaround Time

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Fraud Abatement & Record Retrieval Services

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Fraud Abatement Services National service capability Services:

Mobile and Stationary Surveillance

Covert surveillance Activity

checks/neighborhood canvass Wellness checks

Robust quality assurance program

All referrals and reports/video delivered via the web

DIGG-IT Unique service Internet based investigation

focusing on the top social networking sites such as Facebook, Myspace, Orkut, Youtube, LinkedIn

Civil and Criminal History E-Commerce sites such as

EBay and Craigslist Deep Web Research into the

interests, lifestyles, and activities of your claimants

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Record Retrieval Services National service capability Service offering:

Authorization Procurement Subpoena Preparation and Service Expedited Service Index Hospital Records Provider Research Copy Records X-Ray Duplication Record Pick up

Cost-effective solution to attorney charges All services delivered through paralegals and experienced record retrieval

staff High sense of urgency and industry leading turnaround time

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Proprietary Technology – WebOPUS Case Management Portal

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Overview of WebOPUS - Robust case management system designed for the proactive case manager that

creates bottom line results in today’s competitive industry Enables case managers to focus on their patients and provide the most effective

oversight by automating their day-to-day tasks Structured to integrate all of the Managed Care Services and Activities involved

in the continuum of claims management An Information Management Tool used to consolidate and coordinate healthcare

and claims management activities Comprehensive Data Collection and Tracking application Flexible rule base logic to provide situation alerts and create triggers to facilitate

prompt and effective decision making Portal that weaves the data points from all case management activities into one

single comprehensive point of entry

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WebOPUS Capabilities - Roles Supported Case Manager & Coordinator Utilization Review Nurse & Coordinator Call Center Care Coordinator Review Physician Vocational Rehabilitation Specialist IME Coordinator Claims Adjuster Online Approval Adjuster Invoice Coordinator Nurse Bill Review Auditor Network Manager Worksite Coordinator Support Management

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WebOPUS Capabilities - Modules Supported

First Report of Injury/Illness/Absence/Accident/Disability Module Ability to create new claims for workers’ compensation, auto liability, and

general liability Service Referral Module

Ability to create a referral, typically for IME, Peer Review, Desk Audit etc. Production Module - Manage Your Worklist

Primary module. Supports all the various production roles and client and/or industry specific business logic

Browser Module Allows for real time review of cases, documents, notes, treatment plan, return-

to-work etc. Comprehensive Reporting Module

Provides for over 25 canned reports available from the Web, ranging from Open Case with Current Lost Time to Timesheet Management Reports.

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WebOPUS Capabilities - Core Section Overview Activities Section

Search and Attach Treating Medical Provider on a claim Ability to create Loss Descriptors with ICD-9 codes automatically linked Create comprehensive Clinical Treatment & Management Tool

Notes Section Correspondence

Ability to view, email, and/or fax all of the Documents Received & Created Ability to create Standardized and Personal Letter Template Documents

Claimant Summary overview of the demographic and past medical history linked to a claimant

Treatment Plan Summary overview on the Treatment Plan Management and Disability Duration

Billing Ability to view all the Historical and/or Pending bills associated with a claim including

EOR, Medical Image and Payment information Utilization Review

Ability to complete a Utilization Review/Pre Cert on all States, including State required Letters & Correspondence

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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