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Exhibit - PSA - Managed Care Services
City of Miami, Florida Contract No, RFP 605386 PROFESSIONAL SERVICES AGREEMENT By and Between The CITY OF tMIAMI And USIS, INC. This Professional Services Agreement ("Agreement") is entered into this day of , 2017 ( "Effective Date") , by and between the City of Miami, a municipal corporation of the State of Florida, whose address is 444 S.W. 2' Avenue, 10'h Floor, Miami, Florida 33130 ("City"), and, USIS, INC. a corporation, qualified to do business in the State of Florida whose principal address is 5728 Major Blvd., Suite 450, Orlando, FL 32819, hereinafter referred to as the ("Provider"). RECITALS: WHEREAS, the City of Miami issued a Request for Proposals No. 605386 on, October 5, 2016, (the "RFP" attached hereto, incorporated hereby, and made a part of as Exhibit A) for the provision of Managed Care/Medical Bill Review/Audit Services ("Services" as more fully set forth in the scope of work "Scope" attached hereto as Exhibit B) for the City's Risk Management Department and Provider's proposal ("Proposal", attached hereto, incorporated hereby, and made part of hereof as Exhibit C), in response thereto, has been selected as the most responsive, responsible and qualified proposal for the provision of the Services; and WHEREAS, this Professional Services Agreement ("Agreement") was included in the RFP with a statement that it would require execution by the Successful Proposer selected as the Provider; and, WHEREAS, the Evaluation/Selection Committee appointed by the City Manager determined that the Proposal submitted by the Provider was responsive to the RFP requirements and recommended that the City Manager negotiate a contract with the Provider; and WHEREAS, the City wishes to engage the Services of the Provider, and the Provider wishes to perform the Services for the City; and WHEREAS, the City and the Provider desire to enter into this Agreement under the terms and conditions set forth herein. 1 Managed Care/Medical Bill Review/Audit Services City of Miami, Florida Contract No. RFP 605386 NOW, THEREFORE, in consideration of the mutual covenants and promises herein contained, Provider and the City agree as follows: TERMS: 1. RECITALS AND INCORPORATIONS; DEFINITIONS: A. The recitals are true and correct and are hereby incorporated into and made a part of this Agreement. The City's RFP is hereby incorporated into and made a part of this Agreement and attached hereto as Exhibit "A." The Services and Scope of Work are hereby incorporated into and made a part of this Agreement and attached as Exhibit "B." The Provider's Response and Pricing Proposal dated, November 30, 2016, in response to RFP 605386, is hereby incorporated into and made a part of this Agreement as attached Exhibit "C." The Provider's Insurance Certificate is hereby incorporated into and made a part of this Agreement as attached Exhibit "D." The order of precedence whenever there is conflicting or inconsistent language between documents is as follows in descending order of priority: (1) Professional Services Agreement ("PSA") (2) Addenda/Addendum to the RFP; (3) RFP; and (4) Provider's Response and Price Proposal Schedule dated November 30, 2016, acknowledging scope of services and pricing component of services and, response to the Request for Proposals. 2. TERM: The Agreement shall become effective on the date on the first page of this Agreement, and shall be for an initial term of three (3) years. The City Manager shall have the option to administratively extend the Agreement as is needed in the opinion of the City Manager for a period of one hundred and twenty (120) days, and/or the option to renew the Agreement as provided in Section 3, or to terminate the Agreement for convenience, that is, for any or no cause, as provided in Section 16, City's Termination Rights. 3. OPTION TO RENEW: The City Manager shall have the option to renew for two (2) additional one (1) year periods, subject to availability and appropriation of funds. City Commission approval shall not be required for the above stated renewal terms. The total term of the Agreement inclusive of all renewals would be five (5) years. 2 Managed Care/Medical Bill Review/Audit Services City of Miami, Florida Contract No. RFP 605386 4. SCOPE OF SERVICES: A. Provider agrees to provide the Services as specifically described, and under the special terms and conditions set forth in Exhibits "A" and "B" hereto, which by this reference is incorporated into and made a part of this Agreement. B. Provider represents and warrants to the City that: (i) it possesses all qualifications, licenses, certificates, degrees, authorizations, and expertise required for the performance of the Services under this Agreement, including but not limited to full qualification to do business in Florida; (ii) it is not delinquent in the payment of any sums due the City, including payment of permits, fees, occupational licenses, etc., nor in the performance of any obligations or payment of any monies to the City or presently in default of any contract it has with the City, or in presently in default of any contract with the State of Florida or any political subdivision of the State, or of any contract with a Public School Board or Special District of the State of Florida (collectively "Florida Public Agencies") nor has it been debarred or suspended under applicable laws and regulations by any of the foregoing Florida Public Agencies ; (iii) all personnel assigned to perform the Services are and shall be, at all times during the term hereof, fully qualified and trained to perform the tasks assigned to each; (iv) the Services will be performed in the manner described in Exhibit "A"; and (v) each person executing this Agreement on behalf of Provider has been duly authorized to so execute the same and fully bind Provider as a party to this Agreement. C. Provider shall at all times provide fully qualified, competent and physically capable employees to perform the Services under this Agreement. Provider shall possess and maintain any required licenses, permits, degrees, and certifications to perform the Services under this Agreement. City may require Provider to remove any employee the City deems careless, incompetent, insubordinate, or otherwise objectionable and whose continued services under this Agreement is not in the best interest of the City. 5. COMPENSATION: A. The amount of compensation payable by the City to the Provider shall be based on the rates quoted in Exhibit "C" hereto, which by this reference is incorporated into and made a part of this Agreement. The rates for the optional Plan Years 2020, and 2021, shall be negotiated. The Provider shall advise the City of the recommended rates for each optional year one hundred twenty (120) days in advance of the City's open enrollment for the optional year, providing justification for any recommended rate increases above the previous year's rates. 3 Managed Care/Medical Bill Review/Audit Services City of Miami, Florida Contract No. RFP 605386 B. Payment shall be made in arrears based upon work performed to the satisfaction of the City within forty-five (45) days after receipt of Provider's invoice for Services performed, which shall be accompanied by sufficient supporting documentation and contain sufficient detail, to allow a proper audit of expenditures, should the City require one to be performed. Invoices shall be sufficiently detailed so as to comply with the "Florida Prompt Payment Act," §218.70. - 218,79, Florida Statutes, and other applicable laws. No advance or future payments shall be made at any time. C. Provider agrees and understands that (i) any and all y Subcontractors providing Services related to this Agreement shall be paid through Provider and not paid directly by the City; and / or (ii) any and all liabilities regarding payment to or use of y Subcontractors for any of the Services related to this Agreement shall be borne solely by Provider. D. Prices shall remain firm and fixed for the first two (2) years of the Contract. The City reserves the right to negotiate the rates for Year 3 of the initial contract, and for any renewal and/or extension periods. 6. OWNERSHIP OF DOCUMENTS: Provider understands and agrees that any information, document, report or any other material whatsoever which is given by the City to Provider, its employees, or any Subcontractor, or which is otherwise obtained or prepared by Provider solely and exclusively for the City pursuant to or under the terms of this Agreement, is and shall at all times remain the property of the City. Provider agrees not to use any such information, document, report or material for any other purpose whatsoever without the written consent of the City Manager, which may be withheld or conditioned by the City Manager in his/her sole discretion. Provider is permitted to make and to maintain duplicate copies of the files, records, documents, etc. if Provider determines copies of such records are necessary subsequent to the termination of this Agreement; however, in no way shall the confidentiality as permitted by applicable laws be breached. The City shall maintain and retain ownership of any and all documents which result upon the completion of the work and Services under this Agreement as per the terms of this Section 5. 7. AUDIT AND INSPECTION RIGHTS AND RECORDS RETENTION: A. Provider agrees to provide access to the City or to any of its duly authorized representatives, to any books, documents, papers, and records of Provider which are directly pertinent to this Agreement, for the purpose of audit, examination, excerpts, and transcripts. The City may, at reasonable times, and for a period of up to three (3) years following the date of final 4 Managed Care/Medical Bill Review/Audit Services City of Miami, Florida Contract No, RFP 605386 payment by the City to Provider under this Agreement, audit and inspect, or cause to be audited and inspected, those books, documents, papers, and records of Provider which are related to Provider's performance under this Agreement. Provider agrees to maintain any and all such books, documents, papers, and records at its principal place of business for a period of three (3) years after final payment is made under this Agreement and all other pending matters are closed. Provider's failure to adhere to, or refusal to comply with, this condition shall result in the immediate cancellation of this Agreement by the City. B. The City may, at reasonable times during the term hereof, inspect the Provider's facilities and perform such tests, as the City deems reasonably necessary, to determine whether the goods or services required to be provided by Provider under this Agreement conform to the terms hereof. Provider shall make available to the City all reasonable facilities and assistance to facilitate the performance of tests or inspections by City representatives. All audits, tests and inspections shall be subject to, and made in accordance with, the provisions of Sections 18-100, 18-101, and 18-102 of the Code of the City of Miami, Florida, which apply to this Agreement, as same may be amended or supplemented, from time to time. The foregoing City Code Sections as well as the entirety of Chapter 18, "Finance", City of Miami Code, as amended and as applicable, is deemed as being incorporated by reference herein. 8. AWARD OF AGREEMENT: Provider represents and warrants to the City that it has not employed or retained any person or company employed by the City to solicit or secure this Agreement and that it has not offered to pay, paid, or agreed to pay any person, any fee, commission, percentage, brokerage fee, or gift of any kind contingent upon or in connection with, the award of this Agreement. 9. PUBLIC RECORDS: A. Provider understands that the public shall have access, at all reasonable times, to all documents and information pertaining to City Agreements, subject to the provisions of Chapter 119, Florida Statutes, and agrees to allow access by the City and the public to all documents subject to disclosure under applicable laws, Provider's failure or refusal to comply with the provisions of this section shall result in the immediate cancellation of this Agreement by the City. B. Provider shall additionally comply with Section 119.0701, Florida Statutes, including without limitation: (1) keep and maintain public records that ordinarily and necessarily would be required by the City to perform this service; (2) provide the public with access to public records on the same terms and conditions as the City would at the cost provided by Chapter 119, 5 Managed Care/Medical Bill Review/Audit Services City of Miami, Florida Contract No. RFP 605386 Florida Statutes, or as otherwise provided by law; (3) ensure that public records that are exempt or confidential and exempt from disclosure are not disclosed except as authorized by law; (4) meet all requirements for retaining public records and transfer, at no cost, to the City all public records in its possession upon termination of this Agreement and destroy any duplicate public records that are exempt or confidential and exempt from disclosure requirements; and, (5) provide all electronically stored public records that must be provided to the City in a format compatible with the City's information technology systems. Notwithstanding the foregoing, Provider shall be permitted to retain any public records that make up part of its work product solely as required for archival purposes, as required by law, or to evidence compliance with the terms of the Agreement. C. Should Provider determine to dispute any public access provision required by Florida Statutes, then Provider shall do so at its own expense and at no cost to the City. Provider may maintain an exemption for such personal information such as Social Security Numbers of members or medical information exempted by general law. IF THE PROVIDER HAS QUESTIONS REGARDING THE APPLICATION OF CHAPTER 119, FLORIDA STATUTES, TO THE PROVIDER'S DUTY TO PROVIDE PUBLIC RECORDS RELATING TO THIS CONTRACT, CONTACT THE CUSTODIAN OF PUBLIC RECORDS AT (305) 416-1830, Via email at PublicRecords( miamigov.com, or regular email at City of Miami Office of the City Attorney, 444 SW 2" Avenue, 9' FL, Miami, FL 33130. 10. PRIVACY AND CONFIDENTIALITY Provider agrees to develop, adopt, and implement standards to safeguard the privacy and confidentiality of all personal information about eligible employees and members of the Program. For example, Provider shall ensure that Provider does not have completed forms containing personal information sitting in public view, left in unsecured boxes or files, or left unattended in any off -site location. Provider's procedures shall include but not limited to safeguarding the identity of members as members of the Program and preventing unauthorized disclosure of personal information. Provider agrees to report any unauthorized use or disclosure of the members" personal information to the City, within twenty-four (24) hours of any incident of which it becomes aware. Provider agrees to comply with all federal and state laws concerning the privacy and confidentiality of members' information, and agrees to implement any regulations when they become effective. 6 Managed Care/Medical Bill Review/Audit Services City of Miami, Florida Contract No. RFP 605386 In the absence of exigent circumstances, Provider shall not disclose any member's personal information to another business associate for pecuniary gain unless the City specifically prior authorizes such disclosure in writing. Provider agrees to mitigate, to the extent practicable, any harmful effect that is known to the Provider of a use or disclosure of members' information by the Provider in violation of the requirements of this Agreement or federal or state laws. Provider agrees to (i) implement administrative, physical, and technical safeguards that reasonably and appropriately protect the confidentiality, integrity, and availability of the electronic personal information of members that Provider creates, receives, maintains, or transmits; (ii) report to the City any security incident of which the Provider becomes aware, and (iii) ensure that any agent of the Provider, including any Subcontractor or sub consultant, agrees to the same restrictions and conditions that apply to the Provider with respect to such information. Provider agrees not to sell member information. Provider shall not use member information unless it is aggregated blinded data, which is not identifiable on a member basis. Provider shall not use member identified or non -aggregated information for advertising, marketing, promotion or any activity intended to influence sales or market share of any product or service. Provider shall have full financial responsibility for any penalties, fines, or other payments imposed or required as a result of Provider's non-compliance with, or violation of, federal or state requirements, and the Provider shall indemnify the City with respect to any such penalties, fines, or payments. Provider shall assure that all Provider's staff, including Subcontractor or sub consultant, is trained in all privacy requirements, as applicable. At the request of the City, Provider shall offer credit protection for those times in which a member's personal information is accidentally or inappropriately disclosed. This Section is not to be construed to conflict with the provisions of Chapter 119, Florida Statutes nor any exemptions from this Statute. 11. INDIVIDUALLY IDENTIFIABLE HEALTH INFORMATION AND/OR PROTECTED HEALTH INFORMATION. Any person or entity that performs or assists the City with a function or activity involving the use or disclosure of "Individually Identifiable Health Information (IIHI)" and/or Protected Health Information (PHI) shall comply with the Health Insurance Portability and Accountability Act (HIPAA) of 1996. HIPAA mandates the privacy, security, and electronic transfer standards, include but are not limited to: 1. Use of information for performing services required by the Contract or as required law; 7 Managed Care/Medical Bill Review/Audit Services City of Miami, Florida Contract No. RFP 605386 2. Use of appropriate safeguards to prevent non -permitted disclosures; 3. Reporting to the City of any non -permitted use or disclosures; 4. Assurances that any agents and Subcontractor agree to the same restrictions and conditions that apply to the Provider and reasonable assurances that IIHI/PHI will be held confidential; 5. Making PHI available to the customer; 6. Making PHI available to the customer for review and amendment; incorporation of any amendments requested by the customer; 7. Making PHI available to the City for an accounting of disclosures; and 8. Making internal practices, books, and records related to PHI available to the City for compliance audits. PHI shall maintain its protected status regardless of the form and method of transmission paper records, and/or electronic transfer of data). The Provider must give its customers written notice of its privacy information practices including specifically a description of the types of uses and disclosures that would be made with protected health information. 12. COMPLIANCE WITH FEDERAL, STATE AND LOCAL LAWS: Provider understands that agreements with local governments are subject to certain laws and regulations, including laws pertaining to public records, conflict of interest, record keeping, etc. City and Provider agree to comply with and observe all such applicable federal, state and local laws, rules, regulations, codes and ordinances, as they may be amended from time to time. Provider further agrees to include in all of Provider's agreements with Subcontractor for any Services related to this Agreement this provision requiring Subcontractors to comply with and observe all applicable federal, state, and local laws rules, regulations, codes and ordinances, as they may be amended from time to time. 13. INDEMNIFICATION: Provider shall indemnify, defend (at its own cost and expense) and hold harmless the City and its officials, employees and agents for claims (collectively referred to as "Indemnitees") and each of them from and against all loss, costs, penalties, fines, damages, claims, expenses (including attorney's fees) or liabilities (collectively referred to as "Liabilities") by reason of any injury to or death of any person or damage to or destruction or loss of any property arising out of, resulting from, or in connection with (i) the negligent performance or non-performance of the Services contemplated by this Agreement (whether active or passive) of Provider or its 8 Managed Care/Medical Bill Review/Audit Services City of Miami, Florida Contract No. RFP 605386 employees, agents or Subcontractor (collectively referred to as "Provider") which is directly caused, in whole or in part, by any act, omission, default or negligence (whether active or passive or in strict liability) of the Indemnitees, or any of them, or (ii) the failure of the Provider to comply materially with any of the requirements herein, or the failure of the Provider to conform to statutes, ordinances, or other regulations or requirements of any governmental authority, local, federal or state, including without limitation, a claim for infringement of an intellectual property right, copyright, patent or trademark used by the Provider, in connection with the performance of this Agreement even if it is alleged that the City, its officials, agents, andlor employees were negligent. Provider expressly agrees to indemnify, defend and hold harmless the Indemnitees, or any of them, from and against all liabilities which may be asserted by an employee or former employee of Provider, or any of its Subcontractors, as provided above, for which the Provider's liability to such employee or former employee would otherwise be limited to payments under state Workers' Compensation or similar laws. Provider further agrees to indemnify, defend and hold harmless the Indemnitees from and against (i) any and all Liabilities imposed on account of the violation of any law, ordinance, order, rule, regulation, condition, or requirement, related directly to Provider's negligent performance under this Agreement, compliance with which is left by this Agreement to Provider, and (ii) any and all claims, and/or suits for labor and materials furnished by Provider or utilized in the performance of this Agreement or otherwise. Provider's obligations to indemnify, defend and hold harmless the Indemnitees shall survive the termination and/or expiration of this Agreement. The Provider acknowledges that the granting of this Agreement is sufficient and independent consideration for the giving of this Indemnity. Provider understands and agrees that any and all liabilities regarding the use of any Subcontractors for Services related to this Agreement shall be borne solely by Provider throughout the duration of this Agreement and that this provision shall survive the termination or expiration of this Agreement, as applicable. 14. DEFAULT: If Provider fails to comply with any term or condition of this Agreement, or fails to perform in any material way any of its responsibilities or obligations hereunder, and fails to cure such failure after reasonable notice from the City, which period to cure shall be complied with when stated in the written notice form the City, then Provider shall be in default. Upon the occurrence of a default, hereunder the City, in addition to all remedies available to it by law, may immediately, upon written notice to the Provider, terminate this Agreement whereupon all payments, advances, 9 Managed Care/Medical Bill Review/Audit Services City of Miami, Florida Contract No. RFP 605386 or other compensation paid by the City to Provider while Provider was in default shall be immediately returned to the City. Provider understands and agrees that termination of this Agreement under this section shall not release Provider from any obligation accruing prior to the effective date of termination. Should Provider be unable or unwilling to commence to perform the Services within the time provided or contemplated herein, then, in addition to the foregoing, Provider shall be liable to the City for all expenses incurred by the City in preparation and negotiation of this Agreement, as well as all costs and expenses incurred by the City in the re - procurement of the Services, including consequential and incidental damages. 15. RESOLUTION OF AGREEMENT DISPUTES: Provider understands and agrees that all disputes between Provider and the City based upon an alleged violation of the terms of this Agreement by the City shall be submitted to the City Manager for his/her resolution, prior to Provider being entitled to seek judicial relief in connection therewith. In the event that the amount of compensation hereunder exceeds Twenty -Five Thousand Dollars and NolCents ($25,000), the City Manager's decision shall be approved or disapproved by the City Commission. Provider shall not be entitled to seek judicial relief unless: (i) it has first received City Manager's written decision, approved by the City Commission if the amount of compensation hereunder exceeds Twenty -Five Thousand Dollars and No/Cents ($25,000), or (ii) a period of sixty (60) days has expired, after submitting to the City Manager a detailed statement of the dispute, accompanied by all supporting documentation one hundred twenty (120) days if City Manager's decision is subject to City Commission approval; or (iii) City has expressly waived compliance with the procedure set forth in this section by written instruments, signed by the City Manager. In no event may the amount of compensation under this Section exceed the total compensation set forth in Section 5 (A) of this Agreement. 16. CITY'S TERMINATION RIGHTS; OBLIGATIONS UPON TERMINATION: A. The City, acting by and through its City Manager, shall have the right to terminate this Agreement, in its sole discretion, and without penalty, at any time, by giving written notice to Provider at least thirty (30) calendar days prior to the effective date of such termination. In such event, the City shall pay to Provider compensation for Services rendered and approved expenses incurred prior to the effective date of termination. In no event shall the City be liable to Provider for any additional compensation and expenses incurred, other than that provided herein, and in no event shall the City be liable for any consequential or incidental damages. The Provider shall 10 Managed Care/Medical Bill Review/Audit Services City of Miami, Florida Contract No. RFP 605386 have no recourse or remedy against the City for a termination under this subsection except for payment of fees due prior to the effective date of termination. B. The City, by and acting through its City Manager, shall have the right to terminate this Agreement, in its sole discretion, and without penalty, upon the occurrence of an event of an event of default hereunder, and failure to cure the same within thirty (30) days after written notice of default. In such event, the City shall not be obligated to pay any amounts to Provider for Services rendered by Provider after the date of termination, but the parties shall remain responsible for any payments that have become due and owing as of the effective date of termination. In no event shall the City be liable to Provider for any additional compensation and expenses incurred, other than that provided herein, and in no event shall the City be liable for any direct, indirect, consequential or incidental damages. 17. INSURANCE: A. Provider shall, at all times during the term hereof, maintain such insurance coverage(s) as may be required by the City. The insurance coverage(s) required as of the Effective Date of this Agreement are attached hereto as Exhibit '`D" and incorporated herein by this reference. The City RFP number and title of the RFP must appear on each certificate of insurance. The Provider shall add the City of Miami as an additional insured to its commercial general liability, and auto liability policies, and as a named certificate holder on all policies. Provider shall correct any insurance certificates as requested by the City's Risk Management Administrator. All such insurance, including renewals, shall be subject to the approval of the City for adequacy of protection and evidence of such coverage(s) and shall be furnished to the City Risk Management Director on Certificates of Insurance indicating such insurance to be in force and effect and any cancelled or non -renewed policy will be replaced with no coverage gap and a current Certificate of Insurance will be provided. Completed Certificates of Insurance shall be filed with the City Risk Management Director prior to the performance of Services hereunder, provided, however, that Provider shall at any time upon request file duplicate copies of the Certificate of Insurance with the City. B. Provider understands and agrees that any and all liabilities regarding the use of any of Provider's employees or any of Provider's Subcontractors for Services related to this Agreement shall be borne solely by Provider throughout the term of this Agreement and that this provision shall survive the termination of this Agreement. Provider further understands and agrees that insurance for each employee of Provider and each Subcontractors providing Services related 11 Managed Care/Medical Bill Review/Audit Services City of Miami, Florida Contract No. RFP 605386 to this Agreement shall be maintained in good standing and approved by the City Risk Management Administrator throughout the duration of this Agreement. C. Provider shall be responsible for assuring that the insurance certificates required under this Agreement remain in full force and effect for the duration of this Agreement, including any extensions hereof. If insurance certificates are scheduled to expire during the term of this Agreement and any extension hereof, Provider shall be responsible for submitting new or renewed insurance certificates to the City's Risk Management Director as soon as coverages are bound with the insurers. In the event that expired certificates are not replaced, with new or renewed certificates which cover the term of this Agreement and any extension thereof: (i) the City shall suspend this Agreement until such time as the new or renewed certificate(s) are received in acceptable form by the City's Risk Management Director; or (ii) the City may, at its sole discretion, terminate the Agreement for cause and seek re -procurement damages from Provider in conjunction with the violation of the terms and conditions of this Agreement. D. Compliance with the foregoing requirements shall not relieve Provider of its liabilities and obligations under this Agreement. 18. NONDISCRIMINATION: Provider represents to the City that Provider does not and will not engage in discriminatory practices and that there shall be no discrimination in connection with Provider's performance under this Agreement on account of race, color, sex, religion, age, handicap, marital status or national origin. Provider further covenants that no otherwise qualified individual shall, solely by reason of his/her race, color, sex, religion, age, handicap, marital status or national origin, be excluded from participation in, be denied services, or be subject to discrimination under any provision of this Agreement. 19. ASSIGNMENT: The Provider's services are considered unique in nature and highly specialized. This Agreement shall not be assigned, sold, transferred, pledged, encumbered, hypothecated, or otherwise conveyed by Provider, in whole or in part, and Provider shall not assign any part of its operations, without the prior written consent of the City Manager, which may be withheld, denied, or conditioned, in the City's sole discretion through the City Manager. 12 Managed Care/Medical Bill Review/Audit Services City of Miami, Florida Contract No. RFP 605386 20. SUBCONTRACTUAL RELATIONS A. If the Provider will cause any part of this Agreement to be performed by a Subcontractor, the provisions of this Agreement will apply to such Subcontractor and its officers, agents and employees in all respects as if it and they were employees of the Provider; and the Provider will not be in any manner thereby discharged from its obligations and liabilities hereunder, but will be liable hereunder for all acts and negligence of the Subcontractor, its officers, agents, and employees, as if they were employees of the Provider. The services performed by the Subcontractor will be subject to the provisions hereof as if performed directly by the Provider. B. The Provider, before making any subcontract for any portion of the services, will state in writing to the City the name of the proposed Subcontractor the portion of the Services which the Subcontractor is to do, the place of business of such Subcontractor, and such other information as the City may require. The City will have the right to require the Provider not to award any subcontract to a person, firm or corporation disapproved by the City. C. Before entering into any subcontract hereunder, the Provider will inform the Subcontractor fully and completely of all provisions and requirements of this Agreement relating either directly or indirectly to the Services to be performed. Such Services performed by such Subcontractor will strictly comply with the requirements of this Contract. D. In order to qualify as a Subcontractor satisfactory to the City, in addition to the other requirements herein provided, the Subcontractor must be prepared to prove to the satisfaction of the City that it has the necessary facilities, skill and experience, and ample financial resources to perform the Services in a satisfactory manner. To be considered skilled and experienced, the Subcontractor must show to the satisfaction of the City that it has satisfactorily performed services of the same general type which is required to be performed under this Agreement. E. The City shall have the right to withdraw its consent to a subcontract if it appears to the City that the Subcontractor will delay, prevent, or otherwise impair the performance of the Provider's obligations under this Agreement. All Subcontractors are required to protect the confidentiality of the City's and City's proprietary and confidential information. Provider shall furnish to the City copies of all subcontracts between Provider and Subcontractor and suppliers hereunder. Within each such subcontract, there shall be a clause for the benefit of the City in the event the City finds the Provider in breach of this Contract, permitting the City to request completion by the Subcontractor of its performance obligations under the subcontract. The clause shall include an option for the City to pay the Subcontractor directly for the performance 13 Managed Care/Medical Bill Review/Audit Services City of Miami, Florida Contract No. RFP 605386 by such Subcontractor. Notwithstanding, the foregoing shall neither convey nor imply any obligation or liability on the part of the City to any Subcontractor hereunder as more fully described herein. 20. NOTICES: All notices or other communications required under this Agreement shall be in writing and shall be given by hand -delivery or by registered or certified U.S. Mail, return receipt requested, addressed to the other party at the address indicated herein or to such other address as a party may designate by notice given as herein provided, Notice shall be deemed given on the day on which personally delivered; or, if by mail, on the fifth day after being posted or the date of actual receipt, whichever is earlier. TO PROVIDER: TO THE CITY: Ron Warble Executive Vice President 5728 Major Blvd., Suite 450 Orlando, FL 32819 Phone: 407-949-3150 Email Address: ron.warble(@usis-tpa.com Daniel J. Alfonso City Manager 444 SW 2"d Avenue, 10" Floor Miami, FL 33130-1910 Annie Perez, CPPO Procurement Director 444 SW 2"d Avenue, 6" Floor Miami, FL 33130-1910 Victoria Mendez City Attorney City of Miami 444 SW 2"d Avenue, 9" Floor Miami, Florida 33130 Ann -Marie Sharpe Risk Management Director City of Miami 444 SW 2"d Avenue, 9' Floor Miami, Florida 33130 21. MISCELLANEOUS PROVISIONS: A. This Agreement shall be construed and enforced according to the laws of the State of Florida. Venue in any proceedings between the parties shall be in Miami -Dade County, Florida. Each party shall bear its own attorney's fees, Each party waives any defense, whether asserted by motion or pleading, that the aforementioned courts are an improper or inconvenient venue. Moreover, the parties consent to the personal jurisdiction of the aforementioned courts and 14 Managed Care/Medical Bill Review/Audit Services City of Miami, Florida Contract No. RFP 605386 irrevocably waive any objections to said jurisdiction. The parties irrevocably, voluntarily and knowingly waive any rights to a jury trial. B. No waiver or breach of any provision of this Agreement shall constitute a waiver of any subsequent breach of the same or any other provision hereof, and no waiver shall be effective unless made in writing. C. Should any provision, paragraph, sentence, word or phrase contained in this Agreement be determined by a court of competent jurisdiction to be invalid, illegal or otherwise unenforceable under the laws of the State of Florida or the City of Miami, such provision, paragraph, sentence, word or phrase shall be deemed modified to the extent necessary in order to conform with such laws, or if not modifiable, then the same shall be deemed severable, and in either event, the remaining terms and provisions of this Agreement shall remain unmodified and in full force and effect or limitation of its use. D. Provider shall comply with all applicable laws, rules and regulations in the performance of this Agreement, including but not limited to licensure, and certifications required by law for professional service Providers. E. This Agreement constitutes the sole and entire agreement between the parties hereto. No modification or amendment hereto shall be valid unless in writing and executed by properly authorized representatives of the parties hereto. Except as otherwise set forth in Section 2 above, the City Manager shall have the sole authority to extend, amend, or modify this Agreement on behalf of the City. 22. SUCCESSORS AND ASSIGNS: This Agreement shall be binding upon the parties hereto, their heirs, executors, legal representatives, successors, or assigns. 23. INDEPENDENT PROVIDERS: Provider has been procured and is being engaged to provide Services to the City as an independent Provider, and not as an agent or employee of the City. Accordingly, neither Provider, nor its employees, nor any Subcontractor hired by Provider to provide any Services under this Agreement shall attain, nor be entitled to, any rights or benefits under the Civil Service or Pension Ordinances of the City, nor any rights generally afforded classified or unclassified employees. Provider further understands that Florida Workers' Compensation benefits available to employees of the City are not available to Provider, its employees, or any Subcontractor hired by Provider to provide any Services hereunder, and Provider agrees to provide or to require Subcontractor (s) 15 Managed Care/Medical Bill Review/Audit Services City of Miami, Florida Contract No. RFP 605386 to provide, as applicable, workers' compensation insurance for any employee or agent of Provider rendering Services to the City under this Agreement. Provider further understands and agrees that Provider's or Subcontractor's use or entry upon City properties shall not in any way change its or their status as an independent Provider. 24. CONTINGENCY CLAUSE: Funding for this Agreement is contingent on the availability of funds and continued authorization for program activities and the Agreement is subject to amendment or termination due to lack of funds, reduction of funds, failure to allocate or appropriate funds, and/or change in applicable laws or regulations, upon thirty (30) days written notice from the City Manager. 25. FORCE MAJEURE: A "Force Majeure Event" shall mean an act of God, act of governmental body or military authority, fire, explosion, power failure, flood, storm, hurricane, sink hole, other natural disasters, epidemic, riot or civil disturbance, war or terrorism, sabotage, insurrection, blockade, or embargo. In the event that either party is delayed in the performance of any act or obligation pursuant to or required by the Agreement by reason of a Force Majeure Event, the time for required completion of such act or obligation shall be extended by the number of days equal to the total number of days, if any, that such party is actually delayed by such Force Majeure Event. The party seeking delay in performance shall give notice to the other party specifying the anticipated duration of the delay, and if such delay shall extend beyond the duration specified in such notice, additional notice shall be repeated no less than monthly so long as such delay due to a Force Majeure Event continues. Any party seeking delay in performance due to a Force Majeure Event shall use its best efforts to rectify any condition causing such delay and shall cooperate with the other party to overcome any delay that has resulted. 26. CITY NOT LIABLE FOR DELAYS: Provider hereby understands and agrees that in no event shall the City be liable for, or responsible to Provider or any Subcontractor, or to any other person, firm, or entity for or on account of, any stoppages or delay(s) in work herein provided for, or any damages whatsoever related thereto, because of any injunction or other legal or equitable proceedings or on account of any delays) for any cause over which the City has no control. 27. USE OF NAME: 16 Managed Care/Medical Bill Review/Audit Services City of Miami, Florida Contract No. RFP 605386 Provider understands and agrees that the City is not engaged in research for advertising, sales promotion, or other publicity purposes. Provider is allowed, within the limited scope of normal and customary marketing and promotion of its work, to use the general results of this project and the name of the City. The Provider agrees to protect any confidential information provided by the City and will not release information of a specific nature without prior written consent of the City Manager or the City Commission. 28. NO CONFLICT OF INTEREST: Pursuant to City of Miami Code Section 2-611, as amended ("City Code"), regarding conflicts of interest, Provider hereby certifies to the City that no individual member of Provider, no employee, and no Subcontractor under this Agreement nor any immediate family member of any of the same is also a member of any board, commission, or agency of the City. Provider hereby represents and warrants to the City that throughout the term of this Agreement, Provider, its employees, and its Subcontractor shall abide by this prohibition of the City Code. 29. NO THIRD -PARTY BENEFICIARY: No persons other than the Provider and the City (and their successors and assigns) shall have any rights whatsoever under this Agreement. There are no express or implied beneficiaries to this Agreement. 30. SURVIVAL: All obligations (including but not limited to indemnity and obligations to defend and hold harmless) and rights of any party arising during or attributable to the period prior to expiration or earlier termination of this Agreement shall survive such expiration or earlier termination. 31. TRUTH -IN -NEGOTIATION CERTIFICATION, REPRESENTATION AND WARRANTY: Provider hereby certifies, represents and warrants to the City that on the date of Provider's execution of this Agreement, and so long as this Agreement shall remain in full force and effect, the wage rates and other factual unit costs supporting the compensation to Provider under this Agreement are and will continue to be accurate, complete, and current. Provider understands, agrees and acknowledges that the City shall adjust the amount of the compensation and any additions thereto to exclude any significant sums by which the City determines the contract price of compensation hereunder was increased due to inaccurate, incomplete, or non -current wage rates and other factual unit costs. All such contract adjustments shall be made within one (1) year 17 Managed Care/Medical Bill Review/Audit Services City of Miami, Florida Contract No. RFP 605386 of the end of this Agreement, whether naturally expiring or earlier terminated pursuant to the provisions hereof. 32. COUNTERPARTS: This Agreement may be executed in three or more counterparts, each of which shall constitute an original, but all of which, when taken together, shall constitute one and the same agreement. 33. ENTIRE AGREEMENT: This instrument and its attachments constitute the sole and only agreement of the parties relating to the subject matter hereof and correctly set forth the rights, duties, and obligations of each to the other as of its date. Any prior agreements, promises, negotiations, or representations not expressly set forth in this Agreement are of no force or effect. 18 Managed Care/Medical Bill Review/Audit Services City of Miami, Florida Contract No. RFP 605386 IN WITNESS WHEREOF, the parties hereto have caused this instrument to be executed by their respective officials thereunto duly authorized, this the day and year above written. "City" CITY OF MIAMI, a municipal ATTEST: corporation By: Todd B. Hannon, City Clerk Daniel J. Alfonso, City Manager ATTEST: Print Name: Title: (Corporate Seal) APPROVED AS TO LEGAL FORM APPROVED AS TO INSURANCE "Provider" USIS, INC., a Corporation By: Pr' t Name: Ron Warble Title: Executive Vice President (Authorized Corporate Officer) AND CORRECTNESS: REQUIREMENTS: State of 'Floret County of Seminole On 3f2912017. before me Ron Warble Personally appeared, Ron Warble Lk' Personally known to me OR [.. l Proved t0 me on the basis of salrslaCtery evidence 10 be the persontst whose name(sl 'ware subscnbed to the walla"' instrument and has hereby acknowledged t0 me that he.shclhey have ex*erdrd the same in hlsTherr4hee authorized capacity(es) and that by hssther+therr sr0naturels) on the instrument the person{$) or the entity upon behalf of which the persons) acted executed the instrument Wmtess my hand and olfldal seal e�arnvz ary Signature Leslie Whittemore Victoria Mendez Ann -Marie Sharpe City Attorney Risk Management Director 19 Managed Care/Medical Bill Review/Audit Services City of Miami, Florida Contract No. RFP 605386 CORPORATE RESOLUTION (This Resolution needs to authorize the signatory to sign) WHEREAS, USIS, INC., a Florida corporation, desires to enter into an agreement with the City of Miami for the purpose of performing the work described in the contract to which this resolution is attached; and WHEREAS, the Board of Directors at a duly held corporate meeting has considered the matter in accordance with the bylaws of the corporation; NOW, THEREFORE, BE IT RESOLVED BY THE BOARD OF DIRECTORS that this corporation is authorized to enter into the Agreement with the City, and the President and the Secretary are hereby authorized and directed to execute the Agreement in the name of this Corporation and to execute any other document and perform any acts in connection therewith as may be required to accomplish its purpose. IN WITNESS WHEREOF, this 29th day of March , 2017. USIS, INC. ("Provider") An Florida , (State) Corporation By: ( (sign) Print Name: Ron Warble TITLE: Executive Vice President (sign) Print Name: State of Ronda County of Seminole on 3r29/2017. before me. RV* Warble Personally appeared. Ron Warble LX, Person" known to me OR u Proved to me an the bans of satisfactory evidence to be the person(s) whose earners) &'are subscribed to the within instrument and has hereby acknowledged to me that heishethey have executed the same m hrsiterlhrar autharrred Capacrly(res). and that by hr!uherlheir signature(s) on the instrument Ile person(s) or the entity upon behalf of which the persan(s) acted. executed the instrument Witness my hand and official seal -KIND Notary Signature Leslie Vvhrttemore 20 Managed Care/Medical Bill Review/Audit Services LESLIE A WHITTEMORE Healy Public, State of Florida My Comm. Expires dune 14, 2018 Commission No. FF 1082b1 City of Miami, Florida Contract No. RFP 605386 EXHIBIT A RFP NO. 605386 21 Managed Care/Medical Bill Review/Audit Services !Ithj of 4ffianti ANNIE PEREZ, CPPO DANIEL ., ALFONSO Procurement Director City Manager ADDENDUM NO. 1 DATE: October 13, 2016 TO: ALL PROSPECTIVE PROPOSERS SUBJECT: REQUEST FOR PROPOSALS (RFP) NO.: 605386 TITLE: Third Party Administration and Managed Care Services This Addendum becomes a part of the subject solicitation. A. Attached is a copy of the Pre -Proposal Conference attendance sheet. B. Section 3.3. Part 1, Workers' Compensation and Liability Claims Administration, Sub Section 3.3.1, A., titled Hearings Conferences/Trials, Item 4, Page 45, is hereby deleted in its entirety and replaced with the following due to a scrivener's error. 4. Any recommendations made by the Successfuf-P-ropaser-Office of the City Attorney pertaining to the file should be carried out or referred to Office of -the City Attorney Successful Proposer. C. The following are the inquiries as received and the corresponding responses: Q1. Is this RFP for all Liability Claims or only BI and large loss? Al. All liability claims. Q2. Please provide the number of open liability claims to be transferred to the new Third Party Administrator (TPA), broken out by type of claim. A2, Table of open liability claims to be transferred to the new TPA: Open Claim Count Auto Liability - Bodily Injury 22 Auto Liability - Property Damage 1 Employee Benefit Liability 6 Employment Practices Liability 2 Errors & Omissions 12 General Liability Bodily Injury 207 General Liability Property Damage 4 Police Professional Liability 86 Q3. Please provide the number of open Workers' Compensation claims, broken out by Indemnity, and Medical Only. A3. See table below: WC -- Indemnity WC — Medical Open Claim Count 667 39 Q4. Please provide the number of new claims for each of the past three (3) years, broken out by type of claim. A4. See table below. Please note that the claims count includes report/incident only claims. Claim Count 2013 2014 2015 2016 Auto Liability - Bodily Injury 3 0 0 0 Auto Liability - Property Damage 1 0 0 0 Employee Benefit Liability 0 2 0 0 Employment Practices Liability 1 2 1 3 Errors & Omissions 0 4 2 1 General Liability Bodily Injury 52 53 106 163 General Liability Property Damage 2 2 2 5 Police Professional Liability 22 24 18 5 Workers' Compensation 794 652 828 1 631 Totals for 2013-2016 875 739 957 808 Q5. Please provide a breakdown of the current TPA's staffing levels for the services to be provided: a) Workers' Compensation (WC) Supervisors; b) WC Indemnity Adjusters; c) WC Medical Only Adjusters; d) Liability adjusters; and e) Telephonic Nurse Case Managers. A5. a) 1; b) 4; c) 1; d) 2; and e) 0 Q6. Please provide the number of medical bills for each of the past three (3) years. A6. Following are the number of medical bills by year: 2013: 14,552 2014: 13,648 2015: 15,022 2016 YTD: 12,170 Q7. Please provide a Medical Bill Savings Report for each of the past three (3) years. A7. Following is the Medical Savings Report by year: 2013: $11,291,126.39 2014: $10,516,730.55 2015: $11,203,698.45 2016 YTD: $11,658,641.71 Q8. Please provide the name of the current PPO network provider. A8. Gallagher Bassett Managed Care Services Q9. Does the City currently have all Workers' Compensation claims medically triaged by Telephonic Nurse Case Managers? If not, how many claims were medically triaged for each of the past three (3) years? A9. No. Q10. How many claims on average are assigned to Telephonic Nurse Case Management? A10. Twenty-seven (27) claims are assigned on average per year. Q11. How many claims on average are assigned to Field Nurse Case Management? All. Sixty-seven (67) claims, on average, are assigned per year All other information remains the same. APPROVED: AP:Io Procurement Date c, Ann -Marie Sharpe, Director, Risk Management Rafael Suarez -Rivas, Senior Assistant City Attorney William A. Juliachs, Senior Assistant City Attorney Lydia Osborne, CPPO, Assistant Director of Procurement Yadissa Calderon, CPPB, Senior Procurement Manager, Procurement ATTENDANCE SHEET RFP/RFQ NUMBER: RFP 605386 - Third Party Claims Administration and Managed Care Services LOCATION: 6th FL Large Conference Room PURPOSE: Pre -Proposal Conference iDATE: Wednesday, October 12, 2016 at 2:00 PM Completing this attendance sheet is optional. Ted _IS ()Mos cri rce, YorR Scwcizs 150 Pc---- CzIrntr-,Zr<-2?- e( vzA -R__ ( 5-t) 7 19 ( ) ( ) --fat& 6 ct ass VOr-k •-•),n-N ) Rev. 10/18/99 Page Cri#u of tanxt ANNIE PEREZ, CPPO DANIELJ. ALFONSO Procurement Director City Manager I `r ADDENDUM NO. 2 DATE: October 17, 2016 TO: ALL PROSPECTIVE PROPOSERS SUBJECT: REQUEST FOR PROPOSALS (RFP) NO.: 605386 TITLE: Third Party Administration and Managed Care Services This Addendum becomes a part of the subject solicitation. A. Attachment B, Price Proposal Schedule has been deleted in its entirety and replace with two separate Price Proposal Schedules, to accommodate Part 1, Claims Administration, and Part 11, Managed Care. See attached: a. Attachment B1: Claims Administration Price Proposal Schedule; and b. Attachment B2: Managed Care Price Proposal Schedule. Updated forms have also been attached to the Header Section of this solicitation. All references in the Solicitation to Attachment B, Price Proposal Schedule will now be referred to as Attachment B1: Claims Administration Price Proposal Schedule, or B2, Managed Care Price Proposal Schedule, whichever is applicable. B. The following are the inquiries as received and the corresponding responses: Q1. Is this RFP for all Liability Claims or only BI and large loss? Al. All liability claims. Q2. Can a firm submit a combined proposal? A2. No. Proposers may submit a Proposal for either Part 1: Workers' Compensation Claims and Liability Claims Administration, and/or Part II - Managed Care/Medical Bill Review. Proposers must clearly indicate for which Part(s) Proposer is submitting its Proposal for, and must provide all of the information and documentation, in addition to the Supplemental Proposer Questionnaire (Attachment A), which is attached in the Header Section of this Solicitation. Q3. Should all questions be answered for both Par 1 and Part II? A3. Yes. All relevant questions must be responded to. If a question is not relevant to the category (Part 1 or II) Proposer is responding to, the Proposer should respond with "NIA". Proposers must also include the Supplemental Proposer Questionnaire for both category. Q4. Should pricing be submitted on separate forms? A4. Refer to Item A above, Q5. Will the City consider an extension if requested? A5. All inquiries and questions are considered. Q6. When does the City anticipate taking the recommendation to City Commission? A6, It is anticipated that the agenda item for award recommendation will be presented to City Commission in January/February 2017. Q7. When does the City expect for the implementation of the project to commence? A7. It is anticipated that the agenda item for award recommendation will he presented to City Commission in January/February 2017. The notice to proceed with the project will be issued shortly after that. Q8. Does local preference apply to this solicitation? A8. Local preference does not apply to this solicitation. Q9. Will the City require a dedicated or designated Liability Supervisor? A9. The City requires a Liability Supervisor who will be assigned to the contract. Q10. Does the City have an established caseload requirements? A10. No. The Proposer shall indicate it its proposal their established caseload All other information rempns the same. APPROVED: Ir te---- Ar)ie Perez, CPPO, Director S Procurement Date AP:Io ace --4V c. Ann -Marie Sharpe, Director, Risk Management Rafael Suarez -Rivas, Senior Assistant City Attorney William A. Juliachs, Senior Assistant City Attorney Lydia Osborne, CPPO, Assistant Director of Procurement Yadissa Calderon, CPPB, Senior Procurement Manager, Procurement City of Miami, Florida RFP No,605386 ATTACHMENT B1 CLAIMS ADMINISTRATION PRICE PROPOSAL SCHEDULE INSTRUCTIONS: The Proposer's price shall be submitted on this form "Price Proposal Schedule", and in the manner stated herein. Proposer is requested to fill in the applicable blanks on this form and to make no other marks. If proposing more than one category of services (Part I or Part II) Proposer must complete one separate Price Proposal Schedule for each category of service. This Price Proposal Schedule is for Part 1 Services Only: Workers' Compensation Claims and Liability Claims Administration. 1. INITIAL TERM (Years 1 through 3) A. Proposed Total Fees and Costs for Initial Term (Years 1 through 3): The proposed total fees and costs shall include all fees, including one-time and recurring, and value added options, for Part I Services only. (Total fees and costs should be the aggregate price for the initial three years) B. Breakdown of Total Fees and Costs for Initial Term (Years 1 through 3) The Proposer shall break down its price for providing the Claims Administration Services as specified in Section 3, Specifications/Scope of Work. The proposed fees shall be based on: a) the three year initial term Agreement; b) approximately 695 new indemnity claims per year; c) approximately 144 new medical only claims per year; d) a flat fee broken down on an annual basis for the initial three (3) year term; e) the cost for anticipated staffing levels, based on the Proposers proposal; and f) the implementation costs. 1. Proposed Staffing Positions FTE Annual Salary Total Costs 1 Supervisor $ $ 2 $ $ 3 $ $ 4 $ $ 5 $ $ 6 $ $ 7 $ $ 8 $ $ 9 $ $ 10 $ $ 11 $ $ 12 $ $ Proposed Total Fees and Costs $ Third Party Claims Administration Rev. 9/29/ 16 City of Miami, Florida RFP No.605386 2. Proposed Annual Costs (inclusive of staffing costs) Base Cost ($) Projected Increase (%) Total Costs Year 1 $ $ Year 2 $ $ Year 3 $ $ Proposed Grand Total (Years 1-3) $ 3. Proposed One -Time Implementation Costs Item Description Total Costs 1 $ 2 $ 3 $ 4 $ 5 $ Proposed Total Fees and Costs $ Notes: 1) The City reserves the right to correct and re -calculate any errors found in Proposer's calculation. 2) Total Fees and Costs from Tables 1, 2, and 3 in Section 1B above, should equal the aggregate costs in Section 1A above. 2. OPTION TO RENEW YEARS (Two, One -Year Periods - Years 4 and 5) The Proposer shall state its price below for the cost during the optional renewal years. This Price Proposal Schedule is for Part 1 Services only: Workers' Compensation Claims and Liability Claims Administration. A. Proposed Total Fees and Costs for Option to Renew Years (Years 4 and 5): The proposed total fees and costs shall include all fees, and value added options, for Part I Services only. (Total fees and costs should be the aggregate price for the two renewal years) B. Breakdown of Total Fees and Costs for Option to Renew Years (Years 4 and 5) The Proposer shall break down its price for providing the Claims Administration Services as specified in Section 3, Specifications/Scope of Work, during the option to renew years. The proposed fees shall be based on: a) the two (2) additional years of the Agreement; b) approximately 695 new indemnity claims per year; c) approximately 144 new medical only claims per year; d) a flat fee broken down on an annual basis for the two (2) additional years; e) the cost for anticipated staffing levels. City of Miami, Florida RFP No.605386 4. Proposed Staffing Positions FTE Annual Salary Total Costs 1 Supervisor $ $ 2 $ $ 3 $ $ 4 $ $ 5 $ $ 6 $ $ 7 $ $ 8 $ $ 9 $ $ Proposed Total Fees and Costs $ *Use additional paper if required 5. Proposed Annual Costs (inclusive of staffing costs) Base Cost ($) Projected Increase (%) Total Costs Year 1 $ $ Year 2 $ $ Proposed Grand Total (Years 4 and 5) $ Notes: 1) The City reserves the right to correct and re -calculate any errors found in Proposer's calculation, 2) Total Fees and Costs from Tables 4 and 5 in Section 2B above, should equal the aggregate costs in Section 2A above. 3. Additional Services The Scope of Work outlined herein identifies the work that the selected Proposer shall perform under the Agreement. To address future City requests for any additional services; modifications, or changes outside of the scope of work, please provide not -to -exceed hourly rates for personnel who will be assigned to this contract. 6. Additional Services Proposed Hourly Rates Personnel Not -To -Exceed Hourly Rates $ $ $ $ $ $ *Use additional paper if required 3 City of Miami, Florida RFP No.605386 Notes: 1. The proposed prices above in Sections 1A, shall be fixed and firm for the initial term of the Agreement. The proposed prices for the option to renew years, in Sections 2A, may be negotiated prior to the renewal of the contract for each option to renew period, at the sole discretion of the City. Any extensions to the Agreement beyond the five year period, will be at the then current rates. 2. All out-of-pocket expenses, including employee travel, per diem and miscellaneous costs and fees, should be included in the Proposer's proposed price, as they will not be reimbursed separately by the City. Refer to CH.112.061 of the Florida Statutes regarding adherence to travel expenses. 3. Sections 1 and 2 will be used to determine the price points for the price criteria as indicated in Section 5.1, Evaluation Criteria of this Solicitation. 4. Notwithstanding the proposed hourly rates in Sections 3, Additional Services, above, the City reserves the right to negotiate the not -to -exceed pricing on a year by year basis, at the City's sole discretion, 5. The positions identified in the table above shall be the same as the key positions identified in the Proposer's proposal. The City expects that the personnel in those positions will be performing the services. 4 City of Miami, Florida RFP No,605380 ATTACHMENT B2 MANAGED CARE PRICE PROPOSAL SCHEDULE INSTRUCTIONS: The Proposer's price shall be submitted on this form "Price Proposal Schedule", and in the manner stated herein. Proposer is requested to fill in the applicable blanks on this form and to make no other marks. If proposing more than one category of services (Part I or Part II) Proposer must complete one Price Proposal Schedule for each category of service. This Price Schedule is for Part II Services only: Managed Care/Medical Bill Review/Audit Services. 1. INITIAL TERM (Years 1 through 3) A. Proposed Total Fees and Costs for Initial Term (Years 1 through 3): The proposed total fees and costs shall include all fees, including one-time and recurring, and value added options, for Part II Services only. (Total fees and costs should be the aggregate price for the initial three years) B. Breakdown of Total Fees and Costs for Initial Term (Years 1 through 3) The Proposer shall break down its price for providing the Managed Care/Medical Bill Review/Audit Services as specified in Section 3, Specifications/Scope of Work. The proposed fees shall be based on: a) the three (3) year initial term Agreement; b) flat fee broken down on an annual basis for the three (3) year term; c) the cost for anticipated staffing levels, based on the Proposer's proposal; and d) the implementation costs. 1. Proposed Staffing Positions FTE Annual Salary Total Costs 1 Supervisor $ $ 2 $ $ 3 $ $ 4 $ $ 5 $ $ 6 $ $ 7 $ $ 8 $ $ 9 $ $ 10 $ $ 11 $ $ 12 $ $ Proposed Total Fees and Costs $ Third Polly Ciaims Administration Rev. 9/29/ 16 City of Miami, Florida RFP No.605386 2. Proposed Annual Costs (inclusive of staffing costs) Base Cost ($) Projected Increase (%) Total Costs Year 1 $ $ Year 2 $ $ Year 3 $ $ Proposed Grand Total (Years 1 through 3) $ 3. Proposed One -Time Implementation Costs Item Description Total Costs 1 $ 2 $ 3 $ 4 $ 5 $ Proposed Total Fees and Costs $ Notes: 1) The City reserves the right to correct and re -calculate any errors found in Proposer's calculation. 2) Total Fees and Costs from Tables 1, 2, and 3, In Section 1B above, should equal the aggregate costs in Section 1A above. 2. OPTION TO RENEW YEARS (Two, One -Year Periods - Years 4 and 5) The Proposer shall state its proposed price below for the costs during the optional renewal years. This Price Proposal Schedule is for Part II Services Only: Managed Care/Medical Bill Review Services A. Proposed Total Fees and Costs for Initial Term (Years 1 through 3): The proposed total fees and costs shall include all fees, and value added options, for Part 11 Services Only. (Total fees and costs should be the aggregate price for the two renewal years) B. Breakdown of Total Fees and Costs for initial Term (Years 1 through 3) The Proposer shall break down its price for providing the Managed Care/Medical Bill Review Services as specified in Section 3, Specifications/Scope of Work, during the option to renew years. The proposed fees shall be based on: a) the two (2) additional years of the Agreement; b) flat fee broken down on an annual basis for the two years; and c) the cost for anticipated staffing levels, based on the Proposer's proposal. 2 City of Miami, Florida RFP No.605386 4. Proposed Staffing Positions FTE Annual Salary Total Costs 1 Supervisor $ $ 2 $ $ 3 $ $ 4 $ $ 5 $ $ 6 $ $ 7 $ $ 8 $ $ 9 $ $ Proposed Total Fees and Costs $ *Use additional paper if required 5. Proposed Annual Costs (inclusive of staffing costs) Base Cost ($) Projected Increase (%) Total Costs Year 1 $ $ Year 2 $ $ Proposed Grand Total (Years 4 and 5) $ Notes: 1) The City reserves the right to correct and re -calculate any errors found in Proposer's calculation. 2) Total Fees and Costs from tables 4 and 5, in Section 2B above, should equal the aggregate costs in Section 2A above. 3. ADDITIONAL SERVICES (Initial Term and Option to Renew Years) The Scope of Work outlined herein identifies the work that the selected Proposer shall perform under the Agreement. To address future City requests for any additional work; modifications, or changes outside of the scope of work, please provide not -to -exceed hourly rates for personnel who will be assigned to this contract. 6. Additional Services Personnel Proposed Not -To -Exceed Hourly Rates $ $ $ $ $ $ City of Miami, Florida RFP No.605386 *Use additional paper if required Notes: 1) The proposed prices above in Sections 1A, shall be fixed and firm for the initial term of the Agreement. The proposed prices for the option to renew years, in Sections 2A, may be negotiated prior to the renewal of the contract for each option to renew period, at the sole discretion of the City. Any extensions to the Agreement beyond the five year period, will be at the then current rates. 2) All out-of-pocket expenses, including employee travel, per diem and miscellaneous costs and fees, should be included in the Proposer's proposed price, as they will not be reimbursed separately by the City. Refer to CH.112.061 of the Florida Statutes regarding adherence to travel expenses. 3) Notwithstanding the proposed hourly rates in Sections 3, Additional Services, above, the City reserves the right to negotiate the not -to -exceed pricing on a year by year basis, at the City's sole discretion. 4) The positions identified in the table above shall be the same as the key positions identified in the Proposer's proposal. The City expects that the personnel in those positions will be performing the services. 4. BREAKDOWN OF MANAGED CARE/MEDICAL REVIEW/AUDIT SERVICES The Proposer shall state the not to exceed charges in the columns provided in Tables 7 and 8, for the itemized Managed Care Services listed on the following pages: 4 City of Miami. Florida RFP No.605386 A. MANAGED CARE/BILL REVIEW/AUDIT SERVICES ITEMIZED Proposer shall list the not -to -exceed charge for each Service itemized below in Table 7: 7. Itemized Managed Care/Bill Review/Audit Services Services Charges Fee Schedule (Bill Review / UCR / System Savings) All Other Savings • Clinical Validation/Nurse Review (CV) • Preferred Provider Networks (PPO) • Out Of Network (OON) • S.ecialt Networks/ Ph sical Thera« PT Electronic Receipt of Medical Bills Telephonic Case Management Hospital Certification Program Utilization Review Program Physician Review/Peer Review Task Based Field Case Management • Task 1: One Visit Task • Task 2: Two Visit Task • Task 3: Labor Market Survey • Task 4: Vocational Assessment • Task 5: Home Visit Medical Case Management and Vocational Rehabilitation — Hourly Priority Care 365 Durable Medical Equipment (DME) Program - First Script Medical Cost Projection (MCP) and Clinical Recommendations Pharmacy Benefit Management PBM) — First Script Rx Peer to Peer Review (P2P) Drug Utilization A Rx Drug Utilization Assessment (DUA) Return to Work Coordinator (Injury Coordinator) Durable Medical Equipment (DME) Program - First Script Dental Review Program OSHA Reporting Taxes All applicable taxes will be added to the service fees where required 5 City of Miami, Florida RFP No.605386 B. OTHER SERVICES - ITEMIZED: Proposer shall list the not -to -exceed charge for each Service itemized below in Table 7: 8. Other Services SERVICES CHARGES On-line Access GB International Claims Services Consultative Services Loss Control Consulting Services Appraisal Services Fraud Prevention — Gallagher Bassett Investigative Services (GBIS) Special Fraud Investigations - SIU Surveillance Investigations Targeted Field Investigations Targeted Database Investigations MSA Workers Compensation Medicare Set -Aside Allocation (WCMSA) Rush Fees (MSA completed within 7 days) Revisions: Liability Medicare Set -Aside Allocation (LMSA) MSA Submission to CMS Compliance Services Conditional Payment Research (CPR) Conditional Payment Negotiations (CPN) Secure Final Demand for Settlement (SFD) Bundled CP Resolution Services Benefit Coordination & Recovery Contractor Notification Medicare Eligibility Inquiry (MEI) SSDI Verification Release / Settlement Agreement Review Lien Resolution (Advantage Plan, Medicaid, Part D) Taxes (All applicable taxes will be added to the service fees where required) 6 Eit 4Jllthxrni ANNIE PEREZ, CPPO DANIELJ. ALFONSO Procurement Director City Manager ADDENDUM NO. 3 DATE: October 24, 2016 TO: ALL PROSPECTIVE PROPOSERS SUBJECT: REQUEST FOR PROPOSALS (RFP) NO.: 605386 TITLE: Third Party Administration and Managed Care Services This Addendum becomes a part of the subject solicitation. The following are the inquiries as received and the corresponding responses: Qt. Please provide the employee count for City of Miami's (City) full-time and part-time employees. Al. The City employs 3,985 full-time employees, and 152 part-time employees. Q2. What is the City's philosophy for Telephonic and Field Nurse Case Management? A2. The City must approve each assignment of Telephonic and Field Nurse Case Management. Q3, Will the City provide a performance guarantee? A3. The City reserves the right to request that the Successful Proposer enter into a mutually agreed upon performance guarantee at a future date. The addendum to the Professional Services Agreement would include, but not limited to, key performance indicators, target results, and any penalty or gain share amounts. Q4. What would happen to Pharmacy Management Services? - A4. The City wishes to retain those claims currently assigned to Cypress Care. Q5. In reviewing the RFP, there is a reference to Auto losses. Should the proposing TPA be including Auto in the pricing options for Liability, or will the City look to the TPA for GL and WC claims handling? A5. The City will require the Successful Proposer to handle General Liability and Workers' Compensation claims, as well as the existing Auto Claims being handled by current Third Party Administrator (TPA). Q6. Please provide number of medical bills for each of the past five (5) years. A6. The breakdown of medical bills for the past five (5) fiscal years (10/1 through 9/30) are as follows: 2011 to 2012: 16,464 2012 to 2013: 16,198 2013 to 2014: 13,946 2014 to 2015: 14,712 2015 to YTD: 15,726 Q7. Please provide Medical Bill Savings Report for each of the past three (3) years A7. The Medical Bills Savings Report has been attached to the Header Section of the RFP in Oracle. Q8. In attachment A, page 10, Pricing, Part 1, #1, it indicates that "Ali pricing should be on a life of claim basis..." a) Is the City seeking pricing on a life of contract or life of claim basis? b) Will the City accept life of contract pricing proposals? A8. The City is seeking life of contract pricing Q9. Who are the City's excess insurance carriers? A9. The City's past and current excess insurance carriers are: • State National: 1 0/1/04 — 10/1/07 • Star Insurance Company: 10/1/07 - 10/1/09 • No carrier for WC: 10/26/09 — 10/26/10 • Midland: 10/26/10 to present Q10. Provide a breakdown of all the open claims for takeover- by line of coverage and claim type. A10. See chart below: Open Claim Count Auto Liability - Bodily Injury 22 Auto Liability - Property Damage 1 Employee Benefit Liability 6 Employment Practices Liability 2 Errors & Omissions 12 General Liability Bodily Injury 207 General Liability Property_Damage_ 4 Police Professional Liability 86 WC 706 Q11. For the open workers' compensation claims, identify how many are lost time/indemnity and how many are medical only (MO) claims? Alt See chart below: WC — Indemnity WC — Medical Open Claim Count 667 39 Q12. Will the new TPA take over the handling of all open auto liability claims? If so, how many, or will those continued to be handled in house? Al2. Please refer to the response to Question 11. Claims identified therein will be taken over by Successful Proposer. Q13. Does the City require or prefer a fully dedicated (only working on the City's claims) unit for all claims; Workers' Compensation and Liability? Or is the City only requiring that the position of Workers' Compensation Supervisor be dedicated, as stated in Section 3.3.1, number 5? A13. Yes, the City requires a fully dedicated (only working on the City's claims) unit for all claims. Q14. How many claims annually require the services of a Field Adjuster? A14. This number should be determined by the Proposer as Field Adjusters are encouraged to go in the field as they see fit, to conduct credible claim investigation. Q15. Are there any service concerns or issues with the current TPA? Is the City satisfied with the current level of services received, or are there areas of improvement the City is hoping to obtain? A15. There are no concerns at this time, however, continuous improvement is the City's goal. Q16. The solicitation is requesting separate price proposals for claims and managed care services, and indicated the price proposals will be evaluated and possibly awarded independent of each other. If a company is proposing both services, can it all be submitted in one proposal with sections specifically for claims and managed care services (and with separate pricing indicated), or is the City requiring two separate and distinct proposal document submissions? Please clarify. A16. No. Proposers must submit separate Proposals if proposing on both Part 1: Workers' Compensation Claims and Liability Claims Administration, and Part II - Managed Care/Medical BiII Review. Proposers must clearly indicate for which Part(s) Proposer is submitting its Proposal for, and must provide all of the information and documentation, in addition to the Supplemental Proposer Questionnaire (Attachment A), which is attached in the Header Section of this Solicitation for each part. Q17. For Medical Claims Review Services, does the City require that only a flat annual all-inclusive fee (aggregate total for three [31 years) be proposed? A17. Completion of the pricing sheet for Medical Claims Review in its entirety is required. Q18:—'For Managed Care Services, does the City require a flat all-inclusive annual fee or are alternative pricing proposals acceptable (such as medical bill review per bill fees, PPO savings fees, case management fees)? A18. Alternative pricing is acceptable, however, the pricing sheet requested for Managed Care Services must also be completed in its entirety and submitted. Q19. On Attachment B, Price Proposal Schedule, Part 1. A (Claims), if a total three (3) year fee amount is submitted, is it necessary to also complete Section C — Breakdown of total fees? A19. Yes. Q20. The pricing page indicates that pricing should be submitted for the "life of the claim." From the RFP, it appears that the new TPA will assume handling of the existing claims and I see that the number of open claims was included in Addenda #1. a) Is the City requesting pricing for "life of claim for the life of the contract?" b) VVil! the City move the "tail" claims to a new TPA at the end of this contract as well? A20. a) The City is requesting Price for life of the contract. b) Yes, the City will move the "tail" claims to the new TPA. Q21. What PPO network is currently used by the City's current TPA? A21. Gallagher Bassett Managed Care Services (Please refer to Addendum No.1, Q8). Q22. Section 2,8, Minimum Qualification Requirements, Sub -Section A, Item 5 requires TPA to have five continuous years of Florida municipal claims handling experience and with 1 employer of at least 1,500 employees. Our organization has 20 plus years of continuous Florida claim handling; and has been handling public entity claims outside of the State of Florida in numerous states across the US since 1987 for employers with over 100,000 employees including large city, county and state public entities. This requirement may eliminate viable candidates for the City which may be a disadvantage to the City. Will the City please reconsider this requirement or modify it so that potential TPA's with extensive public entity experience regardless of the jurisdictional experience will be sufficient? A22. It is in the City's best interest to award to a Proposer who is experienced in handling Florida exposures, therefore the referenced minimum requirement of five (5) continuous years of experience, handling Florida municipal claims with at least one (1) client having a minimum of 1500 employees, will remain at this time. All other information remains the same. APPROVED AP:lo Ati`nie Perez, CPPO, Director of P, /a/fri /b/ curement Date c. Ann -Marie Sharpe, Director, Risk Management Rafael Suarez -Rivas, Senior Assistant City Attorney William A. Juliachs, Senior Assistant City Attorney Lydia Osborne, CPPO, Assistant Director of Procurement Yadissa Calderon, CPPB, Senior Procurement Manager, Procurement QIit fAin -t ANNIE PEREZ, CPPO DANIELJ. ALFONSO Procurement Director City Manager ADDENDUM NO, 4 DATE: October 26, 2016 TO: ALL PROSPECTIVE PROPOSERS SUBJECT: REQUEST FOR PROPOSALS (RFP) NO.: 605386 TITLE: Third Party Administration and Managed Care Services This Addendum becomes a part of the subject solicitation. A. The deadline for receipt of proposals for RFP605386 has been extended to Wednesday, November 30, 2016, at 2:00 PM (local time), to allow additional time for Proposers to respond. B. The following language has been added to the Certification Statement, which has been revised and attached to the Header Section of the Solicitation: Please list and acknowledge all addendum/addenda received. List the addendum/addenda number and date of receipt (i.e., Addendum No. 1, 7/1/15). If no addenda/addendum was/were issued, please insert "NIA'". Has Proposer reviewed the attached Sample Professional Services Agreement (PSA)? Does the Proposer acknowledge that the attached PSA is an example of the standard Agreement used in conlunction with the services related to this Solicitation and shall not be amended? C. Section 4, Submission Requirements, Subsection 4.1 has been amended to revise the following information: ALL RESPONSES SHALL BE SUBMITTED IN HARD COPY FORMAT ONLY TO INCLUDE ONE (1) ORIGINAL, SIX (6) COPIES, AND AN ELECTRONIC COPY (USB OR CD). NO ON-LINE SUBMITTALS WELL BE ACCEPTED. D. The following are the inquiries as received and the corresponding responses: Q1. Provide the RFP Attachments A and B in Word Format? Al. Attachment A, Proposer Supplemental Questionnaire has been attached to the Header Section of the Solicitation in Word Format. Attachment B, Price Proposal Schedule, has been revised (refer to Addendum No. 2, A) and have been attached to the Header Section of the Solicitation in Word Format, as B1, Claims Administration Price Proposal Schedule, and B2, Managed Care Price Proposal Schedule. Q2. How many claims per year for the past five (5) years had a Telephonic or Field Nurse/Case Manager assigned to them? A2. Please refer to Addendum No. 1, response to question No. 10. Q3. Who is the current broker? A3. The current Third Party Administrator (TPA) is Gallagher Bassett Managed Care Services. Q4. Page 7 of 65, 1.4: Does the City want all addenda submitted with the proposal or just an acknowledgement of addenda, if any, satisfactory? A4. The Proposer shall acknowledge all addenda by indicating same on the Certification Statement that is attached to the Header Section of the Solicitation. See Rem A above. Q5. Page 9 of 65, 1.11, Bid Bond/Bid Security: Please confirm that a Bid Bond is not required for proposal submission, and that there are no special conditions requiring this for the proposal. A5. Bid Bond/Bid Security does not apply to this Solicitation. Q6. Who are the City's excess carriers? A6. Refer to Addendum No. 3, response to Question 9. Q7. Section 4, Submission Requirements, sub -section 4.1, Page 57 of 65, requires One Original and Six Hard Copies. Page 27 of 65 1.78: Requires submission electronically via the Oracle System. Page 57 of 65 4.1 indicates "NO ON-LINE SUBMITTALS WILL BE ACCEPTED". Please clarify. A7. See item C above. The instructions in Section 4, Submission Requirements applies to this Solicitation. The clause pertaining to electronic submission in the Oracle System does not apply. Q8. Please describe the performance guarantee currently used for Managed Care/Medical Bill Review (Part II services). A8. See response in Addendum No. 3, Question 3. All other information remains h- sa e. APPROVED: AP:lo / // Arje Perez, CPPO, Director of Prse'¢'urement Date c. Ann -Marie Sharpe, Director, Risk Management Rafael Suarez -Rivas, Senior Assistant City Attorney William A. Juliachs, Senior Assistant City Attorney Lydia Osborne, CPPO, Assistant Director of Procurement Yadissa Calderon, CPPB, Senior Procurement Manager, Procurement f Ainuti ANNIE PEREZ, CPPO DANIELJ. ALFONSO Procurement Director City Manager is . +c•.t �' } fw 'c IRi4I •. ,6161 1.�14 rrf..ttiir,. • ADDENDUM NO. 5 DATE: October 28, 2016 TO: ALL PROSPECTIVE PROPOSERS SUBJECT: REQUEST FOR PROPOSALS (RFP) NO.: 605386 TITLE: Third Party Administration and Managed Care Services This Addendum becomes a part of the subject solicitation. A. Section 3.3.2, Liability Claims Administration, Item No. 3a, has been deleted in its entirety and corrected with the following language: a) Contact the claimant or the claimant's attorney within 24 hours of the time the accident report is received by the Successful Proposer. In the case of unrepresented claimants, personal contact is required the same day the claim is received. All claim files must contain adjuster's logs documenting all contact and activity. B. The following are the inquiries as received and the corresponding responses: Q1. Please clarify what the City is requiring in Section 2.8, B, #11 regarding Official Disability Guide ("ODG") guidelines being integrated into the rule engine? Al. The City requires the Proposer to incorporate ODG guidelines into the Proposer's decision tree/rule engine, for medical status and progression for Telephonic Case Managers and Field Case Managers, Q2. The RFP references submission of SSAE 16 SOC 1 and 2, report with the proposal. This is not a current standard requirement in the industry. As a TPA approved by all major carriers in the US, there are not any carriers or regulatory agencies requiring more than SSAE 16 (SOC 1) Type II compliance. In fact, in our SOC 1 audit, in addition to testing of information systems against best practices, controls in place to provide security, confidentiality of stored information, processing integrity of transactions, system availability and privacy testing (required in SOC 2), our SOC 1 requires testing of many other internal controls with respect to human resources, accounting, claims management, and other critical internal controls. Given that this SOC 2 may be limited,. not standard requirement in the industry, and could cost hundreds of thousands of dollars to change processes and audit requirements for qualified "Big Four" firms (vs, Industry Cottage firms) to update complex audit programs, would the City would accept SSAE 16 (SOC 1) Type II report? A2. Yes, the City would accept a SSAE 16 (SOC 1) Type II report. Q3. Will the City allow a reasonable and minimum time of twelve (12) business days after the release of answers to questions for submission? A3. Refer to Addendum No. 4. The deadline for submission of proposals has been extended until November 30, 2016, at 2:00 PM. Q4. Who are the current providers for the following managed care programs? a. Bill Review b. PPO Networks (which Networks) c. Medical Case Management A4. The current providers for the referenced managed care programs are as follows: a. Bill Review: Gallagher Bassett Services, Inc. ("Gallagher") b. PPO Networks: Gallagher — Aetna & First Health c. Medical Case Management: Gallagher Q5. Provide the following annual summary information: a. # of Bills b. Amount of Billed Charges c. Amount of Fee Schedule Reductions d. Amount of PPO Reductions e. Fees for Fee Schedule Reduction f. Fees for PPO Network Access g. Fee for Specialty Bill Review A5. The annual summary is as follows: a. # of Bills: 15,726 b. Amount of Billed Charges: $18,815,104 c. Amount of Fee Schedule Reductions: $11,118,442 d. Amount of PPO Reductions: $791,361 e. Fees for Fee Schedule Reduction: $8.50 Per Bill f. Fees for PPO Network Access: 25% of Savings g. Fee for Specialty Bill Review: 25% of Savings Q6. Approximately how many audit -in network and out -network hospital/provider bills, are processed annually? A6. Approximately 150 audit in -network and out -network hospital/provider bills are processed annually. Q7. The City currently uses Cypress Care PBM for claims that are administered in-house, a) How many claims and what types of claims are administered in-house? b) Would the City consider the use of a different PBM for all claims administered by the TPA if it benefits the City (and in accordance to physician dispensed drug policy)? A7. The City desires to retain Cypress Care for the WC claims administered in-house from 2001 and prior. Q8. Will the City pay for specialized Loss Control services that may require the referral to a company specializing in certain loss control services? A8. Yes. The City is expecting a set number of hours to be provided within the Proposer's proposal. Any services needed in excess of the hours provided may have a predetermined rate. Q9. Are single or bi-directional interfaces required? Please explain? What is the RMIS used by the City for this interface(s)? A9. The City currently does not have a RMIS internally. The City is in the process of procuring a system. Upon acquisition of a RMIS, the City ideally would like the Successful Proposer to have bi-directional interface. Q10. Does the City desire access to the TPA claim system? If yes, for approximately how many Users? A10. Yes, the City requires access to the Successful Proposer's TPA claim system for approximately ten (10) Users. Q11. Does the City require a full time Medical Case Manager(s)? If yes, how many? Are medical case management services provided on an hourly or per case rate? Approximately how many cases are referred? a. To telephonic medical case management per year? b. For field case medical case management per year? c. For utilization review per year? All. The City does not require full time Medical Case Managers. Medical case management is bought on an hourly rate, and cases are referred to Medical Case Managers by the City, as needed. Refer to responses to questions 10 and 11 in Addendum No. 1 for the number of cases. Q12. Section 3.3.1, Workers' Compensation Claims Administration, Page 42 of 65, Item 12: a, It appears a full claim status report has to be provided to the City every ninety days on any claim in which an employee is not working full duty. Approximately how many claims at any given time are on restricted duty? b. Approximately how many claim files require a full summary report (for the types of claims noted in Section 12 a), b), c), and d) every 90 days? Al2. a. The City currently is paying Temporary Total Disability ("TTD"), on 55 files; b. There are currently 1,031 files that meet the criteria. The report required is a claims summary format, which should be updated every 90 days for supervisory review. Q13. Please provide the approximate number of all open claims by claim type for all claim years including: a. G L b. Auto1BI/PD c. APA d. POL & ELL e. LEL f. Indemnity. Of the open indemnity approximately how many are Future medical, PD or Grover type claims that require limited / awarded payments per year? g. Medical A13. The approximate number of all open claims, by claim type, for all claim years, are as follows: a. G L: 204 b. AutofBl/PD:143 c. APA: 140 d. POL & ELL: 86 e. LEL: 12 f. Indemnity. 1084. A report with a breakdown of the type of claims is not available at this time. g. Medical:37 Q14. Is a minimum of three (3) attempts to contact appropriate parties required on simple medical claims? Please clarify. A14, Yes, ideally the City requires three (3) attempts to contact parties, so that the City can gain as much information on the front &de of the claim, in the event the claim changes direction unexpectedly. Q15. Attachment B, Cost Proposal: Section B, Managed Care/Medical Bill Review/Audit Services. Please provide: a. Clarification and volume of "Managed Care Services" (assuming this if for medical case management services). b. Number of bills processed for Fee Schedule annually. c. Number of bills processed as "Audit Services". d. Confirmation PPO Network Access fees are an allocated loss adjustment expense (ALAE). A15. Refer to response to question No. 5 above for the information requested for a, b, and c. d. Yes, the PPO access fees are included within the ALAE. Q16. Provide complete loss runs/reports for claims dada by line of coverage for each of the past five (5) years. A16. The Loss Runs Report for claims data has been attached to the Header Section of the Solicitation in Oracle. Q17. Does the current TPA utilize a subcontractor to meet any participation goals with a MBEIWBE or other business enterprise? If yes, who is the subcontractor(s) and for what services? If yes, for what percentage? A17. The current TPA does have subcontractors for parts of the services they provide, however, MBE/WBE's was not a criteria. Q18. Compliance with Federal, State and Local Laws, Item L: Please confirm bidders do not have to provide Prompt Payment discounts. A18. This clause is a part of the City's general terms and conditions. For more information on Prompt Payments refer to Florida Statutes, Sections 218.79 to 218.79. Q19. What is Gallagher's current staffing model for the City of Miami claims by Position and # of FTE(s)? A19 One (1) WC Supervisor; Four (4) WC Indemnity; One (1) WC Medical Only; and Two (2) Liability Adjusters. Q20. Please provide your incoming claim counts by coverage type for the last five (5) years for the following coverage types: a. WC -Indemnity b. WC -Medical only c. Auto BI d. Auto PD e. General Liability BI f. General Liability PD g. Public Officials h. E&O i, EPLI j, Law Enforcement Liability A20. Coverage Type Incoming Claims Count 2012 2013 2014 2015 2016 a WC -Indemnity 460 553 416 613 532 b WC -Medical only 279 247 236 215 121 c Auto 131 97 92 65 49 58 d Auto PD 397 430 398 328 275 e General Liability BI 208 202 221 235 168 f General Liability PD 231 212 198 163 149 g Public Officials 0 0 0 0 0 h E&O 0 0 5 2 1 I EPLI 0 1 2 1 0 j_ Law Enforcement Liability 44 30 33 21 5 Q21. Please provide your current open claim counts by coverage type. a. WC -indemnity b. WC -Medical only c. Auto 131 d. Auto PD e. General Liability BI f. General Liability PD g. Public Officials h. E&O i. EPLI j. Law Enforcement Liability A21. Refer to Addendum No. 1, responses to questions 2 and 3. Q22. Provide a break-out for the total number of legal claims for each of the coverages in question No. 21 above (provide those counts). A22. The City's current TPA is only tracking legal status within the Workers' Compensation Line of Coverage in a report format. The numbers are below: Coverage Type Current Claims Count 2012 2013 2014 2015 2016 a WC -Indemnity 110 114 108 143 67 Q23. Please provide the following for each of the last three (3) years: a. Total number of medical bills by type (DWC-9, DWC-10, DWC-11 and DWC-90) b. total billed (by bill type if that is available) c. total fee schedule paid d, total amount of PPO discounts e. all other UR savings f. total amount paid to providers (by bill type if that is available g. all fees paid for Bill Review services A23. Please see response to Question No. 5. Q24. Regarding -Attachment -A —Section 2,jtem 3b;-Please-define "tape -feed." We are -able to accept file transfer via secure FTP in formats such as .xis and .txt. is this acceptable to the City? A24. Yes, this is acceptable. Q25. Does the City require any subcontractors to mirror the coverage requirements that the TPA must follow? A25. Yes, the City requires that subcontractors shall have equal or higher coverage requirements. Q26. Please provide your current TPA's staffing model, including the number of adjusters dedicated to the City's account. A26. Refer to response for question No. 5. Addendum No 1. Q27. The RFP mentions "scene investigations, and personal claimant contact on all lost time or light duty cases". Will our WC adjusters be housed on site at the City, or do we send our WC TPA adjusters out into the field, or do you want our field adjusters to make these visits? A27. It has not been determined if the Successful Proposer's adjuster will be situated on -site or not, but scene investigations will be needed on as requested basis by the City. The City does not anticipate this to be a high volume. The City will require that a thorough investigation be completed to interview all parties and witnesses at the scene, to get all the information available about the alleged accident. Q28. Section 3.3.2., Item No. 2 of the RFP mentions outside field adjusters for liability claims. Is this fee an allocated expense charged to the claim file, or is it to be included in the annual fee? A28. This should be included within the annual fee. Q29. Section 3.3.2., Item No. 3 of the RFP indicates all under -represented claimants are to be seen in person. How many field assignments have been made by year for the last three years? A29. For clarification purposes, refer to corrected language in A above. Personal contact shall be made by phone on all unrepresented claimants and in person contact will be only needed as requested. Q30. Section 3,5, Item No. 9 of, the RFP indicates the proposer will "maintain these maximum pending caseload levels". What are the City's expected maximum pending caseloads? A30. The Proposer shall state their caseload recommendations. Q31. Section 3.5, Item No. 10 of the RFP, indicates proposers should submit resumes. Will the City accept base -line qualifications of each position in lieu of a resume since we will have to hire adjusters to handle a program of this size? Is the City interested in a new TPA attempting to retain some or all of the current team of supervisors and adjusters? A31. Yes, base -line qualifications are acceptable with the Proposer's proposal. Upon hiring of the selected individuals however, the City will require a copy of the adjuster's resume. The City also has the right to select or reject the team proposed. The current adjusting team are employees of the current TPA. Q32. Is there a requirement to have an office in Miami or Dade County? Would -the City be interested in housing the adjusters on site at the City of Miami? A32. No, it is not required to have an office in the City of Miami or Miami -Dade County. The City has not decided if an on -site adjuster model would be needed at this time. The City has a right to discuss this at time of negotiation. Q33. Which MWBE-certified vendors are currently providing services for the City? Does the City wish to continue receiving services from these vendor partners? A33. Although, the current TPA does have subcontractors for parts of their services, it was not a criteria for inclusion of MBE/WBE, certified vendors. Q34. Will the City consider extending the deadline for proposals? A34. Yes. Please refer to Addendum No. 4. Q35. What is the current caseload by claim type for each adjuster? A35. Refer to Addendum No 2, response to question No 10. Q36. Regarding Attachment A, section 7 on page 7: Google Chrome -compatible or Firefox-compatible claims management system platform providing real-time interactive communication and claims management between nurses, adjusters, the City, and its business units. Our claims system is currently supported on IE 10 and 11. Does the city specifically require support for Chrome and/or Firefox? A36. Internet Explorer 10 and 11 are acceptable. Al! other information remains the same. APPROVED AP:Io r /4/1c:2 5:04 Ane Perez, CPPO, Director of Procurement Dater c. Ann -Marie Sharpe, Director, Risk Management Rafael Suarez -Rivas, Senior Assistant City Attorney William A. Juliachs, Senior Assistant City Attorney Lydia Osborne, CPPO, Assistant Director of Procurement Yadissa Calderon, CPPB, Senior Procurement Manager, Procurement ANNIE PEREZ, CPPO Procurement Director (Eitu of 41*tiami ADDENDUM NO. 6 DANIEL J. ALFONSO City Manager DATE: November 2, 2016 TO: ALL PROSPECTIVE PROPOSERS SUBJECT: REQUEST FOR PROPOSALS (RFP) NO.: 605386 TITLE: Third Party Administration and Managed Care Services This Addendum becomes a part of the subject solicitation. The following are the inquiries as received and the corresponding responses: Q1. Please provide your current contract for Bill Review and Case Management Services. Al. The City's contract for Bill Review and Case Management Services is a bundle package with Gallagher Bassett Services, Inc. (Gallagher). The Contract is attached to the Header Section of the Solicitation, including the attached pricing schedule submitted by Gallagher. All other information rer®®ryains ;the same. APPROVED:,. 7'G� d ; AP:lo Archie Perez, CPPO, Director of Procurement /1//2.- Date c. Ann -Marie Sharpe, Director, Risk Management Rafael Suarez -Rivas, Senior Assistant City Attorney William A. Juliachs, Senior Assistant City Attorney Lydia Osborne, CPPO, Assistant Director of Procurement Yadissa Calderon, CPPB, Senior Procurement Manager, Procurement G. go beyond amass City of Miami 000757 2/15/2016 - 2/15/2017 PRICING OPTION: BUDGETED STAFFING (Based on utilizing GBMCS) go beyond Life of Partnership:Antluai Cost Pitts • Service Estimated Year 3 - .:., Workers Compensation Medical Only Al] Fees included in salries below Indemnity All Fees included in salries below Ind -Ter II -Florida, New York, Ohio and Texas All Fees included in sairies below Ali Fees included in sairies below Liability General Bodily Injury Ail Fees included in salries below General Property Damage All Fees included in salries below Auto Bodily Injury All Fees included in salries below Auto Property Damage All Fees included in salries below Auto Physical Damage All Fees included in salries below Professional Liability All Fees included in salries below Actual Salaries at Commencem Actual Salaries at Actual Salaries at ent of 2nd Commenceme Commencement Actual Salaries at Year of City nt of 3rd Year of 4th Year of Commencement of 5th Actual Salaries at Commencement of 1st Option - of City Option - City Option - Year of City Option - Total Salary Expense Year of City Option - $682.515 $641,114 $607,587 $716,274 $745,298 Total Estimated Service Fee (2,30 multiplier) $1,603,910 $1,474,562 $1,397,451 $1,454,049 $1,512,211 Annual Fee for Licensing of SysFacs (up to six users) $0 $17,50U $17,500 $17,500 517,500 Grand Total $1,603,910 $1,492,062 51,414,951 S1,471,549 $1.529,711 Quoted as fifth year of five additional year -long options for the City of Miami to renew at their sole option. Total dollar increase from year to year not to exceed 4% over expiring year True Salaries to be Calculated at Beginning at Service Period Client and GB to Agree on Staffing Prior to Beginning of Service Period GB will perform normal salary administration pursuant to GB Procedures Budgeted Staffing Cost &Terms (Revision date: 6/8/2015) Page 1 go beyonc G'4LLAGHfL $ASSES City of Miami 000757 2/15/2016 - 2/15/2017 GB MANAGED CARE SERVICES SERVICES Fee Schedule (Bill Review / UCR / System Saving CHARGES $ 8.50 Per Bill All Other Savings • Clinical Validation/Nurse Review (CV) • Preferred Provider Networks (PPO) • Out Of Network (OON) • Specialty Networks/ Physical Therapy (PT) 25 % of Savings 25 % of Savings 25 % of Savings 25 % of Savings Electronic Receipt of Medical Bills $2 additional per bill in all applicable states Telephonic Case Management $75 Medical Triage $290 per Indemnity claim (each 30 days) $130 per Medical Only claim (one time) Hospital Certification Program $120 Inpatient Pre -Certification Utilization Review Program $105 Outpatient Pre -Certification Physician Review/Peer Review $270 per Review Task Based Field Case Management • Task 1: One Visit Task • Task 2: Two Visit Task • Task 3: Labor Market Survey • Task 4: Vocational Assessment • Task 5: Home Visit $530 per assignment $705 per assignment $635 per assignment $590 per assignment $660 ($730 in CA) per assignment Medical Case Management and Vocational Rehabilitation - Hourly $92 per hour plus expenses $103 per hour- AK, CA, HI, NY Priority Care 365 $90 per call Texas HCN Service Options Not Applicable Budgeted Staffing Cost & Terms (Revision date: 6/8/2015) Page 2 G,. LL4Gt3� $ABBE' go begone City of Miami 000757 2/15/2016 - 2/15/2017 GB MANAGED CARE SERVICES , ..• ,,.. , Other State Service Options: • California MPN Service Options • Illinois PPP Service Option • New York PPO Service Option • West Virginia MHCP Service Option SERVICES CHARGES Not applicable Medical Cost Projection (MCP) and Clinical Recommendations $125 per hour Pharmacy Benefit Management (PBM) — First Script Cost of prescriptions — no charge for Bill Review or PPO reductions for PBM transactions Rx Peer to Peer Review (P2P) Drug Utilization A RX Peer to Peer Review Options: • No DUA Performed - $290 per review • DUA Performed in prior 60 days-$865 per review Rx Drug Utilization Assessment (DUA) Drug Utilization Assessment - $575. Return to Work Coordinator (Injury Coordinator) Coordinator - $8,750 per month Durable Medical Equipment (DME) Program- First Script Cost of medical equipment — no charge for Bill Review or PPO reductions for Prospective DME transactions Dental Review Program Charged on a per review basis OSHA Reporting $4,500 per year Includes set-up. OSHA access & unlimited OSHA logs and summaries Taxes All applicable taxes will be added to the service fees where required Client and GB agree as follows: If another preferred managed care vendor other than Gallagher Bassett Managed Care Services is utilized, an administrative fee may apply in exchange for bona fide administrative services, The administrative services may include, but not be limited to overhead costs for the oversight and management of Managed Care vendors which includes the development and oversight of quality standards, development and maintenance of EDI interfaces and reports, and ensuring proper mandatory state compliance and reporting. Budgeted Staffing Cost & Terms (Revision date: 6/8/2015) Page 3 go beyond -ASsE% City of Miami 000757 2/15/2016 - 2/15/2017 OTHER SERVICES SERVICES risxfacs.com - Additional Users CHARGES $1,000 per user GB International Claims Services Varies by Country (pricing provided upon request) Consultative Services Loss Control Consulting Services $140 per hour Appraisal Services TBD Fraud Prevention — Gallagher Bassett Investigative Services (GBIS) Special Fraud Investigations - SIU $85 per hour plus expenses Surveillance Investigations $70 per hour plus expenses Targeted Field Investigations $80 per hour plus expenses Targeted Database Investigations Rate per report Gallagher Bassett Litigation Management Program (GBLMP) Invoice and Matter Management platform for Resolution Manager/counsel 2% of net legal invoice (invoice net of disbursements and invoice review savings). Charged as discount off total payment remitted to counsel unless client elects to fund. 5 client licenses for Legal Analytics platform Attorney -led invoice compliance review Medlnsights MSA (This pricing is for Medlnsights services only. If another vendor is selected, then other pricing applies) Workers Compensation Medicare Set -Aside Allocation (WCMSA) $2,300 per allocation Rush Fees (MSA completed within 7 days) $450 per case Revisions: $150 per hour (One free revision within six months of submission) Liability Medicare Set -Aside Allocation (LMSA) $2,300 Fee MSA Submission to CMS $850 Fee Gallagher Bassett Compliance Services (GBCS) (The following pricing is for GBCS services only. If another vendor is selected, then other pricing applies) Conditional Payment Research (CPR) $200 Flat Rate Conditional Payment Negotiations (CPN) $375 Flat Rate Secure Final Demand for Settlement (SFD) $250 Flat Rate Bundled CP Resolution Services $700 Fiat Rate Budgeted Staffing Cost & Terms (Revision date: 6/8/2015) Page 4 go beyond GA L LAGNs¢ PASSE' City of Miami 000757 2/15/2016 - 2/15/2017 Benefit Coordination & Recovery Contractor Notification $45 Flat Rate Medicare Eligibility Inquiry (MEI) No Charge SSDI Verification $175 Flat Rate Release / Settlement Agreement Review $250 Flat Rate Lien Resolution (Advantage Plan, Medicaid, Part D) $500 Flat Rate per Lien Resolution Taxes All applicable taxes will be added to the service fees where required o beyond Budgeted Staffing Cost & Terms (Revision date: 6/8/2015) Page 5 ._„, go beyond %� Ass 1. Audit Terms: Actual: • Actual — No true -ups will occur City of Miami 000757 2/15/2016 - 2/15/2017 PROGRAM SPECIFIC TERMS AND CONDITIONS 2. Billing and Payment Terms: Fees will be billed Monthly during the calendar year. Fees are payable within 30 days upon receipt of the invoice. Gallagher Bassett reserves the right to charge 1 % per month, or the maximum legal rate, on balances unpaid after 30 days. 3. Budgeted Staffing Claim Pricing Terms: Claims will be handled for the life of the partnership with no additional per claim fees. If you should decide to non -renew or stop using GB in a specific state, the existing open files can be handled in one of three ways: ► Gallagher Bassett would continue to handle the open files at our prevailing rates fee per year per open file. ► Gallagher Bassett would continue to handle the open files on a Time and Expense basis. • Gallagher Bassett would return the files to the client (contingent upon Carrier approval) at the client's expense *Please see Claim Charges outlined in footnote 7 under Program Specific Terms and Conditions. Note: There will be additional charges for ongoing Data Management (RISX-FACS`i), risxfacs.com users, Administration, Banking fees and monthly reports for as long as GB handles claims. 4) Account Administration includes the following: a. Designated Account Manager b_ Detailed Status Reports © $50,000 G. Settlement Authority @ $10,000 (WC)/$3,000 (Liability) d. Banking Administration (SIMMS) e. Two Claim Reviews a Year or One Performance Audit f. Acknowledgement Letter to claimant 4. Data Management includes the following: New Claim Setup Historical Claims Monthly Report by Email or the Website Y Carrier Report Package by Email or Website 5. Pricing is based on using GB Managed Care (GBMCS) or Medlnsights for Bill Review, PPO, out -of -network, utilization review, telephonic case management, MSA and field case management. Budgeted Staffing Cost & Terms (Revision date: 6/8/2015) Page 6 ,itgo beyonc 't 4ssGfi City of Miami 000757 2/15/2016 2/15/2017 G,„ 9d beyond eASSET' 6. Claim Charges: The Claim charge is applicable per claim per line of coverage. Example: A client employee during working hours is involved in an automobile accident with another vehicle with two occupants. Both occupants were injured, both cars were damaged and our client employee was injured. The claims handling charges (example only) will be: Claimant #1 - Auto Liability Bodily Injury $0 Claimant #2 - Auto Liability Bodily injury $0 Claimant Owner - Auto Liability Property Damage $0 Client — Workers' Compensation $0 Client — Auto Physical Damage $0 so Administration included in the cost-plus fee. 7. The pricing of specific service offerings is the proprietary, confidential property of Gallagher Bassett Services, Inc. It has been provided to you for the sole purpose of considering a quote for claims administration services. It is not to be duplicated or shared in any form with anyone other than the individuals of such prospective client that have a business need to know the information. It must be destroyed or returned to Gallagher Bassett Services, Inc. after its intended use. 8. Gallagher Bassett Services, Inc. will not pay a fee, commission, or rebate to any party for the privilege of presenting our proposal or in order to secure the awarding of any program to Gallagher Bassett Services. Budgeted Staffing Cost & Terms (Revision date: 6/8/2015) Page 7 City of Miami 000757 go beyond 2/15/2016 - 2/15/2017 GQ..4m...G___16'11.?c, beyond G. as�ss' GENERAL CONTRACT TERMS AND CONDITIONS 1. Independent resolution managers for Catastrophes - If applicable, following any significant Property loss as a result of a single event (i.e., hurricane, tornado, flood, earthquake, etc), GB reserves the right to retain outside resources (resolution managers) when appropriate and those fees will be paid as an Allocated Expense off the file. 2. Material Change - GB reserves the right to modify its fees upon sixty (60) days prior notice to CLIENT if: a. It is determined that the historical data upon which GB's fees and service charges developed were based upon erroneous, obsolete or insufficient information, or that a change in CLIENT's business will materially change the nature and/or volume of its business or claims as contemplated at the inception of the Agreement b. During the term of the Agreement, legislative and/or regulatory requirements materially impact or change the scope of GB's services or responsibilities 3. Taxes - All applicable taxes will be added to the service fees where required 4. Allocated Expenses: Shall be your responsibility and shall include, but not be limited to: ➢ Legal Fees > Medical Examinations Professional Photographs Travel made at client's request Costs for witness statements ➢ Court reports > Medical records Accident reconstruction ➢ Experts' rehabilitation costs > Chemist Fees for service of process ➢ Collection cost payable to third parties on subrogation > Architects, contractors > Engineer Any other similar cost, fee or expense reasonably chargeable to the investigation, negotiation, settlement or defense of a claim or loss which must have the explicit prior approval of the client > Police, fire, coroner, weather, or other such reports > Property damage appraisals SIU, surveillance and sub rosa investigation > Official documents and transcripts > Pre- and post judgment interest paid 5= Outside Investigation ➢ Index Bureau Reporting > Second Injury Fund Recovery > Data Intelligence Self -Service Reports > Managed Care - Managed Care services may include, but are not limited to: i. Preferred provider organization networks v. Medical case management and Vocational ii. Utilization review services rehabilitation network ili. Automated state fee scheduling vi. Prospective injury management services iv. Light duty/return-to-work programs vii. Hospital bill audit services Budgeted Staffing Cost & Terms (Revision date: 6/8/2015) Page 8 ao beyond: C'-gLLAGN' $ASSES City of Miami 000757 2/15/2016 - 2/15/2017 DEFINITIONS G..• go beyond ¢ -.ASSES Workers Compensation - Medical Only Claims A medical only claim is a work -related Claim that meets the following criteria: (i) payments for either indemnity or vocational rehabilitation were not required, (ii) the Claim has not become contested or in suit, (iii) investigation to determine compensability or subrogation requirements was not required, (iv) no loss notices, captioned reports, client meetings (other than routine meetings where the claim is listed and noted) or settlement authority approvals were required, and (v) payments on the Claim have not exceeded $2,500. Workers Compensation - Indemnity Claims An indemnity claim is a Workers Compensation claim that is not a Medical Only Claim. Incident - Electronic and Manual An Incident is a loss reported electronically through ClaimLine and/or the Web, or set up manually at the branch. GB will review the Incident and make a courtesy call [if necessary] to determine if it is a claim or Incident. GB will have full discretion in the determination and handling of these Incidents and/or their conversion into claim status. Liability Claims Investigate, evaluate and adjudicate all third -party claims for which you may be legally obligated. Third -party claims will be managed and administered in accordance with our product guidelines. Auto Physical Damage (APD)/Property Claims Investigate, evaluate and adjudicate all first -party claims which you report involving damage or loss of real or personal property, First -party claims will be managed and administered in accordance with our product guidelines. Budgeted Staffing Cost & Terms (Revision date: 6/8/2015) Page 9 City of Miami Procurement Department Miami Riverside Center 444 SW 2nd Avenue, 6Ih Floor Miami, Florida 33130 Web Site Address www.miamigov,com/procurement Number: Title: Issue Date/Time: Closing Date/Time: Pre-Bid/Pre-Proposal Conference: Pre-Bid/Pre-Proposal Date/Time: Pre-Bid/Pre-Proposal Location: Deadline for Request for Clarification: Contracting Officer: Hard Copy Submittal Location: Contracting Officer E-Mail Address: Contracting Officer Facsimile: 605386,6 Request for Proposals for Third Party Claims Adm. & Managed Care Services 02-NOV-2016 30-NOV-2016 @ 14:00:00 Voluntary Wednesday, October 12, 2016, at 2:00 PM 444 SW 2nd Avenue, 6th Floor South Conference Room, Miami, Florida Tuesday, November 1, 2016 at 5:00 PM Calderon, Yadissa City of Miami - City Clerk 3500 Pan American Drive Miami FL 33133 US ycalderon@miamigov.com 305-400-5369 Page 1 of 66 Certification Statement Please quote on this form, if applicable, net prices for the items) listed. Return signed original and retain a copy for your files. Prices should include all costs, including transportation to destination. The City reserves the right to accept or reject all or any part of this submission. Prices should be firm for a minimum of 180 days following the time set for closing of the submissions. In the event of errors in extension of totals, the unit prices shall govern in determining the quoted prices. We (I) certify that we have read your solicitation. completed the necessary documents, and propose to furnish and deliver, F.O.S. DESTINATION, the items or services specified herein. The undersigned hereby certifies that neither the contractual party nor any of its principal owners or personnel have been convicted of any of the violations, or debarred or suspended as set in section 18-107 or Ordinance No. 12271. All exceptions to this submission have been documented in the section below (refer to paragraph and section). EXCEPTIONS: We (I) certify that any and all information contained in this submission is true: and we (I) further certify that this submission is made without prior understanding, agreement, or connection with any corporation, firm, or person submitting a submission for the same materials, supplies, equipment. or service, and is in all respects fair and without collusion or fraud. We (I) agree to abide by all terms and conditions of this solicitation and certify that I am authorized to sign this submission for the submitter. Please print the following and sign your name: PROPOSER NAME: ADDRESS: PHONE: FAX: EMAIL: CELL(Optional): SIGNED BY: TITLE: DATE: FAILURE TO COMPLETE, SIGN, AND RETURN THIS FORM SHALL DISOUALIFY THIS RESPONSE. Page 2 of 66 Certifications Legal Name of Firm: FEIN No.: Entity Type: Partnership, Sole Proprietorship. Corporation, etc. Year Established: Business Address: City, State, and Zip Code: Telephone Number: Fax Number: E-mail Address: Office Location: City of Miami, Miami -Dade County, or Other Business Tax Receipt/Occupational License Number: Business Tax Receipt/Occupational License Issuing Agency: Business Tax Receipt/Occupational License Expiration Date: Will Subcontractor or Sub consultant (s) be used? Sub consultant shall mean the same thing as a Page 3 of 66 Subcontractor in these documents. (Yes or No) (if yes for what and what percentage of such work) Will furnish and provide professional services to the City, at minimum, in compliance with all contract documents and in compliance with all applicable laws, rules and regulations. Certifies that neither the Proposer nor any of its principal owners or personnel or any subsidiary of the Proposer, have been convicted of any of the violation(s) or crimes or actions and conduct involving moral turpitude as defined by applicable laws, or debarred or suspended as set forth in Section 18-107, City Code, or as provided by 287.133, Florida Statutes. The Proposer further certifies that the Proposer has not been debarred or suspended by the United States Government, the State of Florida, any political subdivision of the State of Florida or any Special District or Public School Board in the State of Florida. Proposer understands that exceptions not timely or correctly taken are waived. Please list and acknowledge all addendum/addenda received. List the addendum/addenda number and date of receipt (i.e. Addendum No. 1. 7/1/07). If no addendum/addenda was/were issued. please insert N/A. Has Proposer reviewed the attached Sample Professional Services Agreement (PSA)? Does the Proposer acknowledge that the attached PSA is an example of the standard Agreement used in conjunction with the services related to this Solicitation and shall not be amended? Page 4 of 66 Line: 1 Description: Disregard this line item. Please refer to Attachment A, attached to the Header Section of this solicitation. Proposer shall clearly indicate in proposal if providing a response for Part I and/or Part II Services. Category: 95327-00 Unit of Measure: Year Unit Price: $ Number of Units: 3 Total: S Page 5 of 66 605386,6 Table of Contents Terms and Conditions 7 1. General Conditions 7 1.1. GENERAL TERMS AND CONDITIONS 7 2. SPECIAL CONDITIONS 29 2.I. PURPOSE 29 2.2. DEADLINE FOR RECEIPT OF REQUEST FOR ADDITIONAL INFORMATION/ 29 2.3. VOLUNTARY PRE -PROPOSAL CONFERENCE 29 2.4. DEFINITIONS 29 3. Specifications 39 3.1. SPECIFICATIONS/SCOPE OF WORK 39 4. Submission Requirements 57 4.1. CMIA Submission Requirements 57 5, Evaluation Criteria 65 5.1. CMIA Evaluation Criteria 65 Page 6 of 66 605386,6 Terms and Conditions 1. General Conditions 1.1. GENERAL TERMS AND CONDITIONS References to goods only apply insofar as they are applicable to "Goods" as defined in Section 18-73 of the City Code. References to "Professional and Personal Services" are as defined in Section 18-73 of the City Code. Intent: The General Terms and Conditions described herein apply to the acquisition of goods/equipment/services with an estimated aggregate cost of $25,000.00 or more. Definition: A formal solicitation is defined as issuance of an Invitation for Bids, Request for Proposals, Request for Qualifications, or Request for Letters of Interest pursuant to the City of Miami Procurement Code and/or Florida Law, as amended. Formal Solicitation and Solicitation shall be defined in the same manner herein. 1.1. ACCEPTANCE OF GOODS OR EQUIPMENT- Any good(s) or services delivered under this formal solicitation, if applicable, shall remain the property of the seller until a physical inspection and actual usage of the good is made, and thereafter is accepted as satisfactory to the City. It must comply with the terms herein and be fully in accordance with specifications and of the highest quality. In the event the goods/equipment supplied to the City are found to be defective or does not conform to specifications, the City reserves the right to cancel the order upon written notice to the Successful Proposer and return the product to the Successful Proposer at the Successful Proposer's expense. 1.2. ACCEPTANCE OF OFFER- The signed or electronic submission of your proposal shall he considered an offer on the part of the Successful Proposer; such offer shall be deemed accepted upon issuance by the City of a purchase order. 1.3. ACCEPTANCE/REJECTION , The City reserves the right to accept or reject any or all responses or parts of after opening/closing date and request re -issuance on the goods/services described in the formal solicitation. In the event of such rejection, the Director of Procurement shall notify all affected bidders/proposers and make available a written explanation for the rejection. The City also reserves the right to reject the response of any Successful Proposer who has previously failed to properly perform under the terms and conditions of a contract, to deliver on time contracts of a similar nature, and who is not in a position to perform the requirements defined in this formal solicitation. The City further reserves the right to waive any irregularities or minor informalities or technicalities in any or all responses and may, at its discretion, re -issue this formal solicitation. 1A. ADDENDA - It is the bidder's/proposer's responsibility to ensure receipt of all Addenda. Addenda are available at the City's website at: ltttp://www.ci.miami.fl.us/procurement 1.5. ALTERNATE RESPONSES WILL NOT BE CONSIDERED. 1.6. ASSIGNMENT - Successful Proposer agrees not to subcontract. assign, transfer, convey, sublet, transfer, pledge, encumber, or otherwise dispose of the resulting Contract, in whole or in part or any or all of its right, title or interest herein, without City of Miami's prior written consent. These particular services are considered unique in nature and specialized in training and experience and the City will select a Proposer in reliance on such training and experience. 1.7. ATTORNEY'S FEES- In connection ‘vith any litigation, in trial and appellate levels, mediation and arbitration Page 7 of 66 605386.6 arising out of this Contract, each party shall bear their own attorney's fees through and including appellate litigation and any post judgment proceedings. 1.8. AUDIT RIGHTS AND RECORDS RETENTION- The Successful Proposer agrees to provide access at all reasonable times to the City, or to any of its duly authorized representatives, to any books, documents, papers, and records of Successful Proposer which are directly pertinent to this formal solicitation, for the purpose of audit, examination, excerpts, and transcriptions. The Successful Proposer shall maintain and retain any and all of the books, documents, papers and records pertinent to the Contract for three (3) years after- the City makes final payment and all other pending matters are closed. SuccessfulProposer's failure to or refusal to comply with this condition shall result in the immediate cancellation of this contract by the City. The Audit Rights set forth in Section 18-102 of the City Code apply as supplemental terms and are deemed as being incorporated by reference herein. 1.9. AVAILABILITY OF CONTRACT STATE-WIDE- Any Governmental, not -for -profit or quasi - governmental entity in the State of Florida, may avail itself of this contract and purchase any and all goods/services, specified herein from the Successful Proposer at the contract price(s) established herein, when permissible by federal, state, and local laws, rules, and regulations. Each Governmental, not -for -profit or quasi -governmental entity which uses this formal solicitation and resulting bid contract or agreement will establish its own contract/agreernent, place its own orders, issue its own purchase orders. be invoiced there from and make its own payments, determine shipping terms and issue its own exemption certificates as required by the Successful Proposer. 1.10. AWARD OF CONTRACT: A. The Formal Solicitation, Proposer's response, any addenda issued, the Professional Services Agreement ("PSA") attached hereto as an Exhibit, and the purchase order shall constitute the entire contract, unless modified in accordance with any ensuing contract/agreement, amendment or addenda. B. The award of a contract where there are Tie Bids will be decided by the Director of Procurement or designee in the instance that Tie Bids can't be determined by applying Florida Statute Section 287.087, Preference to Businesses with Drug -Free Workplace Programs. C. The award of this contract may be preconditioned on the subsequent submission of other documents as specified in the Special Conditions or Technical Specifications. Proposer shall be in default of its contractual obligation if such documents are not submitted in a timely manner and in the forrn required by the City. Where Proposer is in default of these contractual requirements, the City, through action taken by the Procurement Department, will void its acceptance of the Proposer's Response and may accept the Response from the next lowest responsive, responsible Proposal most advantageous to the City or re -solicit the City's requirements. The City, at its sole discretion, may seek monetary restitution from Successful Proposer and its proposal bond or guaranty, if applicable, as a result of damages or increased costs sustained as a result of the Proposer's default, D. The term of the contract shall be specified in one of three documents which shall be issued to the Successful Proposer. These documents may either be a purchase order. notice of award and/or contract award sheet. E. The City reserves the right to automatically extend this contract for up to one hundred twenty (120) calendar days beyond the stated contract term in order to provide City departments with continual service and supplies while a new contract is being solicited, evaluated, and/or awarded. If the right is exercised, the City shall notify the Successful Proposer, in writing, of its intent to extend the contract at the same price, terms and conditions for a specific number of days. Additional extensions aver the first one hundred twenty (120) day extension may occur. if, the City and the Successful Proposer are in mutual agreement of such extensions. F. Where the contract involves a single shipment of goods to the City, the contract term shall conclude upon Page 8 of 66 605386,6 completion of the expressed or implied warranty periods. G. The City reserves the right to award the contract on a split -order. lump sum or individual -item basis, or such combination as shall best serve the interests of the City unless otherwise specified. H. A Contract/Agreement may be awarded to the Successful Proposer by the City Commission based upon the minimum qualification requirements reflected herein. As a result of a RFP, RFQ, or RFLI, the City reserves the right to execute, a Professional Services Agreement ("PSA" or "Agreement") in substantially the form attached to the Solicitation, with the Proposer, whichever is determined to be in the City's best interests. Such agreement will be furnished by the City, will contain certain terms as are in the City's best interests, and will be subject to approval as to legal form by the City Attorney. Certain terms, including, without limitation, the cancellation for convenience and the hold harmless/ duty to defend and indemnify are long standing City requirements and may not be modified. 1.11. BID BOND/ BID SECURITY -A cashier's or certified check issued by a bank authorized to transact banking business in Florida, or a Bid Bond signed by a recognized surety company that is licensed to do business in the State of Florida, payable to the City of Miami. for the amount bid is required from all Proposers, if so indicated under the Special Conditions. This check or bond guarantees that a Successful Proposer will accept the order or Agreement, as proposed, if it is awarded to Successful Proposer. Successful Proposer shall forfeit bid deposit to the City should City award Agreement to Successful Proposer and Successful Proposer fails to accept the award. The City reserves the right to reject any and all surety tendered to the City. Bid deposits are returned to unsuccessful Proposers within ten (10) days after the award and Successful Proposer's acceptance of award. If one hundred eighty (180) days have passed after the date of the formal solicitation closing date, and no contract has been awarded, all bid deposits will be returned on demand. 1.12. RESPONSE FORM (HARDCOPY FORMAT)- All forms should be completed, signed and submitted accordingly. 1.13. BID SECURITY FORFEITED LIQUIDATED DAMAGES- Failure to execute an Agreement and/or file an acceptable Bid / Payment/ Performance Bond, when required. as provided herein, shall be just cause for the rescission of the award and the forfeiture of the Bid Security to the City, which forfeiture shall be considered, not as a penalty, but in mitigation of damages sustained. Award may then be made to the next lowest responsive, responsible Proposer most advantageous to the City or all responses may be rejected. 1.14. BRAND NAMES- If and wherever in the specifications brand names, makes, models, names of any manufacturers, trade names, or Successful Proposer catalog numbers are specified, it is far the purpose of establishing the type, function, minimum standard of design, efficiency, grade or quality of goods only. When the City does not wish to rule out other competitors' brands or makes, the phrase "OR EQUAL" is added. When proposing an approved equal, Proposers will submit, with their response, complete sets of necessary data (factory information sheets, specifications, brochures, etc.) in order for the City to evaluate and determine the equality of the item(s) proposed. The City shall be the sole judge of equality and its decision shall be final. Unless otherwise specified, evidence in the form of samples may be requested if the proposed brand is other than specified by the City. Such samples are to be furnished after formal solicitation opening/closing only upon request of the City. If samples should be requested, such samples must be received by the City no later than seven (7) calendar days after a formal request is made. L15. CANCELLATION- The City reserves the right to cancel all formal solicitations before it's opening/closing. In the event of bid/proposal cancellation. the Director of Procurement shall notify all prospective bidders/proposers and make available a written explanation for the cancellation. 1,16. CAPITAL EXPENDITURES G Successful Proposer understands that any capital expenditures that the firm makes, or prepares to make, in order to deliver/perform the goods/services required by the City. is a business risk Page 9 of 66 605386,6 which the Proposer must assume. The City will not be obligated to reimburse amortized or unamortized capital expenditures, or to maintain the approved status of any Proposer, If Proposer has been unable to recoup its capital expenditures during the time it is rendering such goods/services, it shall not have any claim upon the City. 1.17. CITY NOT LIABLE FOR DELAYS- It is further expressly agreed that in no event shall the City be liable far, or responsible to, the Successful Proposer, any sub- contractor /sub -consultant, or to any other person for, or on account of, any stoppages or delay in the work herein provided for by injunction or other legal or equitable proceedings or on account of any delay for any cause over which the City has no control. 1.18. COLLUSION - Proposer, by submitting a response, certifies that its response is made without previous understanding, agreement or connection either with any person, firm or corporation submitting a response for the same items/services or with the City of Miami's Procurement Department or initiating department. The Proposer certifies that its response is fair, without control, collusion, fraud or other illegal action. Proposer certifies that it is in compliance with the Conflict of Interest and Code of Ethics Laws. The City will investigate all potential situations where collusion may have occurred and the City reserves the right to reject any and all responses where collusion may have occurred. 1.19. COMPLIANCE WITH FEDERAL, STATE AND LOCAL LAWS - Successful Proposer understands that contracts between private entities and local governments are subject to certain laws and regulations, including laws pertaining to public records, conflict of interest, records keeping, etc. City and Successful Proposer agree to comply with and observe all applicable laws, codes and ordinances as that may in any way affect the goods or equipment offered, including but not limited to: A.Executive Order 11246, which prohibits discrimination against any employee, applicant, or client because of race, creed, color, national origin, sex, or age with regard to, but not limited to, the following: employment practices, rate of pay or other compensation methods, and training selection. B.Occupational, Safety and Health Act (OSHA), as applicable to this Formal Solicitation. C.The State of Florida Statutes, Section 287.1330 on Public Entity Crimes. D.Environment Protection Agency (EPA), as applicable to this Formal Solicitation. E.Uniform Commercial Code (Florida Statutes, Chapters 672-679). F.Americans with Disabilities Act of 1990, as amended. G.National Institute of Occupational Safety Hazards (NIOSH), as applicable to this Formal Solicitation. H.National Forest Products Association (NFPA), as applicable to this Formal Solicitation. I.City Procurement Ordinance City Cade Section 18, Article III. J.Conflict of Interest, City Code Section 2-611; 61. K.Cone of Silence, City Code Section 18-74. L.The Florida Statutes Sections 218.70 to 218.79 on Prompt Payments. Lack of knowledge by the Successful Proposer will in no way be a cause for relief from responsibility. Non-compliance with all applicable local, state, and federal directives, orders, codes, rules, regulations, and laws may be considered grounds for termination of contract(s) at the option of the City Manager. Copies of the City Ordinances may be obtained from the City Clerk's Office. 1.20. CONE OF SILENCE - Pursuant to Section 18-74 of the City of Miami Code, a "Cone of Silence" is imposed Page 10 of 66 605386,6 upon each RFP, RFQ, RFLI, or IFB after advertisement and terminates at the time the City Manager issues a written recommendation to the Miami City Commission. The Cone of Silence shall be applicable only to Contracts for the provision of goods and services and public works or improvements for amounts greater than $200,000. The Cone of Silence prohibits any communication regarding RFPs, RFQs, RFLI or IFBs (bids) between, among others: Potential vendors, service providers, bidders, lobbyists or consultants and the City's professional staff including, but not limited to, the City Manager and the City Manager's staff; the Mayor, City Commissioners, or their respective staffs and any member of the respective selection/evaluation committee. The provision does not apply to, among other communications: oral communications with the City Procurement staff, provided the communication is limited strictly to matters of process or procedure already contained in the formal solicitation document; the provisions of the Cone of Silence do not apply to oral communications at duly noticed site visits/inspections, pre -proposal or pre -bid conferences, oral presentations before selectionlevaluation committees, contract negotiations during any duly noticed public meeting, or public presentations made to the Miami City Commission during a duly noticed public meeting; or communications in writing or by email at any time with any City employee, official or member of the City Commission unless specifically prohibited by the applicable RFP, RFQ, RFLI or IFB (bid) documents (See Section 2.2, of the Special Conditions); or communications in connection with the collection of industry comments or the performance of market research regarding a particular RFP, RFQ, RFLI OR IFB by City Procurement staff. Proposers or bidders must file a copy of any written communications with the Office of the City Clerk, which shall be made available to any person upon request. The City shall respond in writing and file a copy with the Office of the City Clerk, which shall be made available to any person upon request. Written communications may be in the form of e-mail, with a copy to the Office of the City Clerk. In addition to any other penalties provided by law, violation of the Cone of Silence by any Proposer shall render any award voidable. A violation by a particular Proposer, Offeror, Respondent, lobbyist or consultant shall subject same to potential penalties pursuant to the City Code. Any person having personal knowledge of a violation of these provisions shall report such violation to the State Attorney and/or may file a complaint with the Ethics Commission. Proposers should reference Section 18-74 of the City of Miami Code for further clarification. This language is only a summary of the key provisions of the Cone of Silence. Please review City of Miami Code Section 18-74 for a complete and thorough description of the Cone of Silence. You may contact the City Clerk at 305-250-5360, to obtain a copy of same. 1.21. CONFIDENTIALITY- As a political subdivision, the City of Miami is subject to the Florida Sunshine Law and Public Records Law. if this Contract/Agreement contains a confidentiality provision, it shall have no application when disclosure is required by Florida law or upon court order. 1.22. CONFLICT OF INTEREST - Proposers, by responding to this Formal Solicitation, certify that to the best of their knowledge or belief, no elected/appointed official or employee of the City of Miami is financially interested, directly or indirectly, in the purchase of goods/services specified in this Formal Solicitation. Any such interests on the part of the Successful Proposer or its employees must be disclosed in writing to the City. Further, you must disclose the name of any City employee who owns, directly or indirectly, an interest of five percent (5%) or more of the total assets of capital stock in your firm. Page 11 of 66 605386,6 A. Successful Proposer further agrees not to use or attempt to use any knowledge, property or resource which may be within his/her/its trust, or perform his/her/its duties, to secure a special privilege, benefit, or exemption for himself/herself/itself, or others. Successful Proposer may not disclose or use information not available to members of the general public and gained by reason of his/her/its position, except for information relating exclusively to governmental practices, for his/her/its personal gain or benefit or for the personal gain or benefit of any other person or business entity. B. Successful Proposer hereby acknowledges that he/she/it has not contracted or transacted any business with the City or any person or agency acting for the City, and has not appeared in representation of any third party before any board, commission or agency of the City within the past two years. Successful Proposer further warrants that he/she/it is not related, specifically the spouse, son, daughter, parent, brother or sister, to: (i) any member of the commission; (ii) the Mayor: (iii) any City employee; or (iv) any member of any board or agency of the City. C. A violation of this section may subject the Successful Proposer to immediate termination of any professional services agreement with the City, imposition of the maximum fine and/or any penalties allowed by law. Additionally, violations may be considered by and subject to action by the Miami -Dade County Commission on Ethics. 1.23. COPYRIGHT OR PATENT RIGHTS - Proposers warrant that there has been no violation of copyright or patent rights in manufacturing, producing. or selling the goods shipped or ordered and/or services provided as a result of this formal solicitation, and Proposers agree to hold the City harmless from any and all liability, loss, or expense occasioned by any such violation. 1.24. COST INCURRED BY SUCCESSFUL PROPOSER- All expenses involved with the preparation and submission of Responses to the City, or any work performed in connection therewith shall be borne by the Proposer(s). 1.25. DEBARMENT AND SUSPENSIONS (Sec 18-107, City Code) (a) Authority and requirement to debar and suspend. After reasonable notice to an actual or prospective Contractual Party, and after reasonable opportunity for such party to be heard, the City Manager. after consultation with the Chief Procurement Officer and the City Attorney, shall have the authority to debar a Contractual Party, for the causes listed below, from consideration for award of City Contracts_ The debarment shall be for a period of not fewer than three years. The City Manager shall also have the authority to suspend a Contractual Party from consideration for award of City Contracts if there is probable cause for debarment, pending the debarment determination. The authority to debar and suspend Proposer s shall be exercised in accordance with regulations which shall be issued by the Chief Procurement Officer after approval by the City Manager, the City attorney, and the City Commission. (b) Causes for debarment or suspension. Causes for debarment or suspension include the following: (1) Conviction for commission of a criminal offense incident to obtaining or attempting to obtain a public or private Contract or subcontract, or incident to the performance of such Contract or subcontract. (2) Conviction under state or federal statutes of embezzlement, theft. forgery. bribery, falsification or destruction of records, receiving stolen property, or any other offense indicating a lack of business integrity or business honesty. (3) Conviction under state or federal antitrust statutes arising out of the submission of Bids or Proposals. (4) Violation of Contract provisions, IA hich is regarded by the Chief Procurement Officer to be indicative of non - Page 12 of 66 605386.6 responsibility. Such violation may iinclude failure without good cause to perform in accordance with the terms and conditions of a Contract or to perform within the time limits provided in a Contract, provided that failure to perform caused by acts beyond the control of a party shall not be considered a basis for debarment or suspension. (5) Debarment or suspension of the Contractual Party by any federal, state or other governmental entity. (6) False certification pursuant to paragraph (c) below. (7) Found in violation of a zoning ordinance or any other City ordinance or regulation and for which the violation remains noncompliant. (8) Found in violation of a zoning ordinance or any other City ordinance or regulation and for which a civil penalty or fine is due and owing to the City. (9) Any other cause judged by the City Manager to be so serious and compelling as to affect the responsibility of the Contractual Party performing City Contracts. (c) Certification. All Contracts for goods and services, sales, and leases by the City shall contain a certification that neither the Contractual Party nor any of its principal owners or personnel have been convicted of any of the violations set forth above or debarred or suspended as set forth in paragraph (b) (5). (d) Debarment and suspension decisions. Subject to the provisions of paragraph (a), the City Manager shall render a written decision stating the reasons for the debarment or suspension. A copy of the decision shall be provided promptly to the Contractual Party, along with a notice of said party's right to seek judicial relief. 1.26. DEBARRED/SUSPENDED VENDORS - An entity or affiliate who has been placed on the State of Florida debarred or suspended vendor list may not submit a response on a contract to provide goods or services to a public entity, may not submit a response on a contract with a public entity for the construction or repair of a public building or public work, may not submit response on leases of real property to a public entity, may not award or perform work as a Proposer . supplier, subcontractor, or consultant under contract with any public entity, and may not transact business with any public entity. 1.27. DEFAULT/FAILURE TO PERFORM -The City shall be the sole judge of nonperformance, which shall include any failure on the part of the Successful Proposer to accept the award, to furnish required documents, and/or to fulfill any portion of this contract within the time stipulated. Upon default by the Successful Proposer to meet any terms of this agreement, the City will notify the Successful Proposer of the default and will provide the Successful Proposer three (3) days (weekends and holidays excluded) to remedy the default. Failure on the Successful Proposer's part to correct the default within the required three (3) days shall result in the Contract being terminated and upon the City notifying in writing the Successful Proposer of its intentions and the effective date of the termination. The following shall constitute default: A. Failure to perform the work or deliver the goods/services required under the Contract and/or within the time required or failing to use the sub Proposer s, entities and personnel as identified and set forth, and to the degree specified in the Contract. B. Failure to begin the work under this Contract within the time specified. C. Failure to perform the work with sufficient workers and equipment or with sufficient materials to ensure timely completion. D. Neglecting or refusing to remove materials or perform new work where prior work has been rejected as nonconforming with the terms of the Contract. Page 13 of 66 605386,6 E. Becoming insolvent, being declared bankrupt, or committing any act of bankruptcy or insolvency, or making an assignment for the benefit of creditors, if the insolvency, bankruptcy, or assignment renders the Successful Proposer incapable of performing the work in accordance with and as required by the Contract. F. Failure to comply with any of the terms of the Contract in any material respect. All costs and charges incurred by the City as a result of a default or a default incurred beyond the time limits stated, together with the cost of completing the work, shall be deducted from any monies due or which may become due on this Contract. 1.28. DETERMINATION OF RESPONSIVENESS -Each Response will be reviewed to determine if it is responsive to the submission requirements outlined in the Formal Solicitation. A "responsive" response is one which follows the requirements of the formal solicitation, includes all documentation, is submitted in the format outlined in the formal solicitation, is of timely submission, and has appropriate signatures as required on each document. Failure to comply with these requirements may deem a Response non -responsive. A Responsible Proposer shall mean a Proposer who has submitted a Proposal and who has the capability, as determined under the City Procurement Ordinance, in all respects to fully perform the contract requirements; and the integrity and reliability of which give reasonable assurance of good faith and performance. 1.29. DISCOUNTS OFFERED DURING TERM OF CONTRACT -Discount Prices offered in the response shall be fixed after the award by the Commission, unless otherwise specified in the Special Terms and Conditions. Price discounts off the original prices quoted in the response will be accepted from Successful Proposer(s) during the term of the contract. Such discounts shall remain in effect for a minimum of 120 days from approval by the City Commission Any discounts offered by a manufacturer to Successful Proposer will be passed on to the City. 1.30. DISCREPANCIES, ERRORS, AND OMISSIONS -Any discrepancies, errors, or ambiguities in the Formal Solicitation or addenda (if any) should be reported in writing to the City's Procurement Department. Should it be found necessary, a written addendum will be incorporated in the Formal Solicitation and will become part of the purchase agreement (contract documents). The City will not be responsible for any oral instructions, clarifications, or other communications. A. Order of Precedence 4 Any inconsistency in this formal solicitation shall be resolved by giving precedence to the following documents, the first of such list being the governing documents. 1) Addenda (as applicable) 2) Specifications 3) Special Conditions 4) General Terms and Conditions 1.31. EMERGENCY / DISASTER PERFORMANCE - In the event of a hurricane or other emergency or disaster situation, the successful vendor shall provide the City with the commodities/services defined within the scope of this formal solicitation at the price contained within vendor's response. Further. successful vendor shall deliver/perform for the City on a priority basis during such times of emergency. 1.32. ENTIRE BID CONTRACT OR AGREEMENT -The Agreement consists of this City of Miami Formal Solicitation and specifically this General Conditions Section, Proposer 's Response and any written agreement Page 14 of 66 605386,6 entered into by the City of Miami and Proposer in cases involving RFPs, RFQs, and RFL1s, and represents the entire understanding and agreement between the parties with respect to the subject matter hereof and supersedes all other negotiations, understanding and representations, if any, made by and between the parties. To the extent that the agreement conflicts with, modifies, alters or changes any of the terms and conditions contained in the Formal Solicitation and/or Response, the Formal Solicitation and then the Response shall control. This Contract may be modified only by a written agreement signed by the City of Miami and Proposer. 1.33. ESTIMATED QUANTITIES LEstirnated quantities or estimated dollars are provided for your guidance only. No guarantee is expressed or implied as to quantities that will be purchased during the contract period. The City is not obligated to place an order for any given amount subsequent to the award of this contract. Said estimates may be used by the City for purposes of determining the most advantageous proposer meeting specifications. The City reserves the right to acquire additional quantities at the prices proposed or at lower prices in this Formal Solicitation. 1.34. EVALUATION OF RESPONSES A. Rejection of Responses The City may reject a Response for any of the following reasons: 1)Successful Proposer fails to acknowledge receipt of addenda; 2)Successful Proposer misstates or conceals any material fact in the Response; 3)Response does not conform to the requirements of the Formal Solicitation; 4)Response requires a conditional award that conflicts with the method of award; 5)Response does not include required samples, certificates, licenses as required; and, 6)Response was not executed by the Proposer(s) authorized agent. The foregoing is not an all-inclusive list of reasons for which a Response may be rejected. The City may reject and re -advertise for all or any part of the Formal Solicitation whenever it is deemed in the best interest of the City. B. Elimination from Consideration 1) A contract shall not be awarded to any person or firm which is in arrears to the City upon any debt or contract, or which is a defaulter as surety or otherwise upon any obligation to the City. 2) A contract may not he awarded to any person or firm who has failed to perform under the terms and conditions of any previous contract with the City or deliver on time contracts of a similar nature. 3) A contract may not be awarded to any person or firm who has been debarred by the City in accordance with the City's Debarment and Suspension Ordinance. C. Determination of Responsibility 1) Responses will only be considered from entities who are regularly engaged in the business of providing the goods/equipment/services required by the Formal Solicitation. Successful Proposer must be able to demonstrate a satisfactory record of performance and integrity; and, have sufficient financial, material, equipment, facility, personnel resources, and expertise to meet all contractual requirements. The terms "equipment and organization" as used herein shall be construed to mean a fully equipped and well established entity in line with the hest industry practices in the industry as determined by the City. 2) The City may consider any evidence available regarding the financial, technical and other qualifications and Page 15 of 66 605386.6 abilities of a Successful Proposer, including past performance (experience) with the City or any other governmental entity in making the award. 3) The City may require the Proposer(s) to show proof that they have been designated as an authorized representative of a manufacturer or Proposer which is the actual source of supply , if required by the Formal Solicitation. 1.35. EXCEPTIONS TO GENERAL AND/OR SPECIAL CONDITIONS OR SPECIFICATIONS Exceptions to the specifications shall be listed on the Response and shall reference the section. Any exceptions to the General or Special Conditions shall be cause for the Proposal to be considered non -responsive. It also may be cause for a RFP, RFQ, or RFLI to be considered non -responsive; and, if exceptions are taken to the terms and conditions of the resulting agreement it may lead to terminating negotiations. 1.36. F.O.B. DESTINATION -Unless otherwise specified in the Formal Solicitation, all prices quoted/proposed by the Successful Proposer must be F.O.B. DESTINATION, inside delivery, with all delivery costs and charges included in the bid/proposal price, unless otherwise specified in this Formal Solicitation, Failure to do so may be cause for rejection of proposal. 1.37. FIRM PRICES - The Successful Proposer warrants that prices, terms, and conditions quoted in its response will be firm throughout the duration of the contract unless otherwise specified in the Formal Solicitation. Such prices will remain firm for the period of performance or resulting purchase orders or contracts, which are to be performed or supplied over a period of time. 1.38. FLORIDA MINIMUM WAGE -The Constitution of the State of Florida, Article X. Section 24, states that employers shall pay employee wages no less than the minimum wage for all hours worked in Florida. Accordingly, it is the Proposer's and its' subcontractor(s) responsibility to understand and comply with this Florida constitutional minimum wage requirement and pay its employees the current established hourly minimum wage rate, which is subject to change or adjusted by the rate of inflation using the consumer price index for urban wage earners and clerical workers, CPI-W, or a successor index as calculated by the United States Department of Labor. Each adjusted minimum wage rate calculated shall be determined and published by the Agency Workforce Innovation on September 30th of each year and take effect on the following January lst. At the time of responding, it is the Proposer and his/her subcontractor(s), if' applicable, full responsibility to determine whether any of its employees may be impacted by this Florida Law at any given point in time during the term of the contract. If impacted, Proposer must furnish employee name(s), job title(s), job description(s), and current pay rate(s). Failure to submit this information at the time of submitting a response constitute Proposer's acknowledgement and understanding that the Florida Minimum Wage Law will not impact its prices throughout the term of contract and waiver of any contractual price increase request(s). The City reserves the right to request, and Successful Proposer must provide for any and all information to make a wage and contractual price increase(s) determination. In the event a City of' Miami "Living Wage" Ordinance is enacted prior to the award of an Agreement its provisions may be applicable to the employees of the Proposer. 1.39. GOVERNING LAW AND VENUE -The validity and effect of this Contract shall be governed by the laws of the State of Florida. The parties agree that any action, proceeding, mediation or arbitration arising out of this Contract shall take place in Miami -Dade County, Florida. In any action or proceeding each party shall bear their own respective attorneys fees. Page 16 of 66 605386,6 1.40. HEADINGS AND TERMS -The headings to the various paragraphs of this Contract have been inserted for convenient reference only and shall not in any manner be construed as modifying, amending or affecting in any way the expressed terms and provisions hereof. 1.91. HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT (HIPPA)- Any person or entity that performs or assists the City of Miami with a function or activity involving the use or disclosure of individually identifiable health information (IIHI) and/or Protected Health Information (PHI) shall comply with the Health Insurance Portability and Accountability Act (HIPAA) of 1996 and the City of Miami Privacy Standards. HIPAA mandates for privacy, security and electronic transfer standards, which include but are not limited to: A. Use of information only for performing services required by the contract or as required by law; B. Use of appropriate safeguards to prevent non -permitted disclosures; C. Reporting to the City of Miami of any non -permitted use or disclosure; D. Assurances that any agents and sub Proposer s agree to the same restrictions and conditions that apply to the Successful Proposer and reasonable assurances that IIHI/PHI will be held confidential; E. Making Protected Health Information (PHI) available to the customer; F. Making PHI available to the customer for review and amendment; and incorporating any amendments requested by the customer; G. Making PHI available to the City of Miami for an accounting of disclosures; and H. Making internal practices, books and records related to PHI available to the City of Miami for compliance audits. PHI shall maintain its protected status regardless of the form and method of transmission (paper records, and/or electronic transfer of data). The Proposer must give its customers written notice of its privacy information practices including specifically. a description of the types of uses and disclosures that would be made with protected health information. 192 INDEMNIFICATION - Successful Proposer shall indemnify, hold/save harmless and defend at its own costs and expense the City, its officials, officers, agents, directors, and employees, from liabilities. damages, losses, and costs, including, but not limited to reasonable attorney's fees, to the extent caused by the negligence, recklessness or intentional wrongful misconduct of Successful Proposer and persons employed or utilized by Successful Proposer in the performance of this Contract and will indemnify, hold harmless and defend the City, its officials, officers, agents, directors and employees against, any civil actions, statutory or similar claims, injuries or damages arising or resulting from the permitted work, even if it is alleged that the City, its officials and/or employees were negligent. These indemnifications shall survive the term of this Contract. In the event that any action or proceeding is brought against the City by reason of any such claim or demand, Successful Proposer shall, upon written notice from the City, resist and defend such action or proceeding by counsel satisfactory to the City. The Successful Proposer expressly understands and agrees that any insurance protection required by this Contract or otherwise provided by Proposer shall in no way limit the responsibility to indemnify, keep and save harmless and defend the City or its officers, employees, agents and instrumentalities as herein provided. The indemnification provided above shall obligate Successful Proposer to defend at its own expense to and through appellate, supplemental or bankruptcy proceeding, or to provide for such defense, at the City's option, any and all claims of liability and all suits and actions of every name and description which may be brought against the City whether performed by Successful Proposer, or persons employed or utilized by Proposer. This indemnity, hold harmless and duty to defend will survive the cancellation or expiration of the Contract. This indemnity will be interpreted under the laws of the State of Florida, including without limitation and which conforms to the limitations of §725.06 and/or §725.08, Fla. Statutes, as amended from time to time as applicable. Page 17 of 66 605386,6 Successful Proposer shall require all Subcontractor agreements to include a provision that they will indemnify the City. The Successful Proposer agrees and recognizes that the City shall not be held liable or responsible for any claims which may result from any actions or omissions of the Successful Proposer in which the City participated either through review or concurrence of the Successful Proposer's actions. In reviewing, approving or rejecting any submissions by the Successful Proposer or other acts of the Successful Proposer, the City in no way assumes or shares any responsibility or liability of the Successful Proposer or Subcontractor, under this Agreement. 1.43. FORMATION AND DESCRIPTIVE LITERATURE - Proposer must furnish all information requested in the spaces provided in the Formal Solicitation. Further, as may be specified elsewhere, each Proposer must submit for evaluation, cuts, sketches, descriptive literature, technical specifications, and Material Safety Data Sheets (MSDS) as required, covering the products offered. Reference to literature submitted with a previous response or on file with the Buyer will not satisfy this provision. 1.44. INSPECTIONS -The City may, at reasonable times during the term hereof, inspect Successful Proposer's facilities and perform such tests, as the City deems reasonably necessary. to determine whether the goods and/or services required to be provided by the Successful Proposer under this Contract conform to the terms and conditions of the Formal Solicitation. Successful Proposer shall make available to the City all reasonable facilities and assistance to facilitate the performance of tests or inspections by City representatives. All tests and inspections shall be subject to, and made in accordance with, the provisions of the City of Miami Procurement Ordinance Section 18-79, City Code ), as same may be amended or supplemented from time to time. 1.45. INSPECTION OF RESPONSE -Responses received by the City pursuant to a Formal Solicitation will not be made available until such time as the City provides notice of a decision or intended decision or within 30 days after bid closing, whichever is earlier. Proposal results will be tabulated and may be furnished upon request via fax or e-mail to the Sr. Procurement Specialist issuing the Solicitation. Tabulations also are available on the City's Web Site following recommendation for award. 1.46. INSURANCE -Within ten (10) days after receipt of Notice of Award, the Successful Proposer, shall furnish Evidence of Insurance to the Procurement Department, if applicable. Submitted evidence of coverage shall demonstrate strict compliance to all requirements listed on the Special Conditions entitled "Insurance Requirements". The City shall be listed as an "Additional Insured." Issuance of a Purchase Order is contingent upon the receipt of proper insurance documents, If the insurance certificate is received within the specified time frame but not in the manner prescribed in this Solicitation the Successful Proposer shall be verbally notified of such deficiency and shall have an additional five (5) calendar days to submit a corrected certificate to the City. If the Successful Proposer fails to submit the required insurance documents in the manner prescribed in this Solicitation within fifteen (15) calendar days after receipt Notice of Award, the Successful Proposer shall be in default of the contractual terms and conditions and shall not be awarded the contract. Under such circumstances, the Successful Proposer may be prohibited from submitting future responses to the City. Information regarding any insurance requirements shall be directed to the Risk Management Director r, Department of Risk Management, at 444 SW 2nd Avenue, 9th Floor, Miami, Florida 33130, 305-416-1604. The Successful Proposer shall be responsible for assuring that the insurance certificates required in conjunction with this Section remain in effect for the duration of the contractual period; including any and all option terms that may Page 18 of 66 605386,6 be granted to the Successful Proposer. 1.47. INVOICES -Invoices shall contain purchase order number and details of goods and/or services delivered (i.e. quantity, unit price, extended price, etc.); and in compliance with Chapter 218 of the Florida Statutes (The Local Government Prompt Payment Act). L48. LOCAL PREFERENCE A. City Code Section 18-86, states, "the RFP, RFLI or RFQ, as applicable, may, in the exercise of the reasonable professional discretion of the City Manager, director of the using agency, and the Chief Procurement Officer, include a five (5%) percent evaluation criterion in favor of Proposers who maintain a Local office, as defined in Section 18-73. In such cases. this five (5%) percent evaluation criterion in favor of Proposers who maintain a local office will be specifically defined in the RFP, RFLI or RFQ, as applicable; otherwise, it will not apply. 1.49. MANUFACTURER'S CERTIFICATION -The City reserves the right to request from Proposers a separate Manufacturer's Certification of all statements made in the proposal. Failure to provide such certification may result in the rejection of proposal or termination of Agreement. for which the Successful Proposer must bear full liability. 1.50. MODIFICATIONS OR CHANGES IN PURCHASE ORDERS AND CONTRACTS -No contract or understanding to modify this Formal Solicitation and resultant purchase orders or contracts, if applicable, shall be binding upon the City unless made in writing by the Director of Procurement of the City of Miami. Florida through the issuance of a change order, addendum, amendment, or supplement to the contract, purchase order or award sheet as appropriate. 1.51. NO PARTNERSHIP OR JOINT VENTURE -Nothing contained in the Agreement will be deemed or construed to create a partnership or joint venture between the City of Miami and Successful Proposer, or to create any other similar relationship between the parties. 1.52. NONCONFORMANCE TO CONTRACT CONDITIONS -Items may be tested for compliance with specifications under the direction of the Florida Department of' Agriculture and Consumer Services or by other appropriate testing Laboratories as determined by the City, The data derived from any test for compliance with specifications is public record and open to examination thereto in accordance with Chapter 119, Florida Statutes. Items delivered not conforming to specifications may be rejected and returned at Proposer's expense. These non -conforming items not delivered as per delivery date in the response and/or Purchase Order may result in Successful Proposer being found in default in which event any and all re -procurement costs may be charged against the defaulted Proposer . Any violation of these stipulations may also result in the supplier's name being removed from the City of Miami's Supplier's list. 1.53. NONDISCRIMINATION - Successful Proposer agrees that it shall not discriminate as to race, sex, color, age. religion, national origin. marital status, or disability in connection with its performance under this formal. solicitation. Furthermore. Successful Proposer agrees that no otherwise qualified individual shall solely by reason of his/her race, sex, color, age. religion. national origin, marital status or disability be excluded from the participation in, be denied benefits of, or be subjected to, discrimination under any program or activity. In connection with the conduct of its business, including performance of services and employment of personnel, Successful Proposer shall not discriminate against any person on the basis of race, color, religion, disability, age, sex, marital status or national origin. All persons having appropriate qualifications shall be afforded equal opportunity for employment_ 1.54. NON-EXCLUSIVE CONTRACT/ PIGGYBACK PROVISION -At such times as may serve its best interest, the City of Miami reserves the right to advertise for, receive, and award additional contracts for these herein Page 19 of 66 605386.6 goods and/or services, and to make use of other competitively bid (governmental) contracts, agreements, or other similar sources for the purchase of these goods and/or services as may be available in accordance with the applicable provisions of the City of Miami Procurement Ordinance. It is hereby agreed and understood that this formal solicitation does not constitute the exclusive rights of the Successful Proposer(s) to receive all orders that may be generated by the City in conjunction with this Formal Solicitation. 1n addition, any and all commodities, equipment, and services required by the City in conjunction with construction projects are solicited under a distinctly different solicitation process and shall not be purchased under the terms, conditions and awards rendered under this solicitation, unless such purchases are determined to be in the best interest of the City. 1.55. OCCUPATIONAL LICENSE -Any person, firm, corporation or joint venture, with a business location in the City of Miami and is submitting a Response under this Formal Solicitation shall meet the City's Occupational License Tax requirements in accordance with Chapter 31.1, Article I of the City of Miami Charter. Others with a location outside the City of Miami shall meet their local Occupational License Tax requirements. A copy of the license must be submitted with the response: however, the City may at its sole option and in its best interest allow the Successful Proposer to supply the license to the City during the evaluation period, but prior to award. 1.56. ONE PROPOSAL -Only one (1) Response from an individual, firm, partnership. corporation or joint venture will be considered in response to this Formal Solicitation. 1.57. OWNERSHIP OF DOCUMENTS -It is understood by and between the parties that any documents, records, files, or any other matter whatsoever which is given by the City to the Successful Proposer pursuant to this formal solicitation shall at all times remain the properly of the City and shall not be used by the Successful Proposer for any other purposes whatsoever without the written consent of the City. 1.58. PARTIAL INVALIDITY -If any provision of this Contract or the application thereof to any person or circumstance shall to any extent be held invalid, then the remainder of this Contract or the application of such provision to persons or circumstances other than those as to which it is held invalid shall not be affected thereby, and each provision of this Contract shall be valid and enforced to the fullest extent permitted by law. 1.59. PERFORMANCE/PAYMENT BOND zA Successful Proposer may be required to furnish a Performance/Payment Bond as part of the requirements of this Contract, in an amount equal to one hundred percent (100%) of the contract price. Any bond furnished will comply with Florida Law and be in a form acceptable to the City of Miami Risk Management Director. 1.60. PREPARATION OF RESPONSES (HARDCOPY FORMAT) - Proposers are expected to examine the specifications, required delivery, drawings, and all special and general conditions. All proposed amounts, if required. shall be either typewritten or entered into the space provided with ink. Failure to do so will be at the Proposer's risk. A. Each Proposer shall furnish the information required in the Formal Solicitation. The Proposer shall sign the Response and print in ink or type the name of the Proposer, address. and telephone number on the face page and on each continuation sheet thereof on which he/she makes an entry, as required. B. If so required. the unit price for each unit offered shall be shown, and such price shall include packaging, handling and shipping, and F.O.B. Miami delivery inside City premises unless otherwise specified. Proposer shall include in the response all taxes, insurance, social security. workmen's compensation, and any other benefits Page 20 of 66 605386.6 normally paid by the Proposer to its employees. If applicable, a unit price shall be entered in the "Unit Price" column for each item. Based upon estimated quantity, an extended price shall be entered in the "Extended Price" column for each item offered. In case of a discrepancy between the unit price and extended price, the unit price will be presumed correct. C. Proposer must state a definite time, if required, in calendar days for delivery of goods and/or services. D. Proposer should retain a copy of all response documents for future reference. E. All responses, as described, must be fully completed and typed or printed in ink and must be signed in ink with the firm's name and by an officer or employee having authority to bind the company or firm by his/her signature. Proposals having any erasures or corrections must be initialed in ink by person signing the response or the response may be rejected. F. Responses are to remain valid for at least 180 days. Upon award of a contract, the content of the Proposer's response may be included as part of the contract, at the City's discretion. G. The City's Response Forms, shall be used when Proposer is submitting its response in hardcopy format. Use of any other forms will result in the rejection of the response. IF SUBMITTING HARDCOPY FORMAT, THE ORIGINAL AND SIX (6) COPIES OF THESE SETS OF FORMS, UNLESS OTHERWISE SPECIFIED, AND ANY REQUIRED ATTACHMENTS MUST BE RETURNED TO THE CITY OR YOUR RESPONSE MAY BE DEEMED NON -RESPONSIVE. 1.61. PRICE ADJUSTMENTS - Any price decrease effectuated during the contract period either by reason of market change or on the part of the Successful Proposer to other customers shall be passed on to the City of Miami. 1.62. PRODUCT SUBSTITUTES -In the event a particular awarded and approved manufacturer's product becomes unavailable during the term of the Contract, the Successful Proposer awarded that item may arrange with the City's authorized representative(s) to supply a substitute product at the awarded price or lower, provided that a sample is approved in advance of delivery and that the new product meets or exceeds all quality requirements. 1.63. CONFLICT OF INTEREST, AND UNETHICAL BUSINESS PRACTICE PROHIBITIONS Successful Proposer represents and warrants to the City that it has not employed or retained any person or company employed by the City to solicit or secure this Contract and that it has not offered to pay, paid, or agreed to pay any person any fee, commission, percentage, brokerage fee, or gift of any kind contingent upon or in connection with, the award of this Contract. 1.64. PROMPT PAYMENT - Proposers may offer a cash discount for prompt payment; however, discounts shall not be considered in determining the lowest net cost for response evaluation purposes. Proposers are required to provide their prompt payment terms in the space provided on the Formal Solicitation. If no prompt payment discount is being offered, the Proposer must enter zero (0) for the percentage discount to indicate no discount. If the Proposer fails to enter a percentage, it is understood and agreed that the terms shall be 2% 20 days, effective after receipt of invoice or final acceptance by the City, whichever is later. When the City is entitled to a cash discount, the period of computation will commence on the date of delivery, or receipt of a correctly completed invoice, whichever is later. If an adjustment in payment is necessary due to damage, the cash discount period shall commence on the date final approval for payment is authorized. If a discount is part of the contract, but the invoice does not reflect the existence of a cash discount, the City is entitled to a cash discount with the period commencing on the date it is determined by the City that a cash discount applies. Price discounts off the original prices quoted on the Price Sheet will be accepted from Successful Proposers during Page 21 of 66 605386,E the term of the contract. 1.65. PROPERTY -Property owned by the City of Miami is the responsibility of the City of Miami. Such property furnished to a Successful Proposer for repair, modification, study, etc., shall remain the property of the City of Miami. Damages to such property occurring while in the possession of the Successful Proposer shall be the responsibility of the Successful Proposer. Damages occurring to such property while in route to the City of Miami shall be the responsibility of the Successful Proposer. In the event that such property is destroyed or declared a total loss, the Successful Proposer shall be responsible for replacement value of the property at the current market value, less depreciation of the property, if any. 1.66. PROVISIONS BINDING -Except as otherwise expressly provided in the resulting Contract, all covenants, conditions and provisions of the resulting Contract shall be binding upon and shall inure to the benefit of the parties hereto and their respective heirs, legal representatives, successors and assigns. 1.67. PUBLIC ENTITY CRIMES -A person or affiliate who has been placed on the convicted vendor list following a conviction for a public entity crime may not submit a response on a contract to provide any goods or services to a public entity, may not submit a response on a contract with a public entity for the construction or repair of a public building or public work, may not submit responses on leases of real property to a public entity, may not be awarded or perform work as a Proposer, supplier, subcontractor, or subconsultant under a contract with any public entity, and may not transact business with any public entity in excess of the threshold amount provided in Section 287.017, for CATEGORY TWO for a period of 36 months from the date of being placed on the convicted vendor list. 1.68. PUBLIC RECORDS - Successful Proposer understands that the public shall have access, at all reasonable times. to all documents and information pertaining to City contracts, subject to the provisions of Chapter 119, Florida Statutes, and City of Miami Code, Section 18, Article III, and agrees to allow access by the City and the public to all documents subject to disclosure under applicable law. Successful Proposer shall additionally comply with the provisions of Section 119.0701, Florida Statutes, entitled "Contracts; public records". 119.071 Florida Statutes is deemed as being incorporated by reference herein, In summation it provides: Successful Proposer shall additionally comply with Section 119.0701, Florida Statutes, including without limitation: (1) keep and maintain public records that ordinarily and necessarily would be required by the City to perform this service; (2) provide the public with access to public records on the same terms and conditions as the City would at the cost provided by Chapter 119, Florida Statutes, or as otherwise provided by law; (3) ensure that public records that are exempt or confidential and exempt from disclosure are not disclosed except as authorized by law; (4) meet all requirements for retaining public records and transfer , at no cost, to the City all public records in its possession upon termination of this Agreement and destroy any duplicate public records that are exempt or confidential and exempt from disclosure requirements; (5) All electronically stored public records must be provided to the City in a format compatible with the City's information technology systems Successful Proposer's failure or refusal to comply with the provision of this section shall result in the immediate cancellation of this Contract by the City. 1.69. QUALITY OF GOODS, MATERIALS, SUPPLIES, PRODUCTS, AND EQUIPMENT- All materials used in the manufacturing or construction of supplies, materials, or equipment covered by this solicitation shall be new. The items proposed must be of the latest make or model, of the best quality. and of the highest grade of workmanship, unless as otherwise specified in this Solicitation. Page 22 of 66 605386.6 1.70. QUALITY OF WORK/SERVICES- The work/services performed must be of the highest quality and workmanship. Materials furnished to complete the service shall be new and of the highest quality except as otherwise specified in this Solicitation. 1.71. REMEDIES PRIOR TO AWARD (Sec. 18-106)- If prior to Contract award it is determined that a formal solicitation or proposed award is in violation of law, then the solicitation or proposed award shall be cancelled by the City Commission, the City Manager or the Chief Procurement Officer, as may be applicable, or revised to comply with the law. 1.72. RESOLUTION OF CONTRACT DISPUTES (Sec. 18-105) (a) Authority to resolve Contract disputes. The City Manager, after obtaining the approval of the City attorney, shall have the authority to resolve controversies between the Contractual Party and the City which arise under, or by virtue of, a Contract between them; provided that, in cases involving an amount greater than $25,000, the City Commission must approve the City Manager's decision. Such authority extends, without limitation, to controversies based upon breach of Contract, mistake, misrepresentation or lack of complete performance, and shall be invoked by a Contractual Party by submission of a protest to the City Manager. (b) Contract dispute decisions. If a dispute is not resolved by mutual consent, the City Manager shall promptly render a written report stating the reasons for the action taken by [he City Commission or the City Manager which shall be final and conclusive. A copy of the decision shall be immediately provided to the protesting party, along with a notice of such parry's right to seek judicial relief, provided that the protesting party shall not be entitled to such judicial relief without first having followed the procedure set forth in this section. 1.73. RESOLUTION OF PROTESTED SOLICITATIONS AND AWARDS (Sec. 18-104, City Code) (a) Right to protest. The following procedures shall be used for resolution of protested solicitations and awards except for purchases of goods. supplies, equipment, and services, the estimated cost of which does not exceed $25,000. Protests thereon shall be governed by the Administrative Policies and Procedures of Procurement. 1. Protest of Solicitation. i. Any prospective Proposer who perceives itself aggrieved in connection with the solicitation of a Contract may protest to the Chief Procurement Officer. A written notice of intent to file a protest shall be filed with the Chief Procurement Officer within three days after the Request for Proposals, Request for Qualifications or Request for Letters of Interest is published in a newspaper of general circulation. A notice of intent to file a protest is considered filed when received by the Chief Procurement Officer; or ii. Any prospective Proposer who intends to contest the Solicitation Specifications or a solicitation may protest to the Chief Procurement Officer. A written notice of intent to file a protest shall be filed with the Chief Procurement Officer within three days after the solicitation is published in a newspaper of general circulation. A notice of intent to file a protest is considered filed when received by the Chief Procurement Officer. 2. Protest of Award. i. A written notice of intent to file a protest shall be filed with the Chief Procurement Officer within two days after receipt by the Proposer of the notice of the City Manager's recommendation for award of Contract, which will be posted on the City of Miami Procurement Department website, in the Supplier Corner, Current Solicitations and Page 23 of 66 605386,6 Notice of Recommendation of Award Section. The notice of the City Manager's recommendation can be found by selecting the details of the solicitation and is listed as Recommendation of Award Posting Date and Recommendation of Award To fields. If "various" is indicated in the Recommendation of Award To field, the Successful Proposer must contact the buyer for that solicitation to obtain the suppliers name. It shall be the responsibility of the Successful Proposer to check this section of the website daily after responses are submitted to receive the notice; or ii. Any actual Responsive and Responsible Bidder whose Bid is lower than that of the recommended bidder may protest to the Chief Procurement Officer, A written notice of intent to file a protest shall be filed with the Chief Procurement Officer within two days after receipt by the bidder of the notice of the City's determination of non - responsiveness or non -responsibility. The receipt by bidder of such notice shall be confirmed by the City by facsimile or electronic mail or U.S. mail, return receipt requested, A notice of intent to file a protest is considered filed when received by the Chief Procurement Officer. iii. A written protest based on any of the foregoing utust be submitted to the Chief Procurement Officer within five (5) days after the date the notice of protest was filed. A written protest is considered filed when received by the Chief Procurement Officer. The written protest may not challenge the relative weight of the evaluation criteria or the formula for assigning points in making an award determination. The written protest shall state with particularity the specific facts and law upon which the protest of the solicitation or the award is based, and shall include all pertinent documents and evidence and shall be accompanied by the required Filing Fee as provided in subsection (f). This shall form the basis for review of the written protest and no facts, grounds, documentation or evidence not contained in the protester's submission to the Chief Procurement Officer at the time of filing the protest shall be permitted in the consideration of the written protest. No time Nvill be added to the above limits for service by mail. In computing any period of time prescribed or allowed by this section, the day of the act, event or default from which the designated period of time begins to run shall not be included. The last day of the period so computed shall be included unless it is a Saturday, Sunday or legal holiday in which event the period shall run until the end of the next day which is neither a Saturday, Sunday or legal holiday. Intermediate Saturdays, Sundays and legal holidays shall be excluded in the computation of the time for filing. (b) Authority to resolve protests; hearing officer (s). Hearing officers appointed by the City shall have authority to resolve protests filed under this Chapter of the City Code. The City Manager shall appoint a hearing officer, from a separate list of potential hearing officers pre -approved by the City Commission, to resolve protests filed in accordance with this Section, no later than five (5) working days following the filing of a bid protest. The hearing officer shall have the authority, to settle and resolve any written protest. The hearing officer shall submit said decision to the protesting party and to the other persons specified within ten (10) days after he/she holds a hearing under the protest. (1) Hearing officer. The hearing officer may be a Special Master as defined in Chapter 2, Article X, Sec. 2-811 of the City Code, or a lawyer in good standing with the Florida Bar for a minimum of ten (10) years with a preference given to a lawyer who has served as an appellate or trial judge. The hearing officer may be appointed from alternative sources (e.g. expert consulting agreements, piggyback contracts, etc.) where the City Commission adopts a recommendation of the City Attorney that such action is necessary to achieve fairness in the proceedings. The engagement of hearing officers is excluded from the Procurement Ordinance as legal services. The hearing officers appointed in the pre -qualified group should be scheduled to hear protests on a rotational basis. (2) Right of Protest. Any actual bidder or proposer who has standing under Florida law dissatisfied and aggrieved Page 24 of GC 605386,6 with the decision of the City regarding the protest of a solicitation or the protest of an award as set forth above in this Section may request a protest hearing. Such a written request for a protest must be initiated with a notice of intent to protest followed by an actual protest as provided in Section 18-104(a). The notice of intent to protest and the actual protest must each be timely received by the Chief Procurement Officer and must comply with all requirements set forth in Section 18-104 (a). Failure to submit the required notice of intent to protest and the actual protest within the specified timeframes will result in an administrative dismissal of the protest. (3) Hearing Date. Within thirty (30) days of receipt of the notice of protest the Chief Procurement Officer shall schedule a hearing before a hearing officer, at which time the person protesting shall be given the opportunity to demonstrate why the decision of the City relative to the solicitation or the award, which may include a recommendation for award by the City Manager to the City Commission, as applicable, should be overturned. The party recommended for award, if it is a protest of award, shall have a right to intervene and be heard. (9) Hearing Procedure. The procedure for any such hearing conducted under this Article shall be as follows: (i) The City shall cause to be served by certified mail a notice of hearing stating the time, date, and place of the hearing. The notice of hearing shall be sent by certified mail, return receipt requested. to the mailing address of the protester. (ii) The party, any intervenor and the City shall each have the right to be represented by counsel, to call and examine witnesses, to introduce evidence, to examine opposing or rebuttal witnesses on any relevant matter related to the protest even though the matter was not covered in the direct examination, and to impeach any witness regardless of which party first called him/her to testify. The hearing officer may extend the deadline for completion of the protest hearing for good cause shown, but such an extension shall not exceed an additional five (5) business days. The hearing officer shall consider the written protest and supporting documents and evidence appended thereto, supporting documents or evidence from any intervenor, and the decision or recommendation as to the solicitation or award being protested, as applicable. The protesting party, and any intervenor, must file all pertinent documents supporting his/her protest or motion to intervene at least five (5) business days before the hearing. as applicable. The hearing officer shall allow a maximum of two (2) hours for the protest presentation and a maximum of two (2) hours for the City response. When there is an intervenor, a maximum of two (2) hours will be added for the intervenor. In the event of multiple protests for the same project, the hearing officer shall allocate time as necessary to ensure that the hearing shall not exceed a total of one (1) day. (iii) The hearing officer shall consider the evidence presented at the hearing. In any hearing before the hearing officer, irrelevant, immaterial, repetitious, scandalous or frivolous evidence shall be excluded. All other evidence of a type commonly relied upon by reasonably prudent persons in the conduct of their affairs shall be admissible whether or not such evidence would be admissible in trial in the courts of Florida. The hearing officer may also require written summaries, proffers, affidavits , and other documents the hearing officer determines to be necessary to conclude the hearing and issue a final order within the time limits set forth by this section,. (iv) The hearing officer shall determine whether procedural due process has been afforded, whether the essential requirements of law have been observed, whether the decision was arbitrary, capricious, an abuse of discretion, in accordance with the law or unsupported by substantial evidence as a whole; substantial evidence means such relevant evidence as a reasonable mind might accept as adequate to support a conclusion. (v) Within ten (10) days from the date of the hearing, the hearing officer shall complete and submit to the City Manager, the City Attorney, any intervenor, the Chief Procurement Officer and the person requesting said hearing a final order consisting of his/her findings of fact and conclusions of law as to the denial or granting of the protest, as applicable. (vi) The decisions of the hearing officer are final in terms of City decisions relative to the protest, Page 25 of 66 605386,6 Any appeal from the decision of the hearing officer shall be in accordance with the Florida Rules of Appellate Procedure. (c) Compliance with filing requirements. Failure of a party to timely file either the notice of intent to file a protest or the written protest, together with the required Filing Fee as provided in subsection (f), with the Chief Procurement Officer within the time provided in subsection (a), above, shall constitute a forfeiture of such party's right to file a protest pursuant to this section. The protesting party shall not be entitled to seek judicial relief without first having followed the procedure set forth in this section (d) Stay of Procurements during protests. Upon receipt of a written protest filed pursuant to the requirements of this section, the City shall not proceed further with the solicitation or with the award of the Contract until the protest is resolved by the Chief Procurement Officer or the City Commission as provided in subsection (b) above, unless the City Manager makes a written determination that the solicitation process or the Contract award must be continued without delay in order to avoid an immediate and serious danger to the public health, safety or welfare. (e) Costs. All costs accruing from a protest shall be assumed by the protestor. (f) Filing Fee. The written protest must be accompanied by a filing fee in the form of a money order or cashier's check payable to the City in an amount equal to one percent of the amount of the Bid or proposed Contract. or $5000.00, whichever is less, which filing fee shall guarantee the payment of all costs which may be adjudged against the protestor in any administrative or court proceeding. If a protest is upheld by the Chief Procurement Officer and/or the City Commission, as applicable, the filing fee shall be refunded to the protestor less any costs assessed under subsection (e) above. If the protest is denied. the filing fee shall be forfeited to the City in lieu of payment of costs for the administrative proceedings as prescribed by subsection (e) above. 1.74. SAMPLES -Samples of items, when required, must be submitted within the time specified at no expense to the City. If not destroyed by testing, Proposer(s) will be notified to remove samples, at their expense, within 30 days after notification. Failure to remove the samples will result in the samples becoming the property of the City. 1.75. SELLING, TRANSFERRING OR ASSIGNING RESPONSIBILITIES z SuccessfulProposer shall not sell. assign, transfer or subcontract at any time during the tertn of the Contract, the Agreement itself or anv portion thereof, or any part of its operations, or assign, sell, pledge. dispose , convey or encumber any portion of the Agreement or its performance , t required by this contract, except under and by virtue of prior written permission granted by the City Manager, which may be withheld or conditioned, in the City Manager's sole discretion, As this Agreement is considered unique in nature such permission may be refused, withheld or conditioned by the City Manager. 1.76. SERVICE AND WARRANTY When specified, the Successful Proposer shall define all warranty. service and replacements that will be provided. Proposer must explain on the Response to what extent warranty and service facilities are available. A copy of the manufacturer's warranty, if applicable, should be submitted with your response. 1.77. SILENCE OF SPECIFICATIONS -The apparent silence of these specifications and any supplemental specification as to any detail or the omission from it of detailed description concerning any point shall be regarded as meaning that only the best commercial practices are to prevail and that only materials of first quality and correct type, size and design are to be used. All workmanship and services is to be first quality. All interpretations of these specifications shall be made upon the basis of this statement. If your firm has a current contract with the State of Florida, Department of General Services, to supply the items an this solicitation, the Successful Proposer shall quote not more than the contract price; failure to comply with this request will result in disqualification of Proposal. Page 26 of 66 605386,6 1.78. SUBMISSION AND RECEIPT OF RESPONSES -Responses shall be submitted electronically via the Oracle System and additionally, responsesshall be submitted in hardcopy format to the City Clerk, City Hall, 3500 Pan American Drive, Miami, Florida 33133-5509, at or before, the specified closing date and time as designated in the IFB, REP, RFQ, or RFLI. NO EXCEPTIONS. Proposers are welcome to attend the solicitation closing; however, no award will be made at that time. A. Hardcopy responses shall be enclosed in a sealed envelope, box package. The face of the envelope, box or package must show the hour and date specified for receipt of responses, the solicitation number and title, and the name and return address of the Proposer. Hardcopy responses not submitted on the requisite Response Forms may be rejected. Hardcopy responses received at any other location than the specified shall be deemed non -responsive. Directions to City Hall: FROM THE NORTH: 1-95 SOUTH UNTIL IT TURNS INTO US1. US1 SOUTH TO 27TH AVE., TURN LEFT, PROCEED SOUTH TO SO. BAYSHORE DR. (3RD TRAFFIC LIGHT), TURN LEFT, I BLOCK TURN RIGHT ON PAN AMERICAN DR. CITY HALL IS AT THE END OF PAN AMERICAN DR. PARKING IS ON RIGHT. FROM THE SOUTH: USI NORTH TO 27TH AVENUE, TURN RIGHT, PROCEED SOUTH TO SO. BAYSHORE DR. (3RD TRAFFIC LIGHT), TURN LEFT. 1 BLOCK TURN RIGHT ON PAN AMERICAN DR. CITY HALL IS AT THE END OF PAN AMERICAN DR. PARKING IS ON RIGHT. B. Facsimile responses will not be considered. C. Failure to follow these procedures is cause for rejection of bid/proposal. D. The responsibility for obtaining and submitting a response on or before the close date is solely and strictly the responsibility of Successful Proposer. The City of Miami is not responsible for delays caused by the United States mail delivery or caused by any other occurrence. Responses received after the solicitation closing date and time will be returned unopened, and will not be considered for award. E. Late or mis-delivered or incorrectly addressed responses will be rejected. F. All responses are subject to the conditions specified herein. Those which do not comply with these conditions are subject to rejection. G. Modification of responses already submitted will be considered only if received at the City before the time and date set for closing of solicitation responses. All modifications must be submitted via the Oracle System or in writing. Once a solicitation closes (closed date and/or time expires), the City will not consider any subsequent submission which alters the responses. H. If hardcopy responses are submitted at the same time for different solicitations, each response must be placed in a separate envelope, box, or package and each envelope, box or package must contain the information previously stated in 1.82.A. 1.79. TAXES -The City of Miami is exempt from any taxes imposed by the State and/or Federal Government. Exemption certificates will be provided upon request. Notwithstanding, Bidders/Proposers should be aware of the fact that all materials and supplies which are purchased by the Successful Proposer for the completion of the contract is subject to the Florida State Sales Tax in accordance with Section 212.08, Florida Statutes, as amended and all amendments thereto and shall be paid solely by the Successful Proposer. 1.80. TERMINATION - The City Manager on behalf of the City of Miami reserves the right to terminate this contract by written notice to the Successful Proposer effective the date specified in the notice should any of the Page 27 of 66 605386,6 following apply: A. A Successful Proposer is determined by the City, to be in breach of any of the terms and conditions of the contract. B. The City has determined that such termination will be in the best interest of the City to terminate the contract for its own convenience: C. Funds are not available to cover the cost of the goods and/or services. The City's obligation is contingent upon the availability of appropriate funds. 1.81. TERMS OF PAYMENT -Payment will be made by the City after the goods and/or services awarded to a Successful Proposer have been received, inspected. and found to comply with award specifications, free of damage or defect, and properly invoiced. No advance payments of any kind will be made by the City of Miami. Payment shall be made after delivery, within 45 days of receipt of an invoice and authorized inspection and acceptance of the goods/services and pursuant to Section 218.74. Florida Statutes and other applicable law. 1.82. TIMELY DELIVERY -Time will be of the essence for any orders placed as a result of this solicitation. The City reserves the right to cancel such orders, or any part thereof, without obligation, if delivery is not made within the time(s) specified on their Response. Deliveries are to be made during regular City business hours unless otherwise specified in the Special Conditions. 1.83. TITLE -Title to the goods or equipment shall not pass to the City until after the City has accepted the goods/equipment or used the goods, whichever comes first. An exception may be made for "trade secrets." If the Response contains information that constitutes a "trade secret", all material that qualifies for exemption from Chapter 119 must be submitted in a separate envelope, clearly identified as "TRADE SECRETS EXCEPTION," with your firm's name and the Solicitation number and title marked on the outside. Please be aware that the designation of an item as a trade secret by you may be challenged in court by any person. By your designation of material in your Response as a "trade secret" you agree to indemnify and hold harmless the City for any award to a plaintiff for damages, costs or attorney's fees and for costs and attorney's fees incurred by the City by reason of any legal action challenging your claim. 1.84. UNAUTHORIZED WORK OR DELIVERY OF GOODS -Neither the Successful Proposer(s) nor any of his/her employees shall perform any work or deliver any goods unless a change order or purchase order is issued and received by the Successful Proposer. The Successful Proposer(s) shall not be paid for any work performed or goods delivered outside the scope of the contract or any work performed by an employee not otherwise previously authorized. 1.85. USE OF NAME -The City is not engaged in research for advertising, sales promotion, or other publicity purposes. No advertising, sales promotion or other publicity materials containing information obtained from this Solicitation are to be mentioned, or imply the name of the City, without prior express written permission of the City Manager or the City Commission. 1.86. VARIATIONS OF SPECIFICATIONS -For purposes of solicitation evaluation, Proposers must indicate any variances from the solicitation specifications and/or conditions, no matter how slight. If variations are not stated on their Response, it will be assumed that the product fully complies with the City's specifications. Page 28 of 66 605386,6 2. SPECIAL CONDITIONS 2.1. PURPOSE The purpose of this Solicitation is to establish a contract(s), for the provision of Third Party Claims Administration andfor Managed Care Services, with a Third Party Claims Administrator, hereinafter referred to as "Successful Proposer", as specified herein, from a source(s), fully compliant with the terms, conditions, and stipulations of the solicitation. 2.2. DEADLINE FOR RECEIPT OF REQUEST FOR ADDITIONAL INFORMATION/ Any questions or clarifications concerning this solicitation shall be submitted by email or facsimile to the Procurement Department, Attn: Yadissa Calderon; fax: (305) 400-5369 or ernail: ycalderon@ci.miami.fl.us, and a copy filed with the Office of the City Clerk at clerks@nriamigov.com, pursuant to Section 1.20. Cone of Silence. The solicitation title and number shall be referenced on all correspondence. All questions must be received no later than Tuesday, November I, 2016 at 5:00 PM. All responses to questions will be sent to all prospective Proposers in the form of an addendum. NO QUESTIONS WILL BE RECEIVED VERBALLY OR AFTER SAID DEADLINE. 2.3. VOLUNTARY PRE -PROPOSAL CONFERENCE Proposers are strongly encouraged to attend theVoluntary Pre -Proposal Conference, which will occur on Wednesday, October 12, 2016, at 2:00 PM (local time), at 444 SW 2nd Avenue, 6th Floor South Conference Room, Miami, Florida. A discussion of Ole requirements of the Solicitation will occur at that time. Each Proposer is required, prior to submitting a Proposal, to acquaint themselves thoroughly with any and all conditions and/or requirements that may in any manner affect the work to be performed. No allowances will be made because of lack of knowledge of these conditions. The purpose of the Pre -Proposal Conference is to allow Proposers an opportunity to present questions to staff and obtain clarification of the requirements of the Solicitation documents. Because the City considers the conference to be critical to understanding the solicitation requirements. attendance is highly recommended. 2.4. DEFINITIONS "City Manager" shall mean the City Manager of the City of Miami who is the Chief Administrative Officer of the City. Whenever the word "City" is used, unless another body or board or commission is mentioned by name in decisions made by the City relative to this Agreement. the City shall mean the "City Manager." "Director" for purposes of this Agreement shall mean the Director of the City of Miami Risk Management Department. The City' Project Manager, may at her discretion consult with the Director about any matter regarding the Agreement, and the Director will provide her input if so requested. "City Commission" shall mean the Miarni City Commission, the municipal legislative body, ‘vho will consider the award of this Agreement and would be required to approve this Agreement. The City Commission is the only entity who may increase the funding, the budget or the moneys paid under this Agreement. 2.4.TERM OF AGREEMENT Page 29 of 66 605386,6 The Proposer(s) qualified to provide the services requested herein, shall be required to execute a Professional Services Agreement ("Agreement") with the City, which shall include, but not be limited to, the following terms: 1)The term of the Agreement shall be for three (3) years, with an option to renew for two (2) additional one (1) year periods. 2)The City Manager shall have the option to extend or terminate the Agreement. Continuation of the Agreement beyond the initial three (3) year period is a City prerogative: not a right of the Successful Proposer(s). This prerogative will be exercised only when such continuation is clearly in the best interest of the City. 3)The City Manager may cancel the Agreement for convenience on thirty (30) days prior written notice to the Successful Proposer(s), and the Successful Proposer(s) will have no recourse except to be paid its direct fees and costs incurred prior to the effective date of cancelation. 4)The Hold Harmless. Duty to Defend, Indemnity and Insurance terms and requirements provided for in this RFP. 2.5. EXECUTION OF AN AGREEMENT The Successful Proposer(s) evaluated and ranked in accordance with the requirements of this Solicitation, shall be awarded an opportunity to negotiate a Professional Services Agreement (Agreement) with the City. The City reserves the right to execute, or not execute, as applicable. an Agreement with the Successful Proposer(s) in substantially the same form as the draft Agreement attached to the Header Section of this Solicitation. Such Agreement which will be furnished by the City, will contain certain terms as are in the City's best interest, and will be subject to approval as to legal form by the City Attorney. 2.6. CONDITIONS FOR RENEWAL Each renewal of the Agreement is subject to the following: 1) Continued satisfactory performance compliance with the specifications, terms and conditions established herein. 2) Availability of funds 2.7.NON-APPROPRIATION OF FUNDS In the event no funds or insufficient funds are appropriated and budgeted or are otherwise unavailable in any fiscal period for payments due under this Agreement, then the City, upon written notice to the Successful Proposer(s) or his assignee of such occurrence, shall have the unqualified right to terminate the Agreement without any penalty or expense to the City. No guarantee, warranty or representation is made that any project(s) will be awarded to any firm (s). 2.8. MINIMUM QUALIFICATION REQUIREMENTS Proposer(s) shall satisfy each of the following requirements cited below- Failure to do so will result in the Proposal being deemed non-responsive. Page30 of 66 605386,6 A.Workers' Compensation Claims and Liability Claims Administration Proposer shall: 1)Be authorized (licensed) as a Claims Administrator by the State of Florida, as of proposal due date; 2)Have dedicated/designated adjusters in the State of Florida with a minimum of three (3) years' experience, directed bya dedicated Supervisor, with at least five (5) years' recent experience. 3)Be approved by all of the City's excess carriers; 4)Be compliant throughout the life of the Agreement and must be compliant at the time of proposal submittal, in Statement on Auditing Standard No. 70 (SAS70)/ Statement on Standards for Attestation Engagement 16 (SSAE16); 5)Have a minimum of five (5) continuous years of experience, handling Florida municipal claims, with at least one (1) client having a minimum of 1500 employees; 6)Be in full compliance with the federally -mandated State Children's Health Insurance Program (SCHIP) and Florida Electronic Data Interchange (EDI) requirements; 7)Have electronic capabilities to provide electronic reporting, transfer of data to any/all platforms as directed, and connectivity to Proposer's information system; 8)Have no record of judgments, bankruptcies, pending lawsuits against the City, criminal activities involving moral turpitude, and not have any conflicts of interest that have not been waived by the City Commission; and 9)Not be in arrears or in default of any debt or contract involving the City (as a party to a contract. or otherwise); nor have failed to perform faithfully on any previous contract with the City. This requirement applies to Proposer's principals. officers, or stockholders. B.Manal;ed Care/Medical Bill Review/Audit Services Proposers shall: ()Administer one or more national Preferred Provider Organizations (PPO) that have negotiated contract rates with hospitals and providers, in an order or priority acceptable to Risk Management. Risk Management may, at its sole discretion, disallow the use of any PPO; 2)Have a National pharmacy network; 3)Have the ability to interface with Risk Management Information System (RMIS); 4)Be available twenty-four (24) hours, seven (7) days a week; 5)Proposer's staff nurses (telephonic and onsite) shall have a minimum of five (5) to seven (7) years of experience: 6)Must comply with Florida Agency for Health Care Administration guidelines; Rule Chapter 59A-23; 7)Be required to have Utilization Review Accreditation Commission (URAC) accreditation, as of the proposal due date; 8)Telephonic Case Manager (TCM)/Nurse Case Manager (NCM)are subject to continuing education; 9)Own. management and control PPO networks (can add, remove provider at will); 10)Have a rnechanism to oversee physician/provider performance via scorecard; 11)Official Disability Guidelines (ODG)/American College of Occupational and Environmental Medicine ( ACOEM) schedules must be integrated into the rule engine of the Proposer; and Page 31 of 66 605386,6 12)Own, manage, and control Utilization Review (UR) services. 2.9.FAILURE TO PERFORM Should it not be possible to reach the Successful Proposer or representative, and/or should remedial action not be taken within 48 hours of any failure to perform according to specifications, the City reserves the right to declare Successful Proposer in default of the contract or make appropriate reductions in the contract payment. 2.10.INSURANCE REQUIREMENTS INDEMNIFICATION Successful Proposer shall pay on behalf of, indemnify and save City and its officials harmless, from and against any and all claims, liabilities, losses, and causes of action, which may arise out of Successful Proposer's performance under the provisions of the Agreement, including all acts or omissions to act on the part of Successful Proposer, including any person performing under this Agreement for or on Successful Proposer's behalf, provided that any such claims, liabilities, losses and causes of such action are not attributable to the negligence or misconduct of the City and, from and against any orders, judgments or decrees which may be entered and which may result from this Agreement, unless attributable to the negligence or misconduct of the City, and from and against all costs, attorneys' fees, expenses and liabilities incurred in the defense of any such claim, or the investigation thereof. The Successful Proposer shall furnish to the City of Miami, c/o Procurement Department. 944 SW 2nd Avenue, Gih Floor, Miami, Florida 33130, Certificate(s) of Insurance which indicate that insurance coverage has been obtained which meets the requirements as outlined below: The Successful Proposer shall, at its own cost and expense, acquire and maintain during the term of the Agreement, with carriers having an AM Best Rating of A-VII or better, sufficient insurance to adequately protect the respective interests of the parties, including the Successful Proposer's indemnity obligations. Specifically, the Successful Proposer must carry the following minimum types and amounts of insurance on an occurrence basis or in the case of coverage that cannot be obtained on an occurrence basis, then coverage can be obtained on a claims -made basis with a three (3) year tail following the termination or expiration of this Agreement: a) Commercial General Liability:Written on an occurrence form. including but not limited to premises -operations, broad form property damage, products /completed operations, contingent and contractual exposures, personal injury and advertising injury, with limits of at least $1,000,000 per occurrence and $2,000,000 general aggregate. This coverage should be written on a primary and non-contributory basis, and should list the City as an additional insured; b) Workers' Compensation Insurance:Statutory Workers' Compensation Insurance and Employers' Liability Insurance in the minimum amount of $1,000,000 each employee by accident, $1,000,000 each employee by disease and $1,000,000 aggregate by disease with benefits afforded under the laws of the state or country in which the services are to be perforated. Policy will include an alternate employer endorsement providing coverage in the event any employee of the Successful Proposer sustains a compensable accidental injury while on work assignment with Company. Insurer for Vendor will be responsible for the Workers' Compensation benefits due such injured employee: c) Commercial Automobile Liability: If an automobile is used by the Successful Proposer in connection with the performance of its obligations under this Agreement, then Comprehensive Automobile Liability Insurance for any owned, non -owned, lured, or borrowed automobile used in the performance of Successful Proposer's obligations under this Agreement is required in the minimum amount of $1.000.000 each accident combined for bodily injury and property damage. City of Miami should be listed as an additional insured; d) Professional Errors and Omissions Liability: Insurance in the minimum amount of $10,000,000 per claim and Page 32 of 66 605386,6 policy aggregate, protecting the City against Successful Proposer's professional negligence, failure to perform professional duties and breach of contractual obligations under this Agreement, including but not limited to, coverage for claims services and certification that there is no security breach or unauthorized use exclusion on this policy; e) Network Security/Privacy Liability (Cyber Liability): Insurance in the minimum amount of $5,000,000 per occurrence including but not limited to protection of private or confidential information whether electronic or non -electronic; network security and privacy liability; protection against liability for systems attacks; denial or loss of service; introduction, implantation or spread of malicious software code; security breach; unauthorized access and use; including regulatoy action expenses: cyber extortion coverage; and notification and credit monitoring expenses f) Employee Dishonesty/Fidelity: Insurance including 3rd Party Liability in the minimum amounts of$1,000,000 each occurrence for acts of all Staff: and g) Excess Umbrella Liability (Excess Follow Form):Minimum limits of $10,000,000 per occurrence/aggregate. This coverage is excess over all applicable liability policies. The above insurance limits may be achieved by a combination of primary and umbrella/excess liability policies. 1. Prior to the execution of this Agreement (or seven (7) calendar days prior to the start of work under this A greement) and annually upon the anniversary date(s) of the insurance policy's renewal date(s), the Successful Proposer will furnish the City with a Certificate of Insurance evidencing the coverages set forth above and naming the City, its subsidiaries, affiliates, authorized distributors, directors, officers, employees, partners and agents as an "Additional Insured" on the Successful Proposer's Commercial General Liability and Commercial Auto Liability policies listed above and natne the City, its subsidiaries, affiliates, authorized distributors, directors, officers, employees, partners and agents as a "Loss Payee" on the Successful Proposer's Fidelity policy. 2. The Successful Proposer shall provide the City thirty (30) calendar days written notice of any cancellation, non -renewal, termination, material change or reduction in coverage, 3. The Successful Proposer's insurance as outlined above shall be primary and non-contributory coverage. 4. The coverage territory for the stipulated insurance shall be on a worldwide basis. 5. The Successful Proposer must ensure that any subcontractors or other service providers the Successful Proposer engages to provide the services required under this Agreement, acquire and maintain at all tunes, with insurance companies with a minimum A.M. Best Rating A-VII, the same levels of insurance coverage as are outlined above. The Successful Proposer and subcontractors of the Successful Proposer, will cause their insurance companies to waive their right of recovery against the City. 6. The stipulated limits of coverage above shall not be construed as a limitation of any potential liability to Company, and failure to request evidence of' this insurance shall not be construed as a waiver of the Successful Proposer's obligation to provide the insurance coverage specified. BINDERS ARE UNACCEPTABLE. The insurance coverage required shall include those classifications, as listed in standard liability insurance manuals, which most nearly reflect the operations of the Successful Proposer. All insurance policies required above shall be issued by companies authorized to do business under the laws of the State of Florida, with the following qualifications: Certificates will indicate no modification or change in insurance shall be made without thirty (30) days written advance notice to the certificate holder. Page 33 of 66 605386.6 NOTE: CITY RFP NUMBER AND/OR TITLE OF RFP MUST APPEAR ON EACH CERTIFICATE, AND THE CITY MUST BE LISTED AS THE INSURED AND/OR ADDITIONAL INSURED. Compliance with the foregoing requirements shall not relieve the Successful Proposer of his liability and obligation under this section or under any other section of this Agreement. --If insurance certificates are scheduled to expire during the contractual period, the Successful Proposer shall be responsible for submitting new or renewed insurance certificates to the City at a minimum of ten (10) calendar days in advance of such expiration. --In the event that expired certificates are not replaced with new or renewed certificates which cover the contractual period, the City shall: (a) Suspend the Agreement until such time as the new or renewed certificates are received by the City in the manner prescribed in the RFP. (b) The City may. at its sole discretion, terminate this Agreement for cause and seek re -procurement damages from the Successful Proposer in conjunction with the General and Special Terms and Conditions of the solicitation. The Successful Proposer shall be responsible for assuring that the insurance certificates required in conjunction with this Section remain in force for the duration of the contractual period; including any and all option terms that may be granted to the Successful Proposer. 2.11.PROJECT MANAGER, CITY MANGER, DIRECTOR, CITY COMMISSION Upon award, Successful Proposer shall report and work directly NA ith Ms. Angella Breadwood, Claims Manager, Risk Management Department, who shall be designated as the City Project Manager, for purposes of day to day administration of this Agreement. 2.12,SUBCONTRACTOR(S) OR SUBCONSULTANT(S) A subconsultant, herein referred to as subcontractor, is an individual or firm contracted by the Successful Proposer or Successful Proposer's firm to assist in the perforrance of services required under this Solicitation. A subcontractor shall be paid through Successful Proposer or Successful Proposer's firm and not paid directly by the City. Subcontractors are allowed by the City in the performance of the services delineated within this Solicitation. Proposer must clearly reflect in its Proposal the major subcontractor(s) to be utilized in the performance of required services, The City retains the right to accept or reject any subcontractor(s) proposed at time of proposal submittal or prior to contract execution. Any and all liabilities regarding the use of subcontractors shall be borne solely by the Successful Proposer and insurance for each subcontractor must be maintained in good standing and approved by the City throughout the duration of the Agreement. Neither Successful Proposer nor any of its subcontractors are considered to be employees or agents of the City. Failure to list all subcontractors, and provide the required information, may disqualify any proposed subcontractors) from performing work under this Solicitation. Proposers shall include in their proposal the requested subcontractor(s) information and include all relevant information required of the Proposer. In addition, within five (5) working days after the identification of the award to the Successful Proposer(s), the Successful Proposer(s) shall provide a list confirming the subcontractors that the Successful Proposer(s) intends to utilize in the Agreement, if applicable. The list shall include, at a minimum, the name, location of the place of business for each subcontractor, the services subcontractor will provide relative to any contract that may result from this Solicitation, any applicable licenses, references. ownership, and other information required of Successful Proposer(s). 2.13.TERMINATION Page 34 of 66 605386.6 A. FOR DEFAULT If the Successful Proposer defaults in its performance under the Agreement and does not cure the default within thirty (30) clays after written notice of default, the City Manager may terminate the Agreement. in whole or in part, upon written notice without penalty to the City of Miami. In such event the Successful Proposer shall be liable for damages including the excess cost of procuring similar supplies or services: provided that if, (1) it is determined for any reason that the Successful Proposer was not in default or (2) the Successful Proposer failure to perform is without his or his subcontractor's control, fault or negligence, the termination will be deemed to be a termination for the convenience of the City of Miami. B. FOR CONVENIENCE The City Manager may terminate this Agreement, in whole or in part, upon thirty (30) days prior written notice, when it is in the best interest of the City. If the Agreement is for supplies, products, equipment, or software, and so terminated for the convenience by the City the Successful Proposer will be compensated in accordance with an agreed upon adjustment of cost. To the extent that the Agreement is for services and so terminated, the City of Miami shall be liable only for payment in accordance with the payment provisions of the Agreement for those services rendered prior to termination. 2.14. PRIMARY CLIENT (FIRST PRIORITY) The Successful Proposers) agree upon award of this Agreement that the City shall be its primary client, and shall be serviced first during a schedule conflict arising between this Agreement, and any other contracts Successful Proposer(s) may have with any other cities and/or counties to perform similar services, as a result of any catastrophic events such as tornadoes, hurricanes, severe storms or any other public emergency impacting various areas during or approximately the same time. 2.15. UNAUTHORIZED WORK The Successful Proposer(s) shall not begin work until a Purchase Order and/or a Notice to Proceed is received. 2.16.CHANGES/ALTERATIONS Proposer may change or withdraw a proposal at any time prior to proposal submission deadline; however, no oral modifications will be allowed. Written modifications shall not be allowed following the proposal submission deadline. 2.17. COMPENSATION PROPOSAL Price must be submitted on the Price Proposal Form, Attachment B, as provided. See Header Section of the RFP for the form. Proposer(s) may submit a proposal for one and/or both category of services. Refer to Section 3,1, Background. In the event a Proposer is submitting a proposal for both categories of services, a separate Price Pro posal Form is required for each category of service. Proposer shall detail any and all fees and costs to provide the required services as listed below. and in accordance with the Submission Requirement for each of the category of service Proposer is submitting a proposal for. Part I - Third Party Claims Administration a.workers compensation claims b.Iiability claims including; i.Automobile (AL) ii. General liability (GL) iii. Employment practice liability iv. Law enforcement liability Page 35 of 66 605386.6 v. Public Officials liability Part II - Managed Care/Medical Bill Review Services Proposer shall additionally provide a detailed list of all costs to provide all services as detailed in Section 3, Scope of Services, as proposed. Failure to submit compensation proposal as required,may disqualify Proposer from consideration. Proposer shall submit a guaranteed, all-inclusive annual fee as previously detailed. This fee is to represent all claims, administrative, and Toss data fees. Proposed rates are to be guaranteed annual fees for the initial three (3) years, and for the two (2) option to renew years, as opposed to per claim time and expense or any other fee proposal. Proposals not containing an all-inclusive guaranteed annual fee for initial three (3) years and two option to renew years. for all specified services, will not be considered. The pursuit of subrogation and recovery from the Special Disability Fund is to be included in the Proposers annual fee, Clearly indicate any charge not included in the proposed annual fee. A flat rate is desirable, with no charges for duplicates and for bill review at fee schedule or UC only for reductions after. Proposer shall provide prices in U.S dollars for the required services. It is important that Proposer outline features of the Proposal, such as value-added product(s) and/or service(s) that would not normally be addressed in a pricing evaluation, as they are of a non -monetary nature. As such, Proposer should include any relevant services or products that will be provided to the City which are not priced in its Proposal, but which will enhance the acquisition process. Proposer shall be responsible for indicating in its Proposal the cost, if any, of assuming these prior claims and data conversion and whether it is a one-time charge or an annual charge. As the current Proposer utilizes an on-line claim processing system where all data is maintained, updated and payments are issued, the Successful Proposer(s) must provide the City with a bank reconciliation tape and a tape to interface with the City's financial information. The Successful Proposer(s) wilt include in its costs for the provision of an enhanced system and for the conversion of any data necessary. The City's proposed performance guarantee may be negotiated with the City. Provide any and all additional costs, item by item, as identified by Proposer in any other area not previously discussed and detail what those additional costs, if applicable, would entail. Include which entity (Proposer or City) that will be responsible for payment of those costs. 2.18.EVALUATION/SELECTION PROCESS AND CONTRACT AWARD The procedure for response evaluation, selection, and award is as follows: (1) Solicitation issued; (2) Receipt of proposals; (3) Opening and listing of all proposals received; Page 36 of 66 605386.6 (4) The Department of Procurement (Procurement) staff will review each proposal for compliance with the proposal submission requirements of the solicitation, including verifying that each proposal includes all documents required; (5) An Evaluation Committee, appointed by the City Manager, comprised of appropriate City staff and members of the community, as deemed necessary, with the appropriate technical expertise and/or knowledge, shall meet to evaluate each proposal in accordance with the requirements of this solicitation and based upon the evaluation criteria as specified herein; (6) The Evaluation Committee (Committee) reserves the right, in its sole discretion, to request Proposers to make oral presentations before the Committee as part of the evaluation process. The presentation may be scheduled at the convenience of the Committee and shall be recorded; (7) The Committee reserves the right to rank the proposals and shall submit its recommendation to the City Manager for acceptance. If the City Manager accepts the Committee's recommendation, the City Manager's recommendation for award of contract will be posted on the City of Miami Procurement Department website. in the Supplier Corner, Current Solicitations and Notice of Recommendation of Award Section. The notice of the City Manager's recommendation can be found by selecting the details of the solicitation and is listed as Recommendation of Award Posting Date and Recommendation of "Award To" fields. If "various" is indicated in the Recommendation of Award To" field, the Proposer must contact the Procurement Contracting Officer for that solicitation to obtain the suppliers names. The City Manager shall make his recommendation to the City Commission requesting the authorization to negotiate and/or execute an Agreement with the recommended Proposer(s). No Proposer(s) shall have any rights against the City arising from such negotiations or termination thereof: (8) The City Manager reserves the right to reject the Committee's recommendation, and instruct the Committee to re-evaluate and make another recommendation, reject all proposals, or recommend that the City Commission reject all proposals; (9) The City Manager will negotiate a final Agreement with the Successful Proposer, which will be presented to the City Commission; (10) The City Commission may review, consider and approve the negotiated Agreement Ivith the Successful Proposer(s). 2.19.ADDITIONAL SERVICES Services not specifically identified in this request may be added to any resultant Agreement upon successful negotiation and mutual consent of the contracting parties. The City reserves the right to add or delete any service(s), at any time. Should the City determine to add an additional service(s) for which pricing was not previously secured, the City shall ask the Successful Proposer to provide reasonable cost(s) for same. Should the City determine the pricing unreasonable, the City reserves the right to negotiate cost(s) or seek another firm/entity for the provision of said service(s). 2.20. RECORDS During the Agreement period, and for a least five (5) subsequent years thereafter, Successful provide City access to all files and records maintained on the City's behalf. 2.21.AMENDMENTS TO THE CONTRACT The City Manager shall have the right and authority to amend and execute any necessary modifications to this Agreement on behalf of the City, in a form acceptable to the Office of the may be necessary for said purpose. Proposer(s) shall amendments and City Attorney, as Page 37 of 66 605386,6 2.22. TRUTH IN NEGOTIATION CERTIFICATE Execution of the resulting Agreement by the Successful Proposer shall act as the execution of truth -in -negotiation certificate stating that wage rates and other factual unit costs supporting the compensation of the resulting Agreement are accurate, complete. and current at the time of contracting. The original contract price and any additions thereto shall be adjusted to exclude any significant sums by which City determines the contract price was increased due to inaccurate. incomplete, or non -current wage rates and other factual unit costs. All such contract adjustments shall be made within one (1) year following the end of the Agreement term. 2.23.ADDITIONAL TERMS AND CONDITIONS No additional terms and conditions included as part of your solicitation response shall be evaluated or considered, and any and all such additional terms and conditions shall have no force or effect and are inapplicable to this solicitation. If submitted either purposely, through intent or design, or inadvertently, appearing separately in transmittal letters, specifications. literature, price lists or warranties. it is understood and agreed that the General Conditions and Special Conditions in this solicitation are the only conditions applicable to this solicitation and that the Proposer's authorized signature affixed to the Proposer's acknowledgment form attests to this. If a Professional Services Agreement (PSA) or other Agreement is provided by the City and is expressly included as part of this solicitation, no additional terms or conditions which materially or substantially vary, modify or alter the terms or conditions of the PSA or Agreement, in the sole opinion and reasonable discretion of the City will be considered, Any and all such additional terms and conditions shall have no force or effect and are inapplicable to this PSA or Agreement. 2.24.ATTACHMENTS TO RFP A.Exhibit 1: Third Party Claim Administration Contract with current Claim Administrator, Gallagher Bassett Services, Inc. (Gallagher); and B.Exhibit 2: Labor Agreements with the following: I (a) Fraternal Order of Police (FOP): 1(b) International Association of Fire Fighters (IAFF): 1(c) American Federation of State, County and Municipal Employees 79 (AFSCME): 1(d) American Federation of State County and Municipal Employees (AFSCME). All attachments can be found in the Header Section of this Solicitation. Page 38 of 66 605386,6 3. Specifications 3.1. SPECIFICATIONS/SCOPE OF WORK 3.1BACKGROUND The Department of Risk Management (Risk Management) provides optimum service to employees and the public through a variety of interrelated health, safety and liability/loss control programs. The prevision of these crucial prevention -oriented programs greatly enhances the working environment and serves as an incentive for employee recruitment, retention and satisfaction, while protecting the City's assets, employees and citizens. Its objectives include goals to eliminate, where possible, the threat of accident and other forms of liability, and where it is possible to eliminate the risk, to at the very least, reduce the possibility of an accident or risk occurring. Currently, the City has approximately 4,141 full time employees, which include Law Enforcement officers, fire personnel, solid waste collectors, parks personnel. and does not include seasonal employees. There are four (4) Labor Unions in the City: ()Fraternal Order of Police (FOP); 2)American Federation of State County and Municipal Employees (AFSCME); 3)International Association of Fire Fighters (IAFF); and 4)American Federation of State, County and Municipal Employees 79 (AFSCME). Labor Unions represent eighty-five percent (85%) of the City's workforce. The City has created and maintains a Self -Insurance program which provides protection to the City for all property and casualty loss exposures. workers' compensation claims, and provides group health benefits to active and retired employees. In addition, Risk Management monitors the City's injured workers. Attention is focused in the areas of safety awareness, prevention, treatment of injured workers, rehabilitation, job placement. education, and communications with the employees and the departments. Guidelines for the treatment and care of injured employees are based on Chapter 440, Florida Statutes, which governs the State's requirements for the provision of Workers' Compensation benefits. However, as a result of bargaining agreements, additional benefits may be due depending on the bargaining unit. The Successful Proposer(s) mist become familiar with the existing labor agreements (attached in the Header Section of this Solicitation). The City's current Third Party Claims Administrator, Gallagher Bassett Services, Inc. (Gallagher), utilizes Risx Facs claim processing system where all data is maintained, updated, and payments are issued. The adjudication of workers' compensation medical bills and payments to the City's providers are performed through this system. Claims administration under this RFP, will include the takeover of current claims from Gallagher. The City seeks a Claims Administrator to provide the best quality claims services and the most reliable and valid data possible using the most useful, user-friendly claim systems available. The City uses in-house counsel on all litigated claims. as necessary. Risk Management works closely with the City's Attorney Office in a best -practices approach to manage litigated claims. The City is focused on the management of all claims, but has a laser focus on Workers Compensation claims as they represent approximately 80% of the City's annual claims cost. A Return to Work program is being implemented as the City recognizes that prompt return to work aids in controlling claims costs. Individual department heads are directly responsible for claims occurring in their departments, as claims cost are allocated by department. Therefore, each department is highly motivated to support effective loss control, safety, and liability and workers compensation claim management. Page 39 of 66 605386,6 The City utilizes a 24/7 claims intake center. This type of system facilitates expedited handling, in order to process and close claims in the most efficient manner, for the benefit of the employees. Due to the City's Fire and Police operations, the City has devoted significant resources and has been and remains focused on managing presumption -related Workers Compensation claims. The City has never lost a litigated presumption case, and the rate of presumption claim denial is eighty-five percent (85%). Close attention is also paid to closure rates and sound reserving practices. The partnership between Risk Management, the City`s legal department, and outside counsel where needed, is unique and also quite effective. Case law is closely monitored and utilized to most effectively handle each situation. The City experiences approximately 756 claims per year on average. The ratio of medical only to loss time case is 40:60, i.e. forty percent (40%) medical only, and sixty percent (60%) loss time. Of the approximate 4,141 full-time City employees, the following generally represents the location of their residences: REGION 1 REGION 2 COUNT (*) Broward FL 606 Collier FL 1 Lee FL 2 Leon FL 1 Martin FL 1 Miami -Dade FI_ 35099 Palm Beach FL 16 Seminole FL 1 St. Lucie FL 3 Bronx FL 1 The City is soliciting for two (2) Category of Services: Part I - Workers' Compensation Claims and Liability Claims Administration; and Part II L Managed Care/Medical Bill Review. Proposers may submit a proposal for either Part I: Workers' Compensation Claims and Liability Claims Administration, and/or Part II - Managed Care/Medical Bill Review. Proposals will receive a separate score, in each Category of Service for which a proposal is submitted. Proposals will be ranked on a Category of Services basis. For example. proposals submitted for Part 1, Workers' Compensation Claims and Liability Claims Administration, will only be ranked against other proposals submitted for the Workers' Compensation Claims and Liability Claims Administration. 3.2 CITY'S CLAIM EXPERIENCE Below is the City's Claims experience by years: Page40of66 605386,6 Table No. 1 Policy Year GL Auto BI/PD APD POL & ELL WC LEL Total 10/1/10 - 9/30/11 300 355 113 8 821 42 1639 10/1/11 - 9/30/12 410 421 84 2 748 39 1704 10/1/12 - 9/30/13 419 433 87 0 795 34 1768 10/1/13 - 9/30/14 412 355 109 3 680 26 1585 10/1/14 - 9/30/15 351 270 68 1 765 14 1469 2010 - 2014 (Average) 378 367 92 4 762 31 1633 Table No. 2 Policy Year GL Auto BI/PD APD POL & ELL WC LEL Total 10/1/10 - 9/30/11 $566,237 $659,129 $201,201 $618,715 $6,848,127 $2,490,514 $11,383,923 10/1/11 - 9/30/12 $712,157 $1,725,636 $147,499 $0 $6,215,610- $235,809 $9,036,711 10/1/12 - 9/30/13 $1,154,438 $707,976 $134,866 $0 $6,666,574 $512,050 $9,175,903 10/1/13 - 9/30/14 $664,786 $610,034 $218,272 $38,000 S6,435,261 $331,468 $8297,820 10/1/14 - 9/30/15 $546,951 $1.052,972 $122,527 $1,000 $4,773,880 $101,680 $6,599,010 2010 - 2014 (Average) $728,914 $951,149 $164,873t $164,429 $6.187,890 $734,304 $8,898,673, Table No. 3 Policy Year Indemnity Medical Total 10/1/10 - 9/30/11 447 374 821 10/1/11 - 9/30/12 444 304 748 10/1/12 - 9/30/13 549 246 795 10/1/13 - 9/30/14 445 235 680 10/1/14 - 9/30/15 504 261 765 2010 - 2014 (Average) 478 284 762 3.3 PART 1 - WORKERS COMPENSATION CLAIMS AND LIABILITY CLAIMS ADMINISTRATION 3.3.1:WORKERS COMPENSATION CLAIMS ADMINISTRATION The Successful Proposer(s) shall be responsible for performing at a minimum, the following services: 1. Establish reporting procedures which are compatible with the needs and organizational structure of the City as determined by Risk Management. Notice of injury report will be submitted by the City. to the Successful Proposer in paperless format (i.e. internet or email). 2. Establish claims acknowledgement procedures to the City's satisfaction. 3. Provide all necessary forms and instructions for use. Such forms shall include appropriate first reports of injury with mailing address of claim administrator pre-printed thereon. These forms shall be provided electronically if requested. The cost of providing these forms shall be included within the proposed price. 4, Develop a cost effective staffing structure to include the number of adjusters, designated to appropriately Page 41 of 66 605386.6 handle the City's claims. The City reserves the right to negotiate and approve the final staffing plan and any cost associated with the changes. In addition, the City will have the right to request removal of personnel assigned to the City's Agreement. Removal will take effect within thirty (30) days of written request by the City. 5. Provide a dedicated Claims Supervisor to be assigned exclusively to the City's contract. 6. Receive and examine on behalf of the City all reports of employee injury claims. 7. Establish and maintain complete files on each claim. 8. Accept or deny all reported claims for employees' injuries on behalf of the City in accordance with the applicable workers compensation law. The decision to controvert a claim must first be discussed with and approved by Risk Management and/or the Office of the City Attorney. 9. Conduct the required investigations deemed necessary, as it relates to Workers Compensation, including scene investigations, and personal claimant contact on all lost time or light duty cases. Contact with claimants must be attempted within twenty-four (24) hours of the Successful Proposer's receipt of the claim. Field investigations and claimant contact must be performed by employees of the Successful Proposer. Independent adjusters shall not be used to provide this service. 10. Perform job site visits, to become familiar with exposures unique to the City. 11. Provide a report to the City's Project Manager, every thirty (30) days, indicating all employees who are losing time or working in a light duty or restricted capacity. 12. Submit a full summary to Risk Management and/or the office of the City Attorney [where legal review or litigation has commenced], every ninety (90) days, on all claims of the following types; a.any claim in which an employee is not working full duty; b.total incurred claim value exceeding $2,000; c.potentially controverted cases; d.cardiovascular claims; and e.claims in which settlement (washout) is recommended. 13. Prepare, and maintain files necessary for legal defense of claims and/or other litigation (such as actions for subrogation), or other proceedings. 14. Pay in a timely fashion(within 30 days) all claims and expenses from the loss fund account established by the City. which will be maintained by the Successful Proposer. Fees and civil penalties for late payments are to be paid by the Successful Proposer unless caused due to late reporting by the City. 15. Pursue all possibilities of subrogation from third parties and recovery from Special Disability Trust Fund [SDTF] and report such activities in the time, manner and method, as deemed necessary by the City and/or the Office of the City Attorney [where legal review or litigation has commenced]. 16. While the Office of the City Attorney will designate the attorney(s) that provide the defense of claims, as well as litigation strategy. the Successful Proposer shall provide the City's defense attorney(s) a complete copy of the file in question and monitor and actively participate in the activities of the City's defense attorney(s). 17. The Successful Proposershall attend Workers Compensation hearings, mediations, and pension board hearings involving work -related injuries, as requested by the City. 18. Make written recommendations to Risk Management regarding any procedures or condition that should be examined to prevent future claims. which are revealed during the Successful Proposer's investigation of a claim. 19. Contact Risk Management by telephone on all claims where the compensability or the relatedness of the medical expenses on the claim is in question, and conduct such investigation, or such additional investigation. as deemed necessary by Risk Management or the Office of the City Attorney. Page 42 of 66 605386.6 20. Contact employees who experience loss time at least every two (2) weeks, for the duration of temporary total disability payments. When an employee is represented, the City attorney shall be contacted when appropriate. If City attorney contact is appropriate, that contact should be on a sixty (60)-day basis. 21. Report all lost time and/or questionable cases to the Index Bureau. All lost time shall be re -indexed every six (6) months. 22. Establish initial reserves within ten (10) days of the first report of the claims being reported. All files must be reserved adequately to extend through the expected life of the claim. Although all the necessary facts may not be available at the onset of a claim, reserves should be adjusted when medical information or investigation indicates the existing reserve is inadequate or overstated. The following factors shall be considered when establishing reserve: a.the injury; b.the investigation; c.medical treatment and costs; d.projected temporary total disability benefits to be paid; e.projected permanent partial disability and impairment benefits; and f.potential use of outside experts (rehabilitation service providers, attorneys, etc.).; 23. The Successful Proposer shall review the adequacy of reserves at least every three (3) months, and document the file accordingly. 24. Present in writing all settlements to Risk Management and the Office of the City Attorney for approval, regardless of the amount. The injured employee will not be contacted regarding settlement until approval of proposed settlement is obtained from Risk Management and/or the Office of the City Attorney. 25. Follow all Division of Workers' Compensation (DWC) rules when compensation, medical, or other benefits are being controverted. The case must be discussed with Risk Management before the claim is denied and/or the Office of the City Attorney, where legal review or litigation has commenced. 26. Obtain medical reports as necessary, in such manner as approved by Risk Management and the Office of the City Attorney to determine the status of the employee's injury and to verify disability. 27. Report all claims involving a fatality to Risk Management and the Office of the CityAttorney immediately. Payments on these and all other Workers' Compensation matters shall be made in accordance with the Florida Workers' Compensation law and or governing contractual agreements. Periodic activity/status checks shall be performed to ensure that dependents who receive survivor's benefits are still eligible to receive them, and notify Risk Management regarding those activity checks. The Office of the City Attorney shall be notified on litigated cases, or cases where legal review has commenced. 28. Prepare and file with the appropriate State agency all applications required for the City's qualification as a self -insurer. 29. Prepare, maintain and file all records and reports as may be required by legal authorities (State, local and Federal). Attach copies of reports. 30. Prepare, maintain and file statistical information required by Workers' Compensation Rating Bureaus, including all required data necessary for the promulgation of experience modifications. 31. Review for accuracy and approve the appropriateness of State assessments, prior to the due date of the assessment. 32. Establish an interest bearing bank account to make claim. indemnity, expense, and legal payments on checks drawn from this account. It is understood that all funds in this account are City funds and shall be returned upon the City's request or the termination of the Agreement. Regarding this account. the Successful Proposer shall: Page 43 of 66 605386,6 a.Reconcile on a monthly basis, the account and provide all monthly bank statements to the City, along with a request for a deposit from the City to maintain the balance needed in the account, as determined by the City. b.Ensure that any interest earned on the account be applied to reducing the subsequent monthly deposit by the City. c.Submit a monthly statement including the following: i, balance at inception; if. total disbursements by date and claimant; 111. balance at closing; and iv. amount of deposit required. d.List all checks along with all statements supplied to the City. 33. Successful Proposer shall provide to the City, bank account transactions and other information, additionally or in lieu of, on-line or via other means for "'real-time" access by the City 34. Ensure that all adjusters handling City's cases are kept abreast of the Workers' Compensations Statutes, DWC rules, and applicable laws. 35. Ensure that the minimum standards of performance of Successful Proposer's personnel conform to the Florida statutes and administrative rules or future changes, if any, 36. Ensure all DWC filings, including compromise settlement agreement payments. are made in a correct and timely manner. 37. Provide notification of suit being filed against the City for any reason, to the Office of the City Attorney, and to Risk Management with twenty-four (24) hours of suit being filed. 38. Aggressively pursue recoveries to the satisfaction of the City, including recoveries based on subrogation and SDTF. As regards to subrogation recoveries involving injuries to the claimant caused by third parties. the Successful Proposer acknowledges that such recoveries may include reductions in future workers' compensation benefits as provided by Florida Workers' Compensation Law based on formulas provided in Chapter 440 and case law interpreting such law, and shall be responsible for documenting and collecting such recoveries from health care providers and the claimant as mutually agreed upon by the claimant and the City upon the claimant's recovery from the third party[iesj. 39. The Successful Proposer will pursue, track, and provide quarterly reports on all SDTF, as well as subrogation recoveries in such manner as deemed necessary by the City Attorney or designee. 40. Be responsible for data integrity. This includes properly inputting all cause codes, location codes, loss description, and other claims information. If a data conversion is involved the Successful Proposer must attest to the integrity of the combined data. 41. Obtain the approval of Risk Management and/or the Office of the City Attorney [where legal review or litigation have commenced] to hire experts in connection with claims against the City. Experts include, but are not limited to, accident reconstruction engineers and experts, medical and rehabilitation vendors and private investigators. 92. Provide the means for the City to perform claims status inquiries. 93. Provide training for supervisory personnel of the City for those individuals responsible for Workers Compensation activities. 44. Comply with all applicable laws and regulations regarding the administration of Workers Compensation benefits. 45. Provide and integrate successfully. an online claims management system that interfaces with all other existing systems to be utilized in the performance of this scope of work. Page 44 of 66 605386,6 46. Work closely with the "safety team" to enhance the Safety Program to reduce claims on an annual basis. 47. Assist in the implementation of the City's Return to Work Program. 48. Provide to the City a performance guarantee, to be negotiated with the City. A.HEARINGS CONFERENCES/TRIALS The Successful Proposer shall ensure that the following requirements for hearing conferences/trials are followed: 1. Pre -hearing or pre-trial reports shall be submitted by the Successful Proposer to the Office of the City Attorney at least two weeks prior to the hearing conference/trial or whenever requested by the Office of the City Attorney. Periodic up -dates on ongoing litigation, as well as provision and inspection of file materials kept by the Successful Proposer by the City Attorney or designee, will be scheduled by the Office of the City Attorney as needed. 2. Reports must contain all information pertinent to the file including transcribed statements and depositions. 3. The Successful Proposer shall obtain settlement authority from the City prior to any hearing conference/trial. 4. Any recommendations made by the Successful Proposer, pertaining to the file should be carried out or referred to Office of the City Attorney. B.REPORTING REQUIREMENTS 1. Successful Proposer shall make an immediate report to the Risk Management Director or designee on: a.fatalities; and b.catastrophic occurrences with potential exposure $50,000 for more. 2. Submit "full captioned reports" N-vithin thirty (30) days of setting reserves at or above $25,000. The content of the "full captioned reports" shall include, not limited to, the following; a.coverage items; b,employee's background; c.dependents; d.employee's job description; e.occurrence: [injury; g.medical management; h.wage and compensation rates: i.dates and periods of disability: j.r'ehabilitation; k.other employee benefits; /.litigation; m.indexlstate filings: n.subrogation; o.remarks and/or recommended actions: and p.strategy for resolution. 3. Submit "full -captioned report'" on all files in litigation. Provide copies of all pleadings along with the report. 4. Ensure that follow-up reports are received within ninety (90) days of the "full -captioned report". 5. Submit monthly experience/statistical reports which shall include, but are not limited to, a summary of experience by department stating cause of accident, frequency and cost. Open and closed claims shall include specific information on the accident date. claimant's name, cause of accident, injury type. amount paid and reserved, and state if the claim is open or has been finalized. These reports must be delivered by the loth of each month, and must provide summary information by department, by participant, and by total program. Page 45 of 66 605386.6 6, Become familiar with existing labor agreements, and report all activities pursuant to those Agreement to the Risk Management Director or designee as requested, at least on a monthly basis, or as required by the City. 7. Provide the necessary reports and/or data to satisfy Florida's self-insurance requirements. Required forms shall be completed by the Successful Proposer and sent to the City for review and appropriate signatures, Required self-insurance reports shall be provided on a timely basis so that the City will have sufficient time to review and execute the documents before the due date. 8. Provide any report(s) requested by the Risk Management Director, Successful Proposer's system shall have the ability to run ad hoc queries. C. "BAD FAITH" PROCEDURES The following procedures shall be followed to avoid potential actions for breach of good faith and fair dealings; 1. Termination of weekly benefits; Weekly benefits may be terminated only upon written or verbal notification by the treating physician or the City when employee returns to work. If return to work information is obtained verbally, the Successful Proposer must follow up in writing with a request for written verification. If treating physician releases the employee to modified work, the Successful Proposer must promptly determine if modified work is available and offered to the employee before benefits are terminated, 2. Controverting claims: The Successful Proposer shall contact the City prior to formally denying a claim. This will not be necessary when controverting the reasonableness and necessity of medical bills. 3. Judgments/settlements: Judgments/settlements should release potential future "bad faith" actions. 4. Penalties and fines: Penalties and fines assessed by the DWC shall be paid by the Successful Proposer if such fines and penalties result from negligent performance of its duties D. PERFORMANCE STANDARDS: WORKERS' COMPENSATION The City performs annual performance standards audit based on the following: Successful Proposer will document all new claim information received from the City, and this information will be available within one (1) hour of receipt, if received during normal business hours, or within the first business hour of the next business day, if received less than one (1) hour before the close of a business day. File shall include First Report of Injury form. 2. A minimum of "three (3) attempts" by the Successful Proposer, to contact the appropriate parties, will be considered a "contact", if followed with the appropriate correspondence within the measurement period. For a workers' compensation claim, three (3) point contacts will be required (claimant, supervisor and treating provider). For a liability claim, two (2) point contacts will be required (claimant and reporting City Supervisor, if applicable) . 3. Successful Proposer shall document, and provide Risk Management written notice of, subrogation, contribution, and/or coordination of benefits recovery potential, as they develop, If a Successful Proposer decides not to pursue any such recovery, Successful Proposer must give written notice to Risk Management of its decision within fourteen (14) days of claim receipt. 4. For Workers' Compensation claim, within fourteen (14) days of receipt of the claim, the claims adjuster will perform a three point contact, send appropriate notification packages to the claimant. as required by Chapter 440, review the claimant's pre -employment physical. and document the Successful Proposer's analysis of the compensability of the claim. Page 46 of 66 605386.6 For liability claims, within fourteen (14) days of receipt of the claim, the Successful Proposer will document appropriate specific directions for the investigation and handling of the case. 5. Within 72 hours of receipt of the claim, initial reserves for the file will be set, thereafter, reserves will be reviewed on an on -going basis, as follows: a.30 days from 72 hour review; b.30 days from 30 day review; c.60 days from last 60 day review; and d.Every 6 months thereafter. Increase or decrease of reserves by $10,000 or more, requires notification to Risk Management. Subsequent to notification, Risk Management reserves the right to discuss the case and request a reconsideration of the reserve of the Successful Proposer. 6.Successful Proposer shall "address" litigation within two (2) days of receipt of litigation notification, or less than two (2) days as requested by the Office of the City Attorney if a shorter deadline is deemed legally necessary by the Office of the City Attorney. This will mean notice of to Risk Management, and referral to the Office of the City Attorney for assignment, within two (2) days, or perhaps less than two (2) days, if requested by the Office of the City Attorney. 7. Required status reports shall be provided to the Risk Management Administrator or designee. Required status reports are outlined in Attachment A, Proposer Supplemental Questionnaire. 8. Settlement evaluation shall be provided to the Office of the City Attorney and Risk Management 30 days prior to mediation. The Successful Proposer shall evaluate, or cause, a third party expert, as deemed necessary, to evaluate the need for a Medicare Set Aside [MSA], and this shall be determined and documented in all settlement evaluations. 9. File/System documentation shall include documentation of return phone calls to injured worker and the City within twenty-four (24) hours or the next business day. 10. File/System documentation shall include documentation that referral appointment was made for a claimant to a network provider specialist (i.e.; Diagnostic testing, Neurologist, Orthopedic) so that claimant was seen by specialist within two (2) weeks of the date of receipt of the referral from the primary treating physician, unless it is clearly documented that, despite Successful Proposer's best efforts, no specialist was available to see claimant within the requisite two weeks period. 3.3.2:LIABILITY CLAIMS ADMINISTRATION Upon receipt of all liability claims, the Successful Proposer, on behalf of the City, shall perform, at a minimum, the following services: 1. Review all first notices of claim reports received from the City, which will consist of loss reports, claim letters and suits, or claims that are phoned, mailed, or faxed in by the City, prior to an assignment to the Successful Proposer's adjuster, approved by the City. 2. Designate the necessary number of outside field adjusters to handle all City claims and also designate an alternate in their absence. The designation of these persons is subject to the approval of the City. Page 47 of 66 605386,6 3, Conduct a thorough and complete investigation of the accident, according to the requirements of the City. Investigations shall include, but not limited to, the following: a)Contact the claimant or the claimant's attorney within 24 hours of the time the accident report is received by the Successful Proposer. In the case of underrepresented claimants, personal contact is required the same day the claim is received. All claim files must contain adjuster's logs documenting all contact and activity. b)Obtain recorded statements from the claimant, witnesses, and the City personnel. Personal contact of all underrepresented claimants by outside adjusters is required. c) Complete a timely scene investigation consisting of photos and diagrams, This is required within two (2) days of receipt of any serious AL or GL claim assignment. d)Obtain the police and/or fire rescue report. e)Ohtain and review all medical reports and bills submitted by the claimant or their attorney. f)Obtain and review all estimates and appraisals for property damage claims. g)Establish appropriate reserves on all claims, and revise the reserves as needed. h)Submit a report to the City within 30 days of receipt of the claim, summarizing: i.Date/time/location of loss; ii.Claimant information; iii.Description of accident; iv.Injuries or damages; v.Witnesses' version; vi.Liahilit_y analysis:and vii.Evaluation of claim (i.e. amount of recommended settlement, denial, reserves, attorney demand). If a settlement recommendation cannot be made at this initial report (due to lack of information), indicate sante and reason. However, remainder of investigation should be completed. 4, Submit a status report every 90 days thereafter to the City until the claim is resolved. The City prefers the above reporting requirements to be accomplished via the on-line claims management system for "real-time" viewing. 5. The Successful Proposer has the authority to settle cases on behalf of the City up to $3,000 per claim for property damage and $3.000 for bodily injury. For any settlement in excess of the above, the Successful Proposer must receive authorization from the City. The request for this authorization must be presented in writing. including the adjuster's evaluation and recommendation in a format required by the City. After authorization is granted, the Successful Proposer will settle the claim and obtain the appropriate release. Additionally the Successful Proposer shall provide a quarterly report to the City on all settlements above and below $10,000. 6. The City will assign an attorney for the legal defense of any claims that goes into suit, The Successful Proposer will assist the City's attorneys with any additional investigations. as deemed necessary by the City or its attorneys. The Successful Proposer will continue to monitor the file in litigation.Successful Proposer will provide a monthly report of all litigated claims in the format specified by the City. 7. Upon notification from the City, the Successful Proposer shall forward a copy of the file in suit, to the City's attorney with a transcription of all settlements. 8. The Successful Proposer shall attend all mediations and trials as requested by the City. With respect to claims with impending trial dates, the designated Successful Proposer's Supervisor or designee, shall take an active and aggressive role in settlement or preparation for trial. 9. The Successful Proposer, after approval of the City, can assign the necessary auto appraiser for property darnage claims. These expenses shall be paid as an allocated expense by the Successful Proposer from the City's loss fund. Page 48 of 66 605386,6 10. Any other claim expense must be approved by the City prior to being incurred. However, expenses for normal claim activities, such as photographs, tapes, supplies, postage, etc., are the responsibility of the Successful Proposer. 11. The Successful Proposer shall meet quarterly (or more frequently if required by the City) with the City Manager, and/or authorized representative, to review all large exposure (over $25,000) incurred cases and report on their status. 12. All claim files are at all times the property of the City. The City has the right to inspect any and all files whenever the City deems necessary. If the Agreement is terminated, the City will receive all original claim files. 13. The Successful Proposer shall make recommendations to the City as to actions that can be taken to prevent future claims. These loss prevention recommendations can be included in the status report. 14. All work must be performed by the employees of the Successful Proposer. The use of any contracted or independent adjuster is prohibited, unless prior approval is granted by the City. 15. The Successful Proposer shall reimburse the City for payments made in error that are non -recoverable from third parties by the Successful Proposer. 16. The Successful Proposer shall provide to the City a performance guarantee, to be negotiated with the City in the provision of Managed Care/Medical Bill Review (Part II services) as cited herein, to improve its effectiveness and efficiency while maximizing City resources. 17. The Successful Proposer shall continue to monitor the file in litigation. and obtain updates from the City Attorney's office, in an effort to prepare reports to the City's excess carriers as required. A.PERFORMANCE STANDARDS: LIABILITY The City performs annual performance standards audit based on the following: 1. Successful Proposer shall document all new claim information received from the City, and this information will be available electronically within one (1) hour of receipt. if received during normal business hours, or within the first business hour of the next business day, if received less than one (1) hour before the close of a business day. File will include First Report of Injury form. 2. A minimum of °three (3) attempts" by the Successful Proposer's claims adjuster to contact the appropriate parties will be considered a "contact", if followed up with appropriate correspondence within the measurement period. 3. Successful Proposer shall document, and give City's Project Manager, written notice of, subrogation, contribution, and/or coordination of benefits recovery potential. If Successful Proposer decides not to pursue any such recovery, it must give written notice to Risk Management of its decision within fourteen (14) days of claim receipt. 4. For liability claims, ~within fourteen (14) days of receipt of the claim, the Successful Proposer shall document appropriate specific direction for the investigation and handling of the case. 5. \Within 72 hours of receipt of the claim, initial reserves for the file shall be set, thereafter, reserves will be reviewed on an on -going basis, as follows: a.30 days from 72 hour review; b.30 days from 30 day review; c.60 days from last 60 day review; and d.Every 6 months thereafter. 6. Successful Proposer shall "address" litigation within two (2) days of receipt of litigation notification. This will mean notice to Risk Management, and referral to the City Attorney's office for assignment, within two (2) days. 7. Required status reports are outlined in Attachment A, Proposer Supplemental Questionnaire. Page 49 of 66 605386,6 The City desires prompt, personal contact of all claimants. Evaluations of each claim shall be made as soon as the necessary information is received by the Successful Proposer. The investigation and evaluation of all claims should be completed prior to suit being filed, since F.S. 768.28 (sovereign immunity statute) requires the claimant provide six months' notice of intention to file suit. The Successful Proposer must have up-to-date policy and procedure manual(s) on hand in the work place. These manual(s) shall describe and discuss the day to clay procedures for adjusting files, and shall be kept in accordance with statutory requirements. The Successful Proposer shall provide adequate toll -free telephone access to the claims office. The Successful Proposer shall provide claims personnel, who shall be available on a 7 day, 24 hour basis, for investigating claims, and must have an maintain an 800 or toll -free number for emergency service, The Successful Proposer shall provide its own office space or facility (s) for its adjuster or staff of adjusters. The Successful Proposer must agree to be responsible to manage liability claims to be opened within the year(s) following contract execution, along with the current inventory of open files. The Successful Proposer shall provide claims administration on a "life of relationship basis." 3.5 STAFFING, QUALITY CONTROL, AND SUPERVISION The Successful Proposer shall render high -quality claims management and adjusting services throughout the term of the Agreement. The Successful Proposer's personnel shall have, as a minimum, the following levels of experience and licensing: 1. Supervisor or Supervising Adjuster shall have five to seven (5-7) years of related experience; 2. Adjusters shall have three (3) years of experience; 3. Medical -only processor(s) shall have one (1) year of experience, and must hold a current Florida Adjuster License: 4. The Successful Proposer's files must reflect evidence of supervisory direction and involvement at every level. All files must be kept current. File review should be performed on 30, 60, 90 or 120 day cycles, as appropriate. Periodic review by the handling adjuster and all supervisors should be reflected in the file. 5. Successful Proposer's Supervisors shall receive all First Reports of Injury and outline investigative needs for the adjusters to follow through. Supervisors should assign the most difficult files to the most qualified adjuster. 6. Successful Proposer shall perform monthly claims review with Risk Managetnent, to include the adjusters, and City Attorney. 7, It is the City's claims management philosophy that the proper and most cost-effective method to handle claims and thereby reduce and control the City's self -insured loss payments. is to ensure the Successful Proposer hires and retains the appropriately qualified professionals to handle the City's claims. Additionally, the adequate number of adjusters and a manageable caseload enables qualified adjusters to perform the required services, The City therefore requires that the Successful Proposer agree to staffing, qualifications, and caseload criteria established by the City. 8. The City reserves the right to the final prior approval of the hiring and/or assignment of the claims manager, supervisors, and adjusters that will handle the City's claims. 9. The Successful Proposer agrees to add staff as necessary, to maintain these maximum pending caseload levels. The Proposer in its response to the RFP. must explain how its office or unit will be staffed, and the level of supervision that «ill be provided. Page 50 of 66 605386,6 10. Claims personnel must be employees of the Successful Proposer. The use of independent adjusters, sub contractors, or temporary adjusters will not be acceptable without prior approval of the City. Successful Proposer's Adjuster trainees are not acceptable for handling of the City's claims. The Proposer must submit with its proposal, the resumes of all claims professionals specifically to be assigned to this account. All Successful Proposer's claims professionals must possess a current Florida adjuster's license. 11. In addition to those services previously discussed, the Successful Proposer will additionally perform the following related services: a.State required filings; b.Loss fund management; c.Cotnputer generated loss runs and other management reports, preferably on-line; and d.Provide an annual SAS 70 audit report. 12. The Successful Proposer shall have the ability to provide full customer service to English, Spanish, and Haitian -Creole speaking individuals, when needed. 13. The Successful Proposer shall make available to the City an individual with management authority to meet with the Risk Management Director, or the designee, upon reasonable notice. This individual shall have the authority to make "agreed to changes." The Successful Proposer's employees shall meet with Risk Management on a quarterly or as -needed basis to discuss claims of interest. Sufficient advance notice will be given by Risk Management to allow adequate preparation and data collection. The Successful Proposer's personnel, including the adjuster or Supervisor, must also be available to attend mediation conferences, as necessary. 3.6 PART II: MANAGED CARE/MEDICAL BILL REVIEW/AUDIT SERVICES The City supports management of the medical component, which is key to returning employees back to work and facilitation of Workers' Compensation claim resolution. The City has the following expectations relating to medical: •A provider who actively and aggressively manages medical, •A network of physicians specializing in Return to Work •A claims management team approach whereby the team understands and works as partners in the RTWITransitional-duty efforts. The City is very interested in the Successful Proposer's philosophy on utilization of TCM & FCM within their claims management model with the understanding that the City may elect to use a separate managed care vendor. The City's current Claims Administrator (Gallagher), utilizes on-line claims processing system where all data is maintained, updated, and payments are issued. The adjudication of Workers' Compensation medical hills and payments to the City's providers are performed through this system. On a monthly basis, Gallagher provides the City with a bank reconciliation report to interface with the City's financial system. The Successful Proposer shall be responsible for the provision of an on-line claim processing system and the conversion of any data necessary for successful integration with any and all other systems, including following the termination of the Contract. Any procedures, equipment, and/or costs necessary to connect with Gallagher's hardware and software, shall be the sole responsibility of the Successful Proposer. A. MANAGED CARE SERVICES The Successful Proposer shall render high -quality claims management services throughout the entire Contract term. The Successful Proposer's personnel shall have, as a minimum, the fallowing levels of experience and licensing: a)Supervisor shall have five to ten (5-10) years of relevant experience; Page 51 of 66 605386.6 b)Nurse Case Manager shall have five to seven (5-7) years of relevant experience: c)Account Representative shall be fully qualified and responsible for the performance of Provider's responsibilities under the Agreement. The Account Representative's responsibilities include. but are not Iimited to: i.Act as Successful Proposer's representative on any claims issue or problems; ii.Act as a liaison between the City, medical network. Successful Proposer, and any other parties as deemed necessary by the City: and iii.Participate with and assist the Risk Management in the performance reviews, as required under the Agreement, and review other claims as requested by Risk Management under the Agreement. d)The Successful Proposer's files must reflect evidence of supervisory direction and involvement at every level. All files must be kept current. File review should be performed on 30, 60, 90, 120 day cycles as appropriate. Periodic review by the handling Nurse Case Manager and Supervisors should be reflected in the file. e)Successful Proposer's Supervisor(s) shall receive all First Report of Injury and outline investigative needs for the Nurse Case Manager to follow through. Supervisor(s) should assign the most difficulty files to the most qualified Nurse Case Manager. f)Successful Proposer shall perform monthly claims review with Risk Management, to include the adjusters, Risk Management and City Attorney. g)The City reserves the right to the final prior approval of the hiring and/or assignment of the Nurse Case Manager, and Supervisor(s) to handle the City's claims. h)The Successful Proposer agrees to add staff, as necessary, to maintain the maximum pending caseload levels. The Proposer, in its response, shall explain how its office, or unit will be staffed. and the level of supervision that will be provided. i)Claims personnel trust be employees of the Successful Proposer. The use of Nurse Case Manager, subcontractor, or temporary Nurse Case Manager. will not be acceptable without prior approval of the City. The Proposer must submit with its proposal, the resumes of all Proposer's claims professionals specifically to be assigned to this account. Ali claims professionals must possess a current Florida adjuster's license. j)The Successful Proposer shall have the ability to provide full service to English. Spanish, and Haitian - Creole speaking individuals, when needed. k)The Successful Proposer shall make available to the City, an individual with management authority, to meet with Risk Management Director or the designee upon reasonable notice. This individual shall have the authority to make "agreed to changes." The Provider will meet Risk Management or the designee on a quarterly or as -needed basis to discuss claims of interest. Sufficient advance notice will be given to allow adequate preparation and data collection. The Successful Proposer's personnel. including the Case Manager or supervisor, must be available to attend mediation conferences as necessary. B. MEDICAL BILL REVIEW AND AUDIT SERVICES Proposers are requested to provide the following medical bill review and audit services: A)Medical Bill Review: 1. Promptly review medical/surgical bills (in and out of network) for accuracy, including, but not limited to, as they relate to the following: a) Duplicate billings; b) Unbundling of charges; c) Up -coding of charges; and d) Approval and appropriate pre -certification Page 52 of 66 605386,6 2. Review all medical bills that: a)Are not subject to fee schedule coding; b)Are for services not specifically addressed in the fee schedule; c)Need an in-depth medical interpretation of the rules and regulations; and d)In the exercise of professional judgment, specifically warrant review 3. Process, pay, and mail bills within 20 days of receipt. 4. Reimburse the City for any overpayments made in the bill review process. within 30 days of identification of overpayment. Reimburse the City for any penalties and/or interest associated with inaccurate payments. B)Medical Auditing Services: 1. Audit -in network and out -network hospital/provider bills: a)Exceeding $5,000; b)Where a departmental charge exceeds 10% of the total bill, excluding room and board charges; and c)Others at the Successful Proposer's direction or specific request by the City for accuracy and appropriateness. 2. Develop and follow written policies on how late charges, no show charges, and special arrangements shall be handled. 3.Develop and provide communication materials to explain the policies and procedures of the Medical Bill Review and Audi Services to the City of Miami's Medical providers. 4. Process. pay and mail bills within 20 days of receipt. 5. Develop and follow written grievance procedures for provider concerns. C. PHARMACEUTICAL MANAGEMENT SERVICES The City currently uses Cypress Care PBM services for claims that are administered in-house. The City desires to retain this relationship. Successful Proposer shall pursue subrogation recoveries pursuant to Workers Compensation lien recovery settlement agreement. Details regarding the PBMS's services should be provided, including access, utilization review services, coordination of claims data and reporting. Some physicians were dispensing drugs directly to injured workers; the City's current Claims Administrator (Gallagher), has taken steps to curtail excessive costs, and will reprice the prescriptions. Fees for pharmaceuticals or pharmaceutical services shall be reimbursable at the applicable fee schedule amount (F.S> 440.13(12c), except where the employer/carrier has contracted for a lower amount. Where the employer/carrier has contracted for such services and the employee elects to obtain them through a provider not a party to the contract, the reimbursement shall be at the scheduled, negotiated, or contract price, whichever is lower. Successful Proposers are requested to address the issue of physician dispensing and the high cost of repackaged drugs. D. LOSS CONTROL SERVICES When requested by the City to do so, the Successful Proposer shall consult with the City, its employees, agents and others, concerning workplaces, operations, work procedures. and equipment owned or operated by the City. and make recommendations to the City regarding same, for the purpose of establishing loss control systems to mitigate and/or control losses, damage. and claims; provided, however, it is understood and agreed, that neither the rights of Page 53 of 66 G05386,6 the Successful Proposer to make inspections. nor its recommendations or reports as to loss control, shall constitute an undertaking on behalf of, or for the benefit of the City, or its employees or others, to determine, warrant, or guarantee that such work places, operations, procedures, or equipment are free and safe from defects and/or hazards. E. IRS FILING REQUIREMENTS OF CLAIMS ADMINISTRATOR (SUCCESSFUL PROPOSER) The Successful Proposer shall: 1. Furnish required tax information for the Internal Revenue Service including 1099s with a copy of the 1099s submitted to the IRS. 2. Prepare, taintain and file all records and reports as may be required by legal authorities (State, local and Federal). 3. Prepare, maintain and file statistical information required by the Division of Workers' Compensation and Rating Bureaus, including all data necessary for the promulgation of experience modification. and as required by any other legal entity(s). F. STATE REQUIRED FILINGS At a minimum, the Successful Proposer shall be required to provide the following services: 1. Prepare and file, on behalf of the City, with the appropriate state agency, all applications required for the City's continued qualification as a self -insurer. 2. Prepare, maintain, and file all records and reports, as may be required by legal State or Federal. 3. Prepare, maintain, and file statistical data, records, or reports, as required by excess insurers, City actuaries, and the State. 4. Prepare, maintain, and file statistical information required by worker's compensation rating bureaus. including all data required for the promulgation of the City's experience modification and state assessment. 5. Prepare and file any other reports as required by the City and the State relating to claims experience, payments, etc. (such as DWC-51, etc.) G. LOSS FUND MANAGEMENT I . The Interest Bearing Account will be maintained at the City's commercial banking institution. The account will be classified as part of the analysis group of the City's accounts. The City will pay all service fees that are normal and customary in this account. All interest earned or service credits generated will accrue to the benefit of the City. 2. The Successful Proposer is required to follow Florida law concerning public deposits. Specifically. the Successful Proposer shall adhere to F.S. 237.211(6) and F.S. 280 Security of Public Deposits. Failure to comply with these laws is sufficient cause for the City to terminate the Agreement with the Successful Proposer. 3. All claims, expense and legal payment will be made by the Successful Proposer on checks drawn on an Page 54 of 66 605386,6 account set up by the Successful Proposer, and funded monthly by the City. It is understood that all funds in this account are City funds, and shall be returned to the City upon request or at termination of the contract. 4. The Successful Proposer is responsible for the monthly reconciliation of this account and shall provide bank statements to the City monthly. along with a request for a deposit from the City to maintain the monthly balance in the loss fund, as determined by the City. 5. The monthly reconciliation statement submitted by the Successful Proposer to the City shall, at minimum, include the following: a.Balance at inception of statement period: b.Total disbursements which cleared. by date and claimant/payee; c,Balance at close of statement period: d.Arttount of deposit required; and e.A list of all checks shall be submitted on a monthly basis. H. COMPUTER LOSS INFORMATION All charges related to these services are to be included in the annual claims administration fee. Any costs associated with programming changes that are necessary to create a report required by the City are the responsibility of the Successful Proposer. In its proposal, Proposer should indicate any fees to be charged for the creation of any special reports requested by the City, as necessary. All reports currently provided to the City are required from the Successful Proposer. 1. Successful Proposer must ensure conductivity with the current system and software used by Risk Management and the Department of Finance, and all other involved departments. Successful Proposer shall continue to ensure, at its cost, that its system remains a viable solution for on-line claims administration, should the City upgrade or replace any aspect of its risk and/or financial system throughout the term of the Contract. 2, All claims data is the property of the City and any data and media will be provided to the City upon request and/or upon termination of the contract. All computer notes will be printed out and placed in the files prior to file transfer to a successor Claims Administrator, 3. The Successful Proposer, at its own expense, shall ensure all claims and payment data is included in their loss runs, by a date as determined by the City. Historical data from the current Claims Administrator's database cannot be purged. Claims data for all open and closed claims must be transferred. 4. Loss runs shall be provided by the Successful Proposer. on a monthly basis, sorted separately by line of coverage (WC. GL, AL), policy year, and department/location. Loss runs should list each claim separately. Specific summary reports must also be provided. This requirement may be satisfied by utilizing the Successful Proposer's on-line system. The following reports, at a minimum, are required: a.Clairns list (lists all claims alphabetically); b.Check register; c.Cumulative report byline of coverage by year: d.Annual summary reports; e.Location report: f.Large loss or severity report; g.Safety report h.Excess insurance report Page 55 of 66 605386,6 i.Litigation report j.Legal payments report k.SAF 200 (OSHA log) 5. Workers Compensation claims, involving no payment or no medical treatment, are reported by the City for inclusion in the database as reporting purpose only (RPO) or first aid or no pay cases and should be identified in the system that same way. 6. The Successful Proposer shall provide the City access via Internet to the system for file review. e-mail, or other purposes, at no additional cost to the City. An 800 or other toll -free number is necessary for on-line connections and faxes if the call is outside Miami -Dade County. I. FEE BILLING The City desires to pay claims administration fees monthly in arrears for claim files established in the previous month. A summary invoice should be broken down by line of coverage and tie to month -end figures as shown on the loss runs. Page 56 of 66 605386,6 4. Submission Requirements 4.1. CMIA Submission Requirements 4.1. SUBMISSION REQUIREMENTS The following documentation shall be included, as a minimum, in the Proposal and submitted to the City. Instructions to Proposers: Proposers should carefully follow the format and instructions outlined below, observing format requirements where indicated. Proposals should contain the information itemized below and in the order indicated. This information should be provided for the Proposer for the work contemplated by this RFP. Proposals submitted which do not include the following items, may be deemed non -responsive, and may not be considered for contract award. ALL RESPONSES SHALL BE SUBMITTED IN HARD COPY FORMAT ONLY TO INCLUDE ONE LL ORIGINAL, SIX (6) COPIES, AND AN ELECTRONIC COPY (USB OR CD). NO ON-LINE SUBMITTALS WILL BE ACCEPTED. The response to this Solicitation shall be presented in the following format. Failure to do so may deem your Proposal non -responsive. Proposers may submit a Proposal for either Part 1; Workers' Compensation Claims and Liability Claims Administration, andlor Part II - Managed Care/Medical Bill Review.Proposers must dearly indicate for which Part(s) Proposer is submitting its Proposal for, and roust provide all of the following for each Part, in addition to the Supplemental Proposer Questionnaire (Attachment A), which is attached in the Header Section of this Solicitation. Proposals will be ranked on a Category of Services basis. For example. Proposals submitted for Part I, Workers' Compensation Claims and Liability Claims Administration. will only be ranked against other Proposals submitted for the Workers' Compensation Claims and Liability Claims Administration. 1. COVER PAGE The Cover Page should include the Proposer's name; Contact Person for the RFP; Firm's Liaison for the Contract; Primary Office Location; Local Business Address, if applicable; Business Phone and Fax Numbers; Title of RFP; RFP Number; Federal Employer Identification Number or Social Security Number. 2. TABLE OF CONTENTS The Table of Contents should outline, in sequential order, the major sections of the proposal as listed below, including all other relevant documents requested for submission. All pages of the proposal, including the enclosures, should be clearly and consecutively numbered and correspond to the table of contents. 3. EXECUTIVE SUMMARY Page 57 of 66 605386,6 A signed and dated summary of not more than two (2) pages containing the Proposer's Qualifications and Experience, Ability to Perform Required Services, and Overall Approach and Methodology to Scope of Work as contained in the submittal. Include the name of the organization, business phone and contact person. Provide a summary of the work to be performed by Proposer. Proposer must meet all requirements and/or criteria in Section 2.6, Minimum Qualification Requirements, and elsewhere in the RFP, including responding to and the following information in Sections 4 through 9, and providing all documents as required, with Proposer's response to this RFP. Attachment A, Proposer Supplemental Questionnaire must also be completed in its entirety. Failure to comply with the above, may deem your proposal non -responsive. 4.PROPOSER'S GENERAL EXPERIENCE, PAST PERFORMANCE, AND EXCEPTIONS I)Describe the Proposer's past performance and experience and state the number of years that the Proposer has been in existence, the current number of employees, and the primary markets served. 2)List all contracts which the Proposer has performed for the City of Miami, describe all work performed for the City and include for each project: (1) name of the City Department which administers or administered the contract, (ii) description of work, (iii) total dollar value of the contract, (iv) dates covering the term of the contract, (v) City contact person and phone number, (vi) statement of whether- Proposer was the prime contractor or subcontractor, and (vii) the results of the project. 3)Provide information concerning any prior or pending litigation, either civil or criminal, involving a governmental agency or which may affect the performance of the services to be rendered herein, in which the Proposer, any of its employees or subcontractors is or has been involved within the last five (5) years, Provide letters of reference from law firms which currently handle your litigation. Provide contact person and phone number for each, 4)Identify if Proposer has taken any exception to the terms of this Solicitation. If so, indicate what alternative is being offered and the cost implications of the exception(s). 5. PROPOSER'S CATEGORY SPECIFIC EXPERIENCE, PAST PERFORMANCE ,Note: Any Proposer submitting a Proposal for both categories of Service, Part I- Workers' Compensation Claims Administration AND Part II: Medical Bill Review and Audit Services (Part I and II) must provide in i(s Loposal, complete and separate responses for applicable Items 5 through 15 below for each Part (Part I or II). 5)Describe Proposer's past performance and experience with regard to the particular service category (Part I and/or Part II). and state the number of years that the Proposer has worked in this area providing a similar type of service, the current nutnber of employees working in this area, and the primary markets served. Provide organizational history and structure. and indicate whether the City has previously awarded any contracts to the Proposer (a list of these City contracts shall be provided in item 2 above). Page 58 of 66 605386,6 6)Provide a detailed description of five (5) comparable contracts (similar in scope of services to those requested herein), which the Proposer has either ongoing or completed within the past five (5) years in the capacity as a Third Party Claims Administrator. The description should identify for each project: (i) client, (ii) client contact person, phone number and email address, (iii) description of work, iv) total dollar value of the contract, (vi) dates covering the term of the contract, (vii) statement of whether Proposer was the prime contractor or subcontractor. Include the Proposer's role and any value added. (viii) Specify if the scheduled completion time and budgets approved by the client were met for each of the listed projects. Where possible, list and describe those projects performed for government clients or similar size private entities (excluding any work performed for the City). In the event that the Proposer has not performed five (5) comparable contracts in the particular category (Part I or Part II), the Proposer should provide information that demonstrated its ability to perform the required services. 7)Describe any relevant industry/subject matter expertise. including any experience in the particular services, and any unique or proprietary project methodologies relevant to [he requested services. 8)Provide a List of clients that have, for whatever reason, discontinued the use of your setviccs within the past two (2) years. and indicate the reasons for the same. The City reserves the right to contact any clients listed as part of the evaluation process. 9)Provide two (2) Letters of Reference, on letterhead, from two different, similar sized governmental entities (as the City), and for which similar services (Part I or Part II) have been performed within the past five (5) years. This information is subject to verification as part of the evaluation process. 10) Provide a complete list of all current Florida clients for which Proposer administers claims in a Workers' Compensation, self-insurance, or retention program. The description should identify for each client: (i) client. and type of entity; (ii) client contact person, phone number, and email address, (iii) description of work, iv) total dollar value of the contract, (vi) dates covering the term of the contract, (vii) statement of whether Proposer was the prime contractor or subcontractor. Specifically identify clients for whom a similar service has been provided, particularly to governmental entities similar in size to the City, Trust, or other similar type as the City. Indicate whether Proposer assisted in disability, safety program, light duty / return -to -work program, etc. 11)Discuss in detail Proposer's qualifications and experience to provide general liability and automobile liability claims administration. Include, in the description. the Proposer's thorough knowledge of all State Statutes and other applicable laws governing this RFP, to demonstrate a complete understanding of the work to be performed. 12)Discuss in detail Proposer's qualifications and experience to provide managed care services. Include the Page 59 of 66 605386,6 Proposer's thorough knowledge of all State Statutes and other applicable laws governing this RFP, to demonstrate a complete understanding of the work to be performed. 13)Provide detailed background on the Proposer's proposed Manager/Supervisor to be assigned the City's account throughout the duration of the contract term, and whether Proposer agrees to City's terms for approval of future Manager/Supervisor, should proposed representative leave Proposer's firm during the contract term. Provide copies of current applicable licenses for work to be performed in the State of Florida. 14)Describe the experience, qualifications and other vital information, including relevant experience on previous similar projects (Part I or Part II), of all key personnel, who will be assigned to the City's contract. This information shall include the functions to be performed by the key individuals, and the caseload of each person assigned to service the account. Include copies of all licenses held by each individual, as all claims professionals must possess a current Florida adjuster's license. Provide cop_y(les) of each adjuster's and Supervisor's Florida Adjusting License, or any other relevant licenses, if applicable. In addition, provide resumes, if available, with job descriptions and other detailed qualification information on all key personnel who will be assigned to the City contract. 15)Provide a complete list of all licensed claim's personnel that will handle City's claims, and/or managed care services, including the Proposer's proposed Manager/Supervisor, Supervising Adjuster, Adjusters, Supervising nurse Case Manager, Case Manager, Medical -only processors, or other individuals including clerical and or support staff detailing education, experience in the area of workers' compensation claims, in the area of managed care, and type of license(s). Include copies of all licenses held by each individual. Note: After qualification submission, but prior to the award of any contract or work order issued, as a result of this RFP. the Proposer has a continuing obligation to advise the City of any changes. intended or otherwise. to the key personnel in its proposal submission. 6. PROPOSER'S ABILITY TO PERFORM REQUIRED SERVICES 16)Provide a complete list of all claims office locations and territory(ies) serviced with Proposer's current personnel, indicating the number of personnel of Proposer, and Proposer's ability to provide required services to the City. 17)Describe where your main office is located, and the location where the primary work will be performed. Indicate location where the Successful Proposer, the Successful Proposer's Manager/Supervisor will be located. 18)Discuss how the Proposer's office or unit will be staffed, and the level of supervision that will be provided. Discuss case assignments, including pending case load for each designated Adjuster and current number of monthly new assignments to each Adjuster, if applicable. Discuss case assignments, including pending case load for each designated nurse Case Manager and current number of monthly new assignments to each nurse Case Manager, if applicable. Page 60 of 66 605386,6 19)Describe how Proposer will ensure managed care services by City employees residing in Miami -Dade, Broward, Palm Beach, and Monroe Counties, among other locales. 20)Discuss whether the award of this contract necessitates an increase in Proposer's staff size to meet the City's staffing and caseload requirements, and whether staff will be in place by the start of the contract, which is estimated to be February 1, 2017. 21)Explain the percentage of time the Proposer's proposed Adjusters will be out of the office doing field work. If all of Proposer's proposed Adjusters are telephone Adjusters, indicate as such. Explain whether Proposer will utilize independent contracted Adjusters. and under what circumstances. Provide the name, address, phone. and contact person for independents you currently utilize, 22) Identify language capabilities (spoken or written) of Proposer's employees and those of the subcontractors or subconsultants. 7. PROPOSED OVERALL APPROACH TO PERFORMING THE SERVICES 23)Discuss in detail Proposer's overall approach to the work to be performed. Describe Proposer's specific project plan and procedures to be used in providing the services, and how Proposer has applied the proposed project approach in comparable contracts. 1 24)Describe Proposer's ability to perform the services described in the Scope of Services, and describe Proposer 's specific policies, plans, procedures or techniques to be used in providing the services requested. The Proposer shall describe its approach to project organization and management, responsibilities of Proposer's management and staff personnel that will perform work in this Solicitation. 25)Provide projected caseloads per employee of Proposer assigned to City account. 26)Describe Proposer's staffing plan to demonstrate that Proposer can be adequately staffed with trained personnel to handle the City's full caseload and have the capability to recruit such staff. 27)Include a statement that at east thirty (30) days prior to replacement of key personnel, Proposer will notify the City's Project Manager, in writing. that replacement employees will possess qualifications and experience equal to or greater than personnel being replaced. 28)Provide a detailed timetable identifying significant milestones for the smooth transition of the operations. Proposer shall identify the necessary support that shall be required from City staff during that transition. 29)Discuss in detail exactly bow all services reflected in the Scope of Work will be accomplished. Include a complete approach Proposer will take to meet all responsibilities expected of Proposer by the City. Include any Page 61 of 66 605386,6 and all information regarding affiliated physicians, other medical personnel, locations to provide said services. and other related information regarding the provision of such services for the City. 30)Provide a description of the standard loss reports, as well as provide a sample and descriptions daily additional reports to be utilized. 3l)Explain whether Proposer currently file state and excess insurance forms on behalf of Proposer's clients. and attach copies of the forms used. 32)Describe Proposer's methodology for evaluating and determining savings as expected within this RFP. Include in detail the mechanisms Proposer would use to track whether proposed savings goal has been met, and methods to meet those goals. Indicate if Proposer is willing to accept the incentive or penalty as indicated, should savings not result. 33)If proposed, describe in detail Proposer's computerized on-line claims management system and software to be utilized during the performance of the scope of work reflected herein. Detail functionality, transition from current system, and if a cost is proposed, indicate in Proposer's Fee Proposal. 34)Detail any procedures, equipment, and/or costs necessary to connect with the City's hardware and software, particularly related to conductivity with Risk and Finance, at the time of this RFP and should the City's system be modified or replaced during the Contract term. Should there be associated costs; indicate those costs, the reasons for the same, and who will pay those costs. Costs, if any. shall be detailed in the Fee Proposal Section. 35)Estimate Proposers minimum start-up time from date of contract award to the date Proposers network would be available to Risk Management. What specific requirements does the Proposer have to initiate set-up, and please explain any additional costs involved. 36)Explain any options which the Proposer's system has that will permit the City to generate reports from, and to make direct inquiries into the Administrator's data base by on-line access. Proposer trust clearly identify in its Proposal the costs of providing any special conversion systems, license and software costs for accessing the system, and the party(s) responsible for the payment of those casts, if any. (Casts shall be fully detailed in Fee Proposal Section). 37)Provide sample reports describing information such as type of accident, accident site. department, date and time, cause of accident, injury, and part of body. Proposer shall describe in detail any safety/loss control reports that are provided by the system, and shall submit a listing of the variety of claims reports available. and provide sample copies of formats that may be requested by the City. 38)Provide the methodology and list of allocated or anticipated expenses to employ outside professionals such. Page 62 of 66 605386,6 as surveillance, rehabilitation, experts, attorneys and others to assist in the investigation and adjustment of claims. 39)Provider shall provide its most recent audited certified business financial statements (or unaudited if audited is not available) as of a date not earlier than the end of the Proposer's preceding official tax accounting period, together with a statement in writing, signed by a duly authorized representative, stating that the present financial condition is materially the same as that shown on the balance sheet and income statement submitted, or with an explanation for a material change in the financial condition. A copy of the most recent business incotne tax return will be accepted if certified financial statements are unavailable. 8. FEE PROPOSAL (Provide prices in U.S dollars) 40)Submit a guaranteed, all-inclusive annual fee as previously detailed in Section 2.17, This fee shall represent all claims, administrative, and loss data fees, and shall be guaranteed annual fees for the initial three (3) years. and the two option to renew years, as opposed to per claim time and expense or any other fee proposal. Proposals not containing an all-inclusive guaranteed annual fee for three (3) years, and the two option to renew years, for all specified services, will not be considered. The pursuit of subrogation and recovery from the Special Disability Fund is to be included in the Proposer's Annual Fee. Clearly indicate any charge not included in the proposed annual fee. 41)As the City is interested in a program which will generate savings over the current expenditures in the workers' compensation area, the proposed fee structure should address the mechanism for achieving a minimum of 15% net savings with an escalating incentive bonus for savings that exceed the minimum and a penalty for a shortfall in the desire net savings. 42)Subrnit a separate quote(s) for existing claims, and a separate quote(s) for prospective claims: pricing on a "per claim" basis for both existing claims and prospective claims. and a breakdown of the cost between lost time vs. medical. In addition, provide a per claim cost vs. flat dollar cost. Include any other charges not included in pricing. Price Proposal must contain rates based on the "life of relationship basis," namely for those prospective claims, and the City's inventory of open files. Provide separate quotes for the assumption of prior claims and for prospective claims commencing on the commencement date of the Contract. 43)Include any relevant services or products that will be provided to the City which are not priced in Proposer's Proposal, but which will enhance the acquisition process. 44)Indicate the cost, if any, of assuming prior claims and data conversion and whether it is a one-time charge or an annual charge. Include in Proposer's proposed price, costs for the provision of an enhanced system and for the conversion of any data necessary. 45)Provide a performance guarantee (may be negotiated with the City). *Provide any, and all additional costs, item by item, as identified by Proposer, in any other area not previously discussed herein. and detail what those additional costs, if applicable. would entail. Include whether Proposer, or the City will be responsible for payment of those additional costs. Page 63 of 66 605386.6 Page 64 of 66 605386,6 5. Evaluation Criteria 5.1. CMIA Evaluation Criteria 5.1. EVALUATION CRITERIA Proposals will be reviewed to determine if the proposal is responsive to the submission requirements outlined in this Solicitation. A responsive proposal is one which follows the requirements of this Solicitation, includes all documentation, is submitted in the format outlined in this Solicitation, is of timely submission, and has the appropriate signatures as required. Failure to comply may result in the Proposal being deemed non -responsive. Proposals will be evaluated by an Evaluation Committee (Committee) which will evaluate and rank proposals based upon the following criteria and weight. The Committee will be comprised of appropriate City personnel and members of the Community, as deemed necessary, with the appropriate experience and knowledge. The criteria are itemized with their respective weight for a maximum total of one -hundred (100) points, per Committee member. CRITERIA PERCENTAGE Technical Criteria and Points 1.Proposer's General Experience, Qualifications, and Past Performance 10 2. Proposer's Category Specific Experience, Qualifications, and Past Performance 25 3. Proposer's and Proposer's Key Personnel's Ability to Perform Required Services 20 4, Proposer's Methodology and Overall Approach to Scope of 20 Price Criteria and Points 5. Fee Proposal 25 1 otal: 100 Proposals will receive a separate score in each category of service (Part I or Part II), for which proposal is submitted. Proposals will be ranked in a category by category basis. For example proposals submitted for Part I, will only be ranked against other proposals submitted for Part I. 5.2Ora1 Presentations Upon completion of the technical criteria evaluation indicated above, rating and ranking, the Committee may choose to conduct an oral presentation with the Proposer(s) which the Committee deems to warrant further consideration. Upon completion of the oral presentation(s), the Committee will re-evaluate, re -rate and re -rank the proposals remaining in consideration, based upon the written documents combined with the oral presentation. 5.3Price Evaluation Page 65 of 66 605386,6 After the evaluation of the technical proposal, in light of the oral presentation(s) if necessary, the Committee will evaluate the price proposals of those Proposers remaining in consideration. The price proposal will be evaluated subjectively in combination with the technical proposal, including an evaluation of how well it matches Proposer's understanding of the City's needs described in this Solicitation, the Proposer's assumptions, and the value of the proposed services. The pricing evaluation is used as part of the evaluation process to determine the highest ranked Proposer. The City reserves the right to negotiate the final terms, conditions and pricing of the contract as may be in the best interest of the City. Page 66 of 66 City of Miami, Florida Contract No. RFP 605386 EXHIBIT B SCOPE OF WORK MANAGED CARE/MEDICAL BILL REVIEW/AUDIT SERVICES 22 Managed CarelMedical Bill Review/Audit Services City of Miami, Florida Contract No. RFP 605386 EXHIBIT B SCOPE OF SERVICES MANAGED CARE/MEDICAL BILL REVIEW/AUDIT SERVICES 1. OVERVIEW The City of Miami (City) is contracting with USIS, Inc. (Provider) to provide managed care/medical bill review/audit services (Services) for full time employees. The Provider will provide the best quality services and the most reliable and valid data possible, using the most useful and user- friendly system available. 2. BACKGROUND The City's Department of Risk Management (Risk) provides optimum service to employees and the public through a variety of interrelated health, safety and liability/loss control programs. The provision of these crucial prevention -oriented programs greatly enhances the working environment and serves as an incentive for employee recruitment, retention and satisfaction, while protecting the City's assets, employees and citizens. Its objectives include goals to eliminate, where possible, the threat of accident and other forms of liability, and where it is possible to eliminate the risk, to at the very least, reduce the possibility of an accident or risk occurring. Currently, the City has approximately 4,141 full time employees, which include Law Enforcement officers, fire personnel, solid waste collectors, parks personnel, and does not include seasonal employees. There are four (4) Labor Unions in the City: Fraternal Order of Police (FOP); American Federation of State County and Municipal Employees (AFSCME); International Association of Fire Fighters (IAFF); and American Federation of State, County and Municipal Employees 79 (AFSCME). Labor Unions represent eighty-five percent (85%) of the City's workforce. The City has created and maintains a Self -Insurance Program which provides protection to the City for all property and casualty loss exposures, workers' compensation claims, and provides group health benefits to active and retired employees. In addition, Risk monitors the City's injured workers. Attention is focused in the areas of safety awareness, prevention, treatment of injured workers, rehabilitation, job placement, education, and communications with the employees and the departments. Guidelines for the treatment and care of injured employees are based on Chapter 440, Florida Statutes, which governs the State's requirements for the provision of Workers' Compensation benefits. However, as a result of bargaining agreements, additional benefits may be due depending on the bargaining unit. The Third Party Administrator must become familiar with the existing labor agreements). The City's current Third Party Claims Administrator, utilizes Risx Facs claim processing system where all data is maintained, updated, and payments are issued. The adjudication of workers' compensation medical bills and payments to the City's providers are performed through this system. The City uses in-house counsel on all litigated claims, as necessary. Risk works closely with the Office of the City Attorney in a best -practices approach to manage litigated claims. The City is 1 Managed Care/Medical Bill Review/Audit Services Rev.3122117 City of Miami, Florida Contract No. RFP 605386 focused on the management of all claims, but has a laser focus on Workers Compensation claims as they represent approximately eighty percent (80%) of the City's annual claims cost. A Return to Work program is being implemented as the City recognizes that prompt return to work aids in controlling claims costs. Individual department heads are directly responsible for claims occurring in their departments, as claims cost are allocated by department. Therefore, each department is highly motivated to support effective loss control, safety, and liability and workers compensation claim management. The City utilizes a 24/7 claims intake center. This type of system facilitates expedited handling, in order to process and close claims in the most efficient manner, for the benefit of the employees. Due to the City's Fire and Police operations, the City has devoted significant resources and has been, and remains focused on managing presumption -related Workers Compensation claims. The City has never lost a litigated presumption case, and the rate of presumption claim denial is eighty-five percent (85%). Close attention is also paid to closure rates and sound reserving practices. The partnership between Risk, the Office of the City Attorney, and outside counsel where needed, is unique and also quite effective. Case law is closely monitored and utilized to most effectively handle each situation. The City experiences approximately 756 claims per year on average. The ratio of medical only to loss time case is 40:60, i.e. forty percent (40%) medical only, and sixty percent (60%) loss time. Of the approximate 4,141 full-time City employees, the following generally represents the location of their residences: REGION I REGION 2 COUNT (*) Broward FL 606 Collier FL 1 Lee FL 2 Leon FL 1 Martin FL 1 Miami -Dade FL 3509 Palm Beach FL 16 Seminole FL 1 St. Lucie FL 3 Bronx FL 1 3. CITY'S CLAIM EXPERIENCE Below is the City's Claims experience by years: Table No. 1 Policy Year GL Auto BI,/PD APD POL & ELL WC LEL Total 10/1/10 - 9 30 1 1 300 355 113 8 821 42 1639 10/1/11 - 9.30i 12 410 421 84 2 748 39 1704 10/1/12 - 9 30/13 419 433 87 0 795 34 1768 10/1/13 - 9 30114 412 355 109 3 680 26 1585 10/1/14 - 9,'30/15 351 270 68 1 765 14 1469 2010 - 2014 (Average) 378 367 92 4 762 31 1633 2 Managed Care/Medical BiII Review/Audit Services Rev.3/22/17 City of Miami, Florida Contract No. REP 605386 Table No. 2 Policy Year GL I Auto BI/PD APD POL & ELL WC LEI. Total 10/ 1.10 - 9.30/ 11 $566,237 $659,129 $201,201 $618,715 $6,848.127 52.490,514 $11,383,923 10/1'11-930/12 $712,157 $1,725,636 $147,499 $0 56215,610 $235,809 $9,036,711 10/ 1:' 12 - 9 30/13 $1,154,438 $707,976 $134,866 $0 $6,666,574 $512,050 $9,175,903 1 10`1113 - 9 30/14 $664,786 $6I0,034 $218,272 $38,000 $6,435,261 5331,468 $8,297,820 10/1/14-930/15 $546,951 $1.052,972 $122,527 $1,000 S4.773,880 $101.680 $6,599,010 2010 - 2014 (Average) $728,914 $951,149 $164,873 $164,429 S6,187,890 $734,304 $8,898,673 Table No. 3 Policy Year Indemnity Medical Total 10/1/10 - 930/11 447 374 821 10/1 1 1 - 9'30/12 444 304 748 10/ 1 ' 12 - 9 30/ 13 549 246 795 10.1 13 - 9 30 14 445 235 680 10r 1:14 - 9 30,15 504 261 765 2010 - 2014 (Average) 478 284 762 4. MANAGED CARE/MEDICAL BILL REVIEW/AUDIT SERVICES The City supports management of the medical component, which is key to returning employees back to work and facilitation of Workers' Compensation claim resolution. The City has the following expectations relating to medical: • A provider who actively and aggressively manages medical, • A network of physicians specializing in Return to Work • A claims management team approach whereby the team understands and works as partners in the RTW/Transitional-duty efforts. The City is very interested in the Provider's philosophy on utilization of TCM & FCM within their claims management model with the understanding that the City may elect to use a separate managed care vendor. The City's current Claims Administrator, utilizes on-line claims processing system where all data is maintained, updated, and payments are issued. The adjudication of Workers' Compensation medical bills and payments to the City's providers are performed through this system. On a monthly basis, the current Claims Administrator provides the City with a bank reconciliation report to interface with the City's financial system. The Provider shall be responsible for the provision of an on-line claim processing system and the conversion of any data necessary for successful integration with any and all other systems, including following the termination of the Contract. Any procedures, equipment, and/or costs necessary to connect with the existing hardware and software, shall be the sole responsibility of the Provider. A. MANAGED CARE SERVICES The Provider shall render high -quality claims management services throughout the entire Contract term. The City relied on the Provider's proposal to determine that the Provider's 3 Managed Care/Medical Blll Review/Audit Services Rev.3/22/1 7 City of Miami, Florida Contract No. RFP 605386 personnel shall have, as a minimum, the following levels of experience and licensing: a) Supervisor shall have five (5) to ten (10) years of relevant experience; b) Nurse Case Manager shall have five (5) to seven (7) years of relevant experience; c) Account Representative shall be fully qualified and responsible for the performance of Provider's responsibilities under the Agreement. The Account Representative's responsibilities include, but are not limited to: i. Act as Provider's representative on any claims issue or problems; ii. Act as a liaison between the City, medical network, Provider, and any other parties as deemed necessary by the City; and iii. Participate with and assist the Risk in the performance reviews, as required under the Agreement, and review other claims as requested by Risk under the Agreement. d) The Provider's files must reflect evidence of supervisory direction and involvement at every level. All files must be kept current. File review should be performed on 30, 60, 90, 120 day cycles as appropriate. Periodic review by the handling Nurse Case Manager and Supervisors should be reflected in the file. e) Provider's Supervisor(s) shall receive all First Report of Injury and outline investigative needs for the Nurse Case Manager to follow through. Supervisor(s) should assign the most difficulty files to the most qualified Nurse Case Manager. f) Provider shall perform monthly claims review with Risk, to include the adjusters, Risk and City Attorney. g) The City reserves the right to the final prior approval of the hiring and/or assignment of the Nurse Case Manager, and Supervisor(s) to handle the City's claims. h) The Provider agrees to add staff, as necessary, to maintain the maximum pending caseload levels. i) Claims personnel must be employees of the Provider. The use of Nurse Case Manager, subcontractor, or temporary Nurse Case Manager, will not be acceptable without prior approval of the City. j) All claims professionals must possess a current Florida adjuster's license. k) The Provider shall have the ability to provide full service to English, Spanish, and Haitian - Creole speaking individuals, when needed, I) The Provider shall make available to the City, an individual with management authority, to meet with Risk Director or the designee upon reasonable notice. This individual shall have the authority to make "agreed to changes." The Provider will meet Risk or the designee on a quarterly or as -needed basis to discuss claims of interest. Sufficient advance notice will be given to allow adequate preparation and data collection. The Provider's personnel, including the Case Manager or supervisor, must be available to attend mediation conferences as necessary. B. MEDICAL BILL REVIEW AND AUDIT SERVICES Provider shall provide the following medical bill review and audit services: A. Medical Bill Review: 1. Promptly review medical/surgical bills (in and out of network) for accuracy, including, but not limited to, as they relate to the following: a) Duplicate billings; b) Unbundling of charges; c) Up -coding of charges; and 4 Managed Care/Medical Bill Review/Audit Services Rev.3122117 City of Miarni, Florida Contract No, RFP 605386 d) Approval and appropriate pre -certification 2. Review all medical bills that are: a) Are not subject to fee schedule coding; b) Are for services not specifically addressed in the fee schedule; c) Need an in-depth medical interpretation of the rules and regulations; and d) In the exercise of professional judgment, specifically warrant review 3. Process, pay, and mail bills within twenty (20) days of receipt. 4. Reimburse the City for any overpayments made in the bill review process, within thirty (30) days of identification of overpayment. Reimburse the City for any penalties and/or interest associated with inaccurate payments. B. MEDICAL AUDITING SERVICES: 1. Audit -in network and out -network hospital/provider bills: a) Exceeding $5,000; b) Where a departmental charge exceeds 10% of the total bill, excluding room and board charges; and c) Others at the Provider's direction or specific request by the City for accuracy and appropriateness. 2. Develop and follow written policies on how late charges, no show charges, and special arrangements shall be handled. 3. Develop and provide communication materials to explain the policies and procedures of the medical bill review and audit services to the City's medical providers. 4. Process, pay and mail bills within twenty (20) days of receipt. 5. Develop and follow written grievance procedures for Provider's concerns. A. PHARMACEUTICAL MANAGEMENT SERVICES The City currently uses Cypress Care Pharmacy Benefit Management (PBM) services for claims that are administered in-house. The City desires to retain this relationship. Provider shall pursue subrogation recoveries pursuant to Workers Compensation lien recovery settlement agreement. Details regarding the PBMS's services should be provided, including access, utilization review services, coordination of claims data and reporting. Some physicians were dispensing drugs directly to injured workers; the City's current Claims Administrator, has taken steps to curtail excessive costs, and will reprice the prescriptions. Fees for pharmaceuticals or pharmaceutical services shall be reimbursable at the applicable fee schedule amount (F.S> 440.13(12c), except where the employer/carrier has contracted for a lower amount. Where the employer/carrier has contracted for such services and the employee elects to obtain them through a provider not a party to the contract, the reimbursement shall be at the scheduled, negotiated, or contract price, whichever is lower. Providers shall address the issue of physician dispensing and the high cost of repackaged drugs. 5 Managed Care/Medical Bill Review/Audit Services Rev.3/22I17 City of Miami, Florida Contract No. RFP 605386 D. LOSS CONTROL SERVICES When requested by the City to do so, the Provider shall consult with the City, its employees, agents and others, concerning workplaces, operations, work procedures, and equipment owned or operated by the City, and make recommendations to the City regarding same, for the purpose of establishing loss control systems to mitigate and/or control losses, damage, and claims; provided, however, it is understood and agreed, that neither the rights of the Provider to make inspections, nor its recommendations or reports as to loss control, shall constitute an undertaking on behalf of, or for the benefit of the City, or its employees or others, to determine, warrant, or guarantee that such work places, operations, procedures, or equipment are free and safe from defects and/or hazards. E. IRS FILING REQUIREMENTS OF CLAIMS ADMINISTRATOR (PROVIDER) The Provider shall: 1. Furnish required tax information for the Internal Revenue Service (IRS) including 1099s with a copy of the 1099s submitted to the IRS. 2. Prepare, maintain and file all records and reports as may be required by legal authorities (State, local and Federal). 3. Prepare, maintain and file statistical information required by the Division of Workers' Compensation and Rating Bureaus, including all data necessary for the promulgation of experience modification, and as required by any other legal entity(s), F. STATE REQUIRED FILINGS At a minimum, the Provider shall be required to provide the following services: 1. Prepare and file, on behalf of the City, with the appropriate state agency, all applications required for the City's continued qualification as a self -insurer. 2. Prepare, maintain, and file all records and reports, as may be required by legal State or Federal. 3. Prepare, maintain, and file statistical data, records, or reports, as required by excess insurers, City actuaries, and the State. 4. Prepare, maintain, and file statistical information required by worker's compensation rating bureaus, including all data required for the promulgation of the City's experience modification and state assessment. 5. Prepare and file any other reports as required by the City and the State relating to claims experience, payments, etc. (such as DWC-51, etc.) G. LOSS FUND MANAGEMENT The Interest Bearing Account will be maintained at the City's commercial banking institution. The account will be classified as part of the analysis group of the City's accounts. The City will pay all service fees that are normal and customary in this account. All interest earned or service credits generated will accrue to the benefit of the City. 6 Managed Care/Medical Bill Review/Audit Services Rev.3/22/17 City of Miami, Florida Contract No. RFP 605386 2. The Provider is required to follow Florida law concerning public deposits. Specifically, the Provider shall adhere to F.S. 237.211(6) and F.S. 280 Security of Public Deposits. Failure to comply with these laws is sufficient cause for the City to terminate the Agreement with the Provider. 3. All claims, expense and legal payment will be made by the Provider on checks drawn on an account set up by the Provider, and funded monthly by the City. It is understood that all funds in this account are City funds, and shall be returned to the City upon request or at termination of the contract. 4. The Provider is responsible for the monthly reconciliation of this account and shall provide bank statements to the City monthly, along with a request for a deposit from the City to maintain the monthly balance in the loss fund, as determined by the City. 5. The monthly reconciliation statement submitted by the Provider to the City shall, at minimum, include the following: a. Balance at inception of statement period; b. Total disbursements which cleared, by date and claimantlpayee; c. Balance at close of statement period; d. Amount of deposit required; and e. A list of all checks shall be submitted on a monthly basis. H. COMPUTER LOSS INFORMATION All charges related to these services are to be included in the annual claims administration fee. Any costs associated with programming changes that are necessary to create a report required by the City are the responsibility of the Provider. All reports currently provided to the City are required from the Provider. Provider must ensure conductivity with the current system and software used by Risk and the City's Finance Department, and all other involved departments. Provider shall continue to ensure, at its cost, that its system remains a viable solution for on-line claims administration, should the City upgrade or replace any aspect of its risk and/or financial system throughout the term of the Contract. 2. All claims data is the property of the City and any data and media will be provided to the City upon request and/or upon termination of the contract. All computer notes will be printed out and placed in the files prior to file transfer to a successor Provider. 3. The Provider, at its own expense, shall ensure all claims and payment data is included in their loss runs, by a date as determined by the City. Historical data from the current Claims Administrator's database cannot be purged. Claims data for all open and closed claims must be transferred. 4. Loss runs shall be provided by the Provider, on a monthly basis, sorted separately by line of coverage (WC, GL, AL), policy year, and departmentllocation. Loss runs should list each claim separately. Specific summary reports must also be provided. This requirement may be satisfied by utilizing the Provider's on-line system. The following reports, at a minimum, are required: a. Claims list (lists all claims alphabetically); 7 Managed CarelMedical Bill Review/Audit Services Rev.3f22117 City of Miami, Florida Contract No. RFP 605386 b. Check register; c. Cumulative report byline of coverage by year; d. Annual summary reports; e. Location report; f. Large loss or severity report; g. Safety report h. Excess insurance report i. Litigation report j. Legal payments report k. SAF 200 (OSHA log) 5. Workers Compensation claims, involving no payment or no medical treatment, are reported by the City for inclusion in the database as reporting purpose only (RPO) or first aid or no pay cases and should be identified in the system that same way. 6. The Provider shall provide the City access via internet to the system for file review, e-mail, or other purposes, at no additional cost to the City. An 800 or other toll -free number is necessary for on-line connections and faxes if the call is outside Miami -Dade County. I. FEE BILLING The City will pay fees monthly in arrears for claim files established in the previous month. A summary invoice should be broken down by line of coverage and tie to month -end figures as shown on the loss runs. 8 Managed Care/Medical Bill Review/Audit Services Rev.3/22/17 City of Miami, Florida Contract No. RFP 605386 EXHIBIT C PROPOSAL AND COMPENSATION 23 Managed Care/Medical Bill Review/Audit Services INCORP OhATEo I8 96 040/ Request For Proposals: PART II: MANAGED CARE/MEDICAL BILL REVIEW RFP #605386 Opening November 30th, 2016 at 2: 00 p.m. EST AmeriSys* USIS, Inc. Contact Person: Ron Warble, Executive Vice President Firm's Liaison: Cheryl Gulasa 140 Alexandria Blvd., Suite H Oviedo, Florida 32765 Phone: 800.752.0886 ext. 3150 Fax: 407.949.3140 Federal Employer Identification Number: 204580645 TABLE OF CONTENTS Part II — Managed Care/Medical Bill Review ITEM PAGE/ATTACHMENTS Executive Summary Pages 1-2 • Certificate of Insurance Page 3 Certification Statement Page 4 Certifications Pages 5-7 Proposer's General Experience, Past Performance, and Exceptions Pages 8-10 • Brown & Brown, Inc. Annual Report Attachment 1 Proposer's Category Specific Experience, Past Performance Pages 11-27 • Cardiac -Exposure Protocol Attachment 2 • Innovative Programs Attachment 3 • Reference Letters Attachment 4 • Resume/Licenses Attachment 5 • Job Descriptions Attachment 6 Proposer's Ability to Perform Required Services Pages 28-31 Proposed Overall Approach to Performing the Services Pages 32-67 • Policies and Procedures Attachrnent 7 • Dimension Health, Inc. Providers Attachment 8 • myMatrixx Attachment 9 • Transition Plan Attachrnent 10 • AmeriSys Sample Reports Attachment 11 Fee Proposal Pages 69-70 Supplemental Proposer Questionnaire Attachment A Pages 71-158 • Risk and Insurance, Revitalizing the Program - Teddy Award Winner Attachrnent 12 • SSAE 16 excerpt Attachment 13 Managed Care Price Proposal Attachment B2 AmeriSys* November 23, 2016 Yadissa A. Calderon, CPPB Procurement Contracting Manager City of Miami Procurement Department 444 SW 2 Ave, 6th Floor Miami, Florida 33130 Reference: Managed Care Services Executive Summary Dear Ms. Calderon: 140 Alexandria Blvd. Suite H Oviedo, Florida 32765 800.752.0886 ext. 3150 Ron Warble AmeriSys is deeply interested in and excited about the opportunity of providing Managed Care / Medical Bill Review services to and on behalf of the City of Miami. We believe our experience dealing with public entities for the core services requested makes AmeriSys an excellent potential partner for the City and its injured employees. We are prepared to begin working with you and your team to design a workers' compensation medical management program plan that meets the unique needs and requests of the City. We recognize that each employer/insured is unique in systems and philosophies and we stand ready to customize our services to best complement the current program. We also recognize that these services and programs are dynamic and require ongoing assessment, evaluation and modifications to remain current with statute and rule as well as technology, medical advances and other efficiency -related information and techniques. As an organization we understand and are ready to implement all services internally that are necessary to meet all of the components identified and required as a part of this RFP. • Having been your Managed Care Partner from 2003 — 2011 AmeriSys is familiar with your various Agencies and Departments. AmeriSys worked closely with the City's Fire and Police with excellent satisfaction expressed. We are familiar with the number of Presumption claims the City historically incurred which represents a significant part of your overall exposure. AmeriSys has developed unique Case Management programs for first responders covered under the Presumption Bill. We believe our BADGE program will assist the City in minimizing exposure to future costs of expensive cardiac events. Our systems allow for readily available access for the City -appointed personnel to medical information, including scanned copies of medicals as well as bill data for the City. The program is fully integrated allowing for case management and utilization review, including bill repricing activity, to share data and provide for expanded reporting capabilities. Page 3 • The AmeriSys Utilization Management Department maintains a URAC Workers' Compensation Utilization Management accreditation by performing all aspects of Utilization Review in accordance to the standards set forth by that organization. • There is a commitment in our organization to security. Our software system as well as our firewalls protect both medical provider information and claimant protected health information in accordance with HIPAA standards (even though Workers' Compensation claims are not subject to HIPPA compliance). Our organization is subject to Sarbanes-Oxley and as a result we have developed highly secured systems and protocols. Our systems are frequently audited and reviewed, both internally and by third party reviewers including annual SSAE 16 (formerly SAS-70) audits. Though this process seems expensive and burdensome at times, we believe that it provides our customer partners confidence that we will handle their resources with great care. • Innovation and efficiencies are critical to any successful program and as a result AmeriSys encourages new ideas from employees and sets improvement goals annually. Our primary office of operation will be in the Orlando area which has a rich labor pool allowing us to recruit and maintain exemplary staffing for this program. Ron Warble, Vice President Authorized to legally bind and authorized to make representations in regard to this procurement on behalf of USIS, Inc. dba AmeriSys USIS Inc. dba AmeriSys PO Box 616648 Orlando, FL 32861 ron.warble(a,usis-tpa.com 407.949.3150 We are able to provide all services internally, with the exception of leasing our medical PPO network, Pharmacy Benefit Manager, Nurse 24/7 triage services and while our Field Case Management services are managed internally, many of the case managers are independent contractors. This is in accordance with the requirements of the RFP. We understand that the services we would be providing on your behalf are for your employees, your colleagues, your citizens and very often friends. We recognize that we must treat each injured employee with respect and genuine interest in his/her well-being and recovery. We do this while also making sure that we protect the financial and human resources that are paid for by the hard earned tax dollars of your City's citizens. We have a stewardship obligation and commitment to the injured employees and the City of Miami. We look forward to oral presentations where we can provide additional information and/or answer any questions about how our organization can assist you in providing a superior workers' compensation medical management program for the City of Miami. Respectfully, y Ron Warble Executive Vice President USIS, Inc. dha AmeriSys Page 2 "'""1 BROWN-3 OP ID: JW kCIICOR OP CERTIFICATE OF LIABILITY INSURANCE �� OATEIMN 11 ; 08/241YY1 2416 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. TIIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(SI, AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER_ IMPORTANT: H the certificate holder is an ADORIONAL INSURED, the pole-cy(res) must be eridorsed. If SUBROGATION IS WAIVED, subject ED the terms and conditions of the policy, certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRCOIUCER NAME "cr LAURIE KOHLER `16095 Brown & Brown of Florida, Inc. Daytona Beach Office PHONE PAx ie c_ No e t :386-239-7242 .lac Nor 386-323-9159 P.O. Box 2412Beach, ..DDPeas: Ikohlel bbdaytona.com Davtana Beach, FL 32115-2412 M. Decker Youngman DOS wERti APFOR OIN© COVERAGE H&C s dieuRER A ;Travelers Prop & Cos of Amer 25674 INSURED BROWN & BROWN INC ETAL INot1R.ERB.Continental Casualty Co 20443 POBOX 2412 DAYTONA BEACH. FL 32115 WsuRERc:Travelers Indemnity 25658 INauRER D : XL Specialty Ins Inc. 37885 POURER E INSURER F ' COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: 11-1S IS TO C€RTFY THAT TI-E POUCeES OF INSURANCE NCE LISTED ?FLOW RAVE BEEN ISSUED TO THE IN LRED NMIED ABOVE FOR TFE POLICY PERIOD INDICATED. NO1WTHSTANC-ING ANY RECUREMENT, TERM OR CONDITION OF ANY CCN'RACT OR OTHER DCCVtMEN'T WITH RESPECT TO WHCH THIS CERTIFICATE MAY BE ISSUED CFI MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEFE-N IS SUBJECT TO ALL THE TERMS, ExCLU 4;Cf S AND CCNDMO i OF SUCH POLICIES. LIMITS S- ANN MAY HAVE BEEN REDUCED BY PAID CLAIMS Ul$R LTR TYPE OF INaURRNCE ADD L.SURR WSD MVO POLICY NUMBERrt1u POLICY Err Dotr'frnl PULl4`Y EXP iWWOD( (1 Lows A X c mINERCLAL OEHERALLLI®ILirV EACH OCCLQREItCE I i,000,0OO X ��4iLI$ raADE �r_a_v TC2IGLSA9527B87S16 01101+2016 01101d2017 14 "'E'°` .0 = IACEa .€s orDre ce, r 1,000,000 'YE,T F,An. nra a��- i 5.000 €CR:Qr14- SAD4-NJURY I t,0000,00a :-Ertl AGCF5. ATE LAM' ADD, Ec PER. 'JENERAL AGGREGATE_ i 2,000,60o X PGL:CY n aE r LOC .ROOLICTD-GOT IPCP ADD i 2,000,00€. 'OTHER. i AUrt MOBILE LIAEIUTf -CSASINEC StNt. E;-2 Ea ACC- em I 1,000.200 A ANY{_-r. TC2.JCAP3527B86216 01/0112016 01.'0112017 e-x+LwINJ'R!.Psesl-.col i _ _ Ali.'OWNED AUTDO 3C Eu4'LET' .AUT-$ 1 :OILY IN.F_RY ,Pc arMent i HIRED Ay'33 X Lac-C4114ED AU -Ma P PERT+ �.141h�E i- xcven,t L .ZLX X UMBRELLA LAB X.,, EAC CCLPF_EN.'E i 5,000,000 6 ~ EXCESS LAB ` 600449 0012016 01l112017 _cGT 5,000,000 OED 1 I RETEN'":;NS i WORKERS COMPENSATION ilWTATL:'E I IE4 A AND EMPLOYERS' LIABILITY r: a ANyaRFFuETCaca.a .m.x.ss: <sE N A TC21UR9517B58016 01,'0112U16 01101!'2017 E_e c AcctDi:it; i 1,000,000 C Mandatory ID M Ex a cED* TRKU139518876116 0111tH 2016 01101/2017 g _D13E.iEE-EA, ESaPLG'E� 1 1,000, 000 r e1. detente d,Y3C OE.G+:rDON 7= CPERAT: Ra betas E E. D'ISEA.?R - POLICY LIMIT I 1,000.000 D INS AGENTS E&O ELU142465-16 0110112016 01.0112017 LIMIT 5.000,000 AGGREGATE 25,000.000 DESCRIPTION OF OPERA'ION& LOCATION& : VEHICLES IACCUrP tot. Addlt.nal Roma SalVdull, May be att.3,31Nni T nt!.., apace la reg radl NAMED INSURED: USIS, INC. dim AMERISYS RFP NUMBER 605386 MANAGED CARE/MEDICAL BILL REVIEW CERTIFICATE HOLDER CANCELLATION CfTYM-1 CITY OF MIAMI PROCUREMENTDEPARTMENT. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF. NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 444 N.W. 2ND AVE. 6TH FLOOR MIAMI, FL 33136 AUTHORIZED REPREE TAnVE i 'Ole0.r0*es''''--' 03 1918-2014 ACORD CORPORATION- All rights reserved_ ACORD 25 (20111011 The ACORD name and logo are registered narks of ACOR❑ Palk Certification Statement Please quote on this form, if applicable, net prices for the item(s) listed. Return signed original and retain a copy for your files. Prices should include all costs, including transportation to destination. The City reserves the right to accept or reject all or any part of this submission. Prices should be firm for a minimum of 180 days following the time set for closing of the submissions. In the event of errors in extension of totals, the unit prices shall govern in determining the quoted prices. We (1) certify that we have read your solicitation, completed the necessary documents, and propose to furnish and deliver, F.O.B. DESTINATION, the items or services specified herein. The undersigned hereby certifies that neither the contractual party nor any of its principal owners or personnel have been convicted of any of the violations, or debarred or suspended as set in section 18- 107 or Ordinance No. 12271. All exceptions to this submission have been documented in the section below (refer to paragraph and section). USIS/ArneriSys has no exceptions to this submission. We (I) certify that any and all information contained in this submission is true; and we (I) further certify that this submission is made without prior understanding, agreement, or connection with any corporation, firm, or person submitting a submission for the same materials, supplies, equipment, or service, and is in all respects fair and without collusion or fraud. We (I) agree to abide by all terms and conditions of this solicitation and certify that I am authorized to sign this submission for the submitter. Please print the following and sign your name: PROPOSER NAME: USIS, Inc. dba AmeriSys ADDRESS: 140 Alexandria Blvd. Suite H Oviedo, Florida 32765 PHONE: 800.752-0886 FAX: 407.949.3140 EMAIL: ron.warble(d),amerisys-info.cotn SIGNED BY: CELL (Optional): 407,810.2684 TITLE: Executive Vice President DATE: November 23, 2016 FAILURE TO COMPLETE, SIGN, AND RETURN THIS FORM SHALL DISOUALIFY THIS RESPONSE. Page 4 Certifications Legal Name of Finn: USIS, Inc. ciba AmeriSys FEIN No.: 204580645 Entity Type: Partnership, Sole Proprietorship, Corporation, etc. - Corporation USIS, Inc. clha AmeriSys is a wholly owned subsidiary of Brown & Brown, Inc. Year Established: Established in 1985. As of April 2000 AmeriSys was acquired and folded into USIS, Inc. a Wholly owned subsidiary of Brown & Brown, Inc. Business Address: 140 Alexandria Blvd., Suite H City, State, and Zip Code: Oviedo, Florida 32765 Telephone Number: 800.752.0886 Fax Number: 407.949.3140 E-mail Address: ron.warbicrcr;amerisys-info.coln Office Location: City of Miami, Miami -Dade County, or Other Orlando, Florida Business Tax Receipt/Occupational License Number: OVIEDO #17-00006592 ORLANDO #500-0520375 Business Tax Receipt/Occupational License Issuing Agency: City of Oviedo, City of Orlando, Orange County katt Randolph. Tan Cow Local Business Tan Racalpt Orange County. Florida rr..•. arum .r. 0. aer•NO. tam —_b, •e.mims w ,ae•-pm.. a..... ,r ww .w..err .r Wm . 4.a1•p•• •..da • e� 0.�.. alto EXPIRES S130,2017 5000.212133 ION MOM 014.1Cf i1e00 ae TOM rae m+� x 1:.1 W4_a. ■w.e. • 9.1-4• G 1,, PAID IsTht .".0' 92M015 •a-o,, .u,.a'W.e{NW w.n.iraayI. WC..." Page 5 CITY OF OVILDO LOCAL BUSINESS TAX RECEIPT 400 ALrx M MA RIM) • Ovirno, FL 32765.407 971-5775 wWW.C#1Yi`r;mFDC NET RP,iPm+Iama: A\IERISE Los.iioo .L,IJre..: 14U .tI EXANURLA BL V D STE R 17 SWAN Ngmher Ixeub D�ir'. b;jp- �xia�u Tas Penxlh ▪ 1 17-00006392 Atqull IV400 r•o.,41? 25.04 a.un 2:t. SEMINOLE CO RUN RE4,11.0,1• ,.4. \ 1' 00001055 A00y11.11, f0.- Sryx,mttir ' U. _U E Ip.16 0.00 40,00 CONSULTANT, GENERAL ) i lFj• i YC, COMMENTS: RESTWCTION5: CONTROL X: 143E, II UST RE CONSPICUOUSLY DISPLAYED TO PUBLIC III; W A r BUSINESS LOCATION Ori OF OKLA VINO {,EFT OFOR! ANDO 5 cb>.O. 14 OM' 00MF.%r PERM/TTIKi YFMoxr,S LOCAL BUMMERS TAX RFtFJPT ....w.c� ~tort, cart* WOO nuarr3s 201 a, imam MM.. VOW OP NO POmow Er woo mn.wtmu:a r+ a.r, ifiw Mr.Pwx Wan MIMMIMMI A ki Business Tax Receipt/Occupational License Expiration Date: 9/30/2017 Will Subcontractor or Sub consultant (s) be used? Sub consultant shall mean the same thing as a Subcontractor in these documents. (Yes or No) (if yes for what and what percentage of such work) Yes, the Dimensions Health, Inc. network will be utilized as the primary provider PPO, Coventry PPO as the secondary or "wrap" network and Matrix Healthcare Services. Inc. dba/myMatrixx will be proposed as the PBM. AmeriSys hires independent FCM subcontractors under the direction of AmeriSys' FCM Supervisor. All subcontracted FCM's are contracted to adhere to the standards of quality set forth by AmeriSys. Nurse 24/7 triage services would also adhere to AmeriSys standards for quality, but would be under a subcontractor. Will furnish and provide professional services to the City, at minimum, in compliance with all contract documents and in compliance with all applicable laws, rules and regulations. AmeriSys agrees. Certifies that neither the Proposer nor any of its principal owners or personnel or any subsidiary of the Proposer, have been convicted of any of the violation(s) or crimes or actions and conduct involving moral turpitude as defined by applicable laws, or debarred or suspended as set forth in Section 18-107, City Code, or as provided by 287.133, Florida Statutes. The Proposer further certifies that the Proposer has not been debarred or suspended by the United States Government, the State of Florida, any political subdivision of the State of Florida or any Special District or Public School Board in the State of Florida. AmeriSys certifies to the above statement. Proposer understands that exceptions not timely or correctly taken are waived. AmeriSys understands that exceptions not timely or correctly taken are waived. Page 6 Please list and acknowledge all addendum/addenda received. List the addendum/addenda number and date of receipt (i.e. Addendum No. 1, 7/1/07). If no addendum/addenda was/were issued, please insert N/A. Addendum No., 1 10/13/2016 Addendum No., 2 10/17/2016 Addendum No., 3 10/24/2016 Addendum No., 4 10/26/2016 Addendum No., 5 10/28/2016 Addendum No., 6 11/2/2016 Has Proposer reviewed the attached Sample Professional Services Agreement (PSA)? Yes, AtneriSys has reviewed the attached Sample Professional Services Agreement. Does the Proposer acknowledge that the attached PSA is an example of the standard Agreement used in conjunction with the services related to this Solicitation and shall not be amended? Yes, AmeriSys acknowledges and agrees to above. Proposer's General Experience, Past Performance, and Exceptions I) Describe the Proposer's past performance and experience and state the number of years that the Proposer has been in existence, the current number of employees, and the primary markets served. USES, Inc. (corporation) dba AmeriSys is a wholly owned subsidiary of Brown & Brown Inc., one of the nation's largest insurance agency/brokerage organizations. The financial and management depth and resources afforded by our affiliation with Brown & Brown assures our customers that we will be there for them even during the most troubling times. AmeriSys has been providing successful medical management and medical bill review/cost containment services to our clients for over 30 years. Many of our clients have been with us for 20+ years. We have an excellent reputation in the Workers' Compensation arena and new business is often through referrals. Honesty and integrity are cornerstones of our culture; from the leadership down, ethical and professional behavior is expected and demonstrated. Our team is professional, experienced, customer service and quality driven, committed to the company's philosophy "Service Beyond the Contract". Our IT department and our systems are kept current and innovative; our IT team is all in-house so we are able to tailor our programs to our clients' needs, and ensure our staff has the current equipment to succeed in their jobs. Our staff members are mainly long term employees; training is thorough; continuing education is encouraged. We have adequate staff to accomplish the job in a quality manner to ensure successful outcomes for our clients and our employees. The State of Florida and State of Georgia are the primary markets served by AmeriSys. AmeriSys currently provides cost containment services which include medical bill review for an insurance company, two Florida self-insurance funds, sell -insured entities including Broward County Government and Palm Beach County, and 20 other self insureds, public and private; and, on behalf of FWCIGA, 8 insolvent insurance carriers. AmeriSys also provides these services to Preferred Governmental Claims Services which includes a Florida Governmental Insurance Trust with over 200 governmental entities as well as 25 self insured public entities. The AmeriSys Medical Management team also provides Telephonic Nurse Case Management and other medical management services to the State of Florida, State of Georgia and all of the clients listed above. AmeriSys currently employees approximately 200 teammates consisting of Administrative Staff, Telephonic Nurse Case Managers, Field Case Managers, Utilization Review Nurses and Medical Bill Review Staff, IT Staff and Support Staff. The AmeriSys Medical Bill Review department consists of a Quality Controller, 1 Supervisor and 11 personnel who currently process over 250,000 bills annually for these clients. This team consistently meets and exceeds all benchmarks established or required of them. Our experienced team has the personnel and ability to meet and exceed the requirements set forth by the City of Miami. AmeriSys has a proprietary Medical Management system, Corrus, which includes our Medical Bill Review component. With proprietary software and our in-house staff of 8 programmers, we have the ability to tailor Corrus to meet the City of Miami's needs. In addition to our software we are continually upgrading our equipment and facilities to best serve our staff and clients. Page 8 For the calendar year 2015, AmeriSys was able to medical management approaches. As an organization $27,082,651 in case management savings. Case including, but not limited to, fee negotiation, directing benefit from contracted rates, the recognition of non-compensable the Maximum Medical Improvement goals for the guidelines. In addition to the case management savings we $9,534,227 in Utilization Review Savings by the procedures andfor procedures that are not causally reviews are done in compliance with the standards assistance of physician advisors in issuing non -certifications. There was an additional $5,823,500 in documented employee to work prior to the benchmarks set by calculated in accordance with the injured employee's importance of a robust return -to -work program offering In the processing of over 253,531 bills, the AmeriSys and rule, utilizing PPO networks. the skills of seasoned specialize in retrospective bill review, reviewed total on those submitted charges. The Fee Schedule Savings $32,529,040 resulting from our professional review average was 11.34% below Fee Schedule. All of savings collectively for our customer partners. We recognize that each client has unique needs, AmeriSys services will be tailored to the client's individual Please reference Attachment 1 — Brown & Brown, 2) List all contracts which the Proposer has performed the City and include for each project: (i) name of the the contract, (ii) description of work, (iii) total dollar the contract, (v) City contact person and phone prime contractor or subcontractor, and (vii) the results offer its customers savings achieved by a variety of we were able to demonstrate in excess of management savings is achieved in variety of ways treatment into the ancillary provider network to body parts or treatments and reaching claim prior to the benchmarks set by the approved were able to document in excess of f identification of medically unnecessary 4, urac) related to the compensable injury. These set forth by URAC and with the ACCREDITED savings accomplished by returning the injured the Official Disability Guidelines, Days saved are average weeklong wage. This also demonstrates the modified duty positions. Bill Review Department in compliance with statute bill reviewers and utilization review nurses who submitted charges of $215,386,620. We saved 55% were 40% of that number with the remaining and contracted savings. Our contracted savings this totaling more than $117,788,132 in documented requirements and expectations. The utilization of needs, expectations and requirements. Inc. Annual Report. for the City of Miami, describe all work performed for City Department which administers or administered value of the contract, (iv) dates covering the term of number, (vi) statement of whether Proposer was the of the project. Name of the city of department Risk Management Description of work Workers' Compensation Managed Care Services Total dollar value of the contract Approximately S200,000 annually Dates covering the term of the contract 2003-2011 City contact person and phone number Angel la Breadwood, 305.416.1751 Prime contractor or Subcontractor Prime Contractor Results of the project Successfully completed Page 9 i 3) Provide information concerning any prior or pending litigation, either civil or criminal, involving a governmental agency or which may affect the performance of the services to be rendered herein, in which the Proposer, any of its employees or subcontractors is or has been involved within the last five (5) years. Provide letters of reference from law firms which currently handle your litigation. Provide contact person and phone number for each. USIS/AmeriSys has not been party to lawsuits, administrative actions or litigation related to fraud, theft, breach of contract, misrepresentation, safety, or wrongful death. However in the normal course of doing business related to workers' compensation claims handling, USIS/AmeriSys was made party to litigation related to the servicing of workers' compensation claims (5) on behalf of its clients. All but one was resolved in our favor, and one is current and pending. Brown & Brown, Inc. (the parent of USIS, Inc.) is publicly traded on the NYSE, is regularly subject to suits and claims that arise in the ordinary course of its business, and is required by law to make periodic Flings with the Securities and Exchange Commission, which are publicly available and which contain additional information concerning legal matters. 4) Identify if Proposer has taken any exception to the terms of this Solicitation. If so, indicate what alternative is being offered and the cost implications of the exception(s). Page 10 Proposer's Category Specific Experience, Past Performance Note: Any Proposer submitting a Proposal for both categories of Service, Part I- Workers' Compensation Claims Administration AND Part II: Medical Bill Review and Audit Services (Part I and II) must provide in its proposal, complete and separate responses for applicable Items 5 through 15 below for each Part (Part I or II). USIS, Inc. is submitting a proposal for both categories of Service. Part I is proposed under USES, Inc. and Part II is proposed under USIS, Inc. dhca AmeriSys. 5) Describe Proposer's past performance and experience with regard to the particular service category (Part and/or Part II), and state the number of years that the Proposer has worked in this area providing a similar type of service, the current number of employees working in this area, and the primary markets served. Provide organizational history and structure, and indicate whether the City has previously awarded any contracts to the Proposer (a list of these City contracts shall be provided in item 2 above). USIS, Inc. (corporation) dba AmeriSys is a wholly owned subsidiary of Brown & Brown Inc., one of the nation's largest insurance agency/brokerage organizations. The financial and management depth and resources afforded by our affiliation with Brown & Brown assures our customers that we will be there for them even during the most troubling times. AmeriSys has been providing successful medical management and medical bill review/cost containment services to our clients for over 30 years. Many of our clients have been with us for 20+ years. We have an excellent reputation in the Workers' Compensation arena and new business is often through referrals, Honesty and integrity are cornerstones of our culture; from the leadership down, ethical and professional behavior is expected and demonstrated. Our team is professional, experienced. customer service and quality driven. committed to the company's philosophy "Service Beyond the Contract'. Our IT department and our systems are kept current and innovative; our IT team is all in-house so we are able to tailor our programs to our clients' needs, and ensure our staff has the current equipment to succeed in their jobs. Our staff members are mainly long term employees; training is thorough; continuing education is encouraged. We have adequate staff to accomplish the job in a quality mariner to ensure successful outcomes for our clients and our employees. The State of Florida and State of Georgia are the primary markets served by AmeriSys. AmeriSys currently provides cost containment services which include medical bill review for an insurance company, two Florida self-insurance funds, self -insured entities including Broward County Government and Palm Beach County Sheriffs Office, and, on behalf of FWCIGA, 8 insolvent insurance carriers. AmeriSys also provides these services to Preferred Governmental Claims Services which includes a Florida Governmental Insurance Trust with over 200 governmental entities, The AmeriSys Medical Management team also provides Telephonic Nurse Case Management services to the State of Florida, State of Georgia and all of the clients listed above. AmeriSys currently employees approximately 200 teammates consisting of Administrative Staff. Telephonic Nurse Case Managers, Field Case Managers, Utilization Review Nurses and Medical Bill Review Staff, IT Staff and Support Staff. The AmeriSys Medical Bill Review department consists of a Quality Controller, 1 Supervisor and 11 personnel who currently process over 250,000 bills annually for these clients. This team consistently meets and exceeds all benchrnarks established or required of them. Our experienced team has the personnel and ability to meet and exceed the requirements set forth by the City of Miami. Page I including, the In reviews assistance employee calculated importance In and specialize on $32,529,040 average savings The AmeriSys has a proprietary Medical Management Review component. With proprietary software and ability to tailor Corrus to meet the City of Miami's upgrading our equipment and facilities to best serve For the calendar year 2015, AmeriSys was able to medical management approaches. As an organization $27,082,651 in case management savings. Case but not limited to, fee negotiation, directing benefit from contracted rates, the recognition of non-compensable Maximum Medical Improvement goals for the guidelines. addition to the case management savings we $9,534,227 in Utilization Review Savings by the procedures and/or procedures that are not causally are done in compliance with the standards of physician advisors in issuing non -certifications. There was an additional $5,823,500 in documented to work prior to the benchmarks set by in accordance with the injured employee's of a robust return -to -work program offering the processing of over 253,531 bills, the AmeriSys rule, utilizing PPO networks, the skills of seasoned in retrospective bill review, reviewed total those submitted charges. The Fee Schedule Savings resulting from our professional review was 11.34% below Fee Schedule. All of collectively for our customer partners. We recognize that each client has unique needs, AmeriSys services will be tailored to the City of Miami's City of Miami previously awarded AmeriSys a system, Corrus, which includes our Medical Bill our in-house staff of 8 programmers, we have the needs. In addition to our software we are continually our staff and clients. offer its customers savings achieved by a variety of we were able to demonstrate in excess of management savings is achieved in variety of ways treatment into the ancillary provider network to body parts or treatments and reaching claim prior to the benchmarks set by the approved `� .r were able to document in excess of it identification of medically unnecessary A urac r related to the compensable injury. These "_ set forth by URAC and with the ACCREDITED 1 zAv;aam 1lnnaur,cm Fepoe,,ut.ni .'+J1. savings accomplished by returning the injured the Official Disability Guidelines. Days saved are average weeklong wage. This also demonstrates the modified duty positions. Bill Review Department in compliance with statute bill reviewers and utilization review nurses who submitted charges of $215,386,620. We saved 55% were 40% of that number with the remaining and contracted savings. Our contracted savings this totaling more than $1 17,788,132 in documented requirements and expectations. The utilization of needs, expectations and requirements. contract for Managed Care Services in 2003. Name of the city of department Risk Management Description of work Workers' Compensation Managed Care Services Total dollar value of the contract Approximately $200,000 annually Dates covering the term of the contract 2003-2011 City contact person and phone number _ Angella Breadwood, 305.4 1 6.1751 Prime contractor or Subcontractor Prime Contractor Results of the project Successfully completed Pace r 2 US'S / ArneriSys Organizational Structure .NW :1 EXECUTIVE VICE PRESIDENT —.rc.«. al Ajire./ • ' Paaaadamera.iaa Aaoa IL.1.lae. i4.A1 ^, 0.4`:h a.2l'I MY i.�YR11 M C'1.. ri __ i1i�1� 1M0 imbraf04 - Irdihro W Raaai.ar 'fM %MOP I 'ax-AAK O..N.m.t -- - -.N .HER. al/ v..Rta r. JI&a aN 1CAA WIC. .. Ya.p.. OW*1.19. CUM* 1M _ C.....ltrly.. Clam. lido C..aw lat. ...IPA CCM Igo RY *a... .la'. bap.- i+Aa • YR wawa,. u 1 — ,,,, ,,x Clow 4yYWam Cl.Mw ioiarrnn Claim 5u dmi.ea. N11M.rn.. fl, �Y.d •. 1C1.CleAsa a.prMn a.. W..y..w.. _I tirAza zys UR ipmaall.. 4.0111 }vim, ft.' n MIrl _ llmaplbnYa ICY". 01.0 ANua1•a• M�...r. A"lumma ICY..xu. MHO ix�. ..« i.VioM1 Y l Aa}u.im .M! Adlua..ra .aoAAWci.n CYI1GNAaala.a". S"W.9n MVO- C.e.v41 Swim l.Watt AAl...in 04 .$ Io . hemlysts i+,'cva.e WA.. a,,,,, ' RMC3' Rama, wAeN i.. I�ii�. a/ Pravda I... C..Ir.x CNW-44340p . Canwtrw YI" I]r�..n, r,vrw.. Rn."x. _. eor.acw Ca✓ThI.Ior 6) Provide a detailed description of five (5) comparable contracts (similar in scope of services to those requested herein), which the Proposer has either ongoing or completed within the past five (5) years in the capacity as a Third Party Claims Administrator. The description should identify for each project: (i) client, (ii) client contact person, phone number and email address, (iii) description of work, iv) total dollar value of the contract, (vi) dates covering the term of the contract, (vii) statement of whether Proposer was the prime contractor or subcontractor. Include the Proposers role and any value added. (viii) Specify if the scheduled completion time and budgets approved by the client were met for each of the listed projects. Where possible, list and describe those projects performed for government clients or similar size private entities (excluding any work performed for the City). Client Broward County BOCC Client contact person Jeff O'Connor Phone number 954.357.7230 Email address JCOCONNOR(a;Ibroward.org Description ot'work Network Access/Bill Review/Intake Total dollar value $50,000+ annually Dates covering the term of the contract Established 2007 and remains active Prime contractor or subcontractor Prime Contractor Value added Established an industry current airborne pathogen exposure program to assist with reports of injuries related to mold exposures. Specify if the scheduled completion time and budgets approved by the client were met for each of the listed projects. Active contract with performance standards being met. Page 13 Client City of Jacksonville Client contact person Twane Duckworth Phone number 904.630.2777 Email address twaned($,coj.nct Description of work Network Access, Medical Bill Review and Medical Only Claims Handling on an as needed basis Total dollar- value $275,000+ annually Dates covering the tern of the contract Established 2013 and remains active Prime contractor or subcontractor Prime Contractor Value added Modified bill approval system to compliment adjusters' unique claims process Specify if the scheduled completion time and budgets approved by the client were met for each of the listed projects. Active contract with performance standards being met. Client Palm Beach County Sheriff's Office Client contact person Hilda Gonzalez Phone number 561.688.3550 Email address gonzalezH c.pbso.org _ Description of work WC Claims TPA, Bill Review, Medical Management Total dollar value S750,000+ annually Dates covering the term of the contract Established 2000 and remains active Prime contractor or subcontractor Prime Contractor Value added First account to work with established Heart and Lung program as well as multiple exposure programs Specify if the scheduled completion time and budgets approved by the client were met for each of the listed projects. Active contract with performance standards being met. Client Orange County Public Schools Client contact person Regina Cochrane Phone number 407.317.3918 Email address regina.cochranerisocps.net Description of work WC Claims TPA, Bill Review and Medical Management Total dollar value S400,000+ annually Dates covering the term of the contract Established 1996 and remains active Prime contractor or subcontractor Prime Contractor Proposer's role and any value added. Due to multiple job descriptions involved, many face to face meetings have been held with providers to educate them on the specific needs P,1gc 14 In the (Part services. N/A 7) of the employees and the school board. Specify if the scheduled completion time and budgets approved by the client were met for each of the listed projects. Active contract with performance standards being met. Client Columbus Consolidated Government Client contact person Anne -Marie Amiel Phone number 706.225.3113 Email address aamiel ccolumbusga.org Description of work WC Claims TPA, Bill Review, Managed Carc Organization Total dollar value $350,000+ annually Dates covering the team of the contract Established 2014 and remains active Prime contractor or subcontractor Prime Contractor Proposer's role and any value added. Initiated Managed Care Services to allow for better control over medical spend on workers' compensation claims Specify if the scheduled completion time and budgets approved by the client were met for each of the listed projects. Active contract with performance standards being met. event that the Proposer has not performed five (5) comparable contracts in the particular category I or Part Il), the Proposer should provide information that demonstrated its ability to perform the required Describe any relevant industry/subject matter expertise, including any experience in the particular services, and any unique or proprietary project methodologies relevant to the requested services. It is our understanding from previously working with the City, that the City has first responders/badged officials that are in your employment which experience presumption and cardiac claims. Please reference BADGE Program Attachment 2 - Cardiac -Exposure Protocol. We believe that the Heart/Lung public presumption claims represent one of the most significant economic exposures to closing claims and the anticipation that most of those claims will deteriorate as the employee ages. David E. Perloff, MD, FACC, FACP, is the AmeriSys BADGE Program Cardiac Medical Director. He has many years of experience in Cardiology and over 10 years of that in dealing with workers' compensation related to the Heart/Lung Presumption Bill. It is also our assumption that the City has injured employees who are prescribed opioids. Please reference Attachment 3 - Innovative Programs for information related to the SECURE program. AmeriSys has developed unique protocols and criteria for managing these complex and cost -driving claims. The program's goals are to improve/enhance return -to -work outcomes, reduce disability duration; prevent unnecessary, dangerous and costly consequences of inappropriate or prolonged utilization of opioid medications while reducing the costs of handling pain management claims. Page 15 8) 9) 10) It is this position and approach of innovation and efficiency that characterizes our organization. Whether it is unique types of claims, unusual working conditions or locations with special information needs, we strive to customize our program to address those unique and individual needs. Our commitment to innovation and efficiency is also coupled with 30+ years of proven experience in providing cost effective and quality -oriented medical care management. It is the careful blend of innovation with proven. tested experience and success that allows for the best in functional and economic outcomes. AmeriSys stands ready to work with your leadership team to identify, develop and implement a program that is best suited to your claims and informational needs. Provide a list of clients that have, for whatever reason, discontinued the use of your services within the past two (2) years, and indicate the reasons for the same. The City reserves the right to contact any clients listed as part of the evaluation process. Marion County P.O. Box 1270 Marion County, Florida 34478 Sheri Wiley 352.629.8359 Marion County selected another TPA through an RFP process. Florida Roofers and Sheet Metal Association SIF 4099 Metric Drive Winter Park. Florida 32792 Brett Stiegel 407.671.3772 FRSA is a Self -Insured Trust which made a decision to create its own Claims Department and began administering claims in-house. After approximately one year after discontinuing services, FRSA contracted with AmeriSys to provide Medical Management Cost Containment services. Provide two (2) Letters of Reference, on letterhead, from two different, similar sized governmental entities (as the City), and for which similar services (Part I or Part II) have been performed within the past five (5) years. This information is subject to verification as part of the evaluation process. Please reference Attachment 4 — Reference Letters. Provide a complete list of all current Florida clients for which Proposer administers claims in a Workers' Compensation, self-insurance, or retention program. The description should identify for each client (i) client, and type of entity; (ii) client contact person, phone number, and email address, (iii) description of work, iv) total dollar value of the contract, (vi) dates covering the term of the contract, (vii) statement of whether Proposer was the prime contractor or subcontractor. Specifically identify clients for whom a similar service has been provided, particularly to governmental entities similar in size to the City, Trust, or other similar type as the City. Indicate whether Proposer assisted in disability, safety program, light duty / return -to -work program, etc. A complete list of current Florida clients for which AmeriSys' provides Medical Management services is listed below. This includes, but not limited to, case management, utilization review, bill review/repricing, access to provider networks (both medical and pharmacy), grievance handling, etc. Client BarCounty Board of County Commissioners Type of Entity Public Client contact person Eve Tooley Phone number 850.248.8231 Email address etooley@,Jbaycountytl.gov Description of work WC Claims TPA Medical Bill Review Total dollar value S 15,000+ annually Dates covering the term of the contract Established 1993 and remains active Prime contractor or subcontractor Prime Contractor Indicate whether Proposer assisted in disability, safety program, light duty / return -to -work program, etc. RTW Client Broward County BOCC Type of Entity _ Public Client contact person Jeff O'Connor Phone number 954.357.7230 Email address JCOCONNOR@broward.org Description of work Network Access/Bill Review/Intake Total dollar value $50,000+ annually Dates covering the term of the contract Established 2007 and remains active Prime contractor or subcontractor Prime Contractor Indicate whether Proposer assisted in disability, safety program, light duty / return -to -work program. etc. Client City of Cocoa Type of Entity Public Client contact person John Titkanich _Phone number 321.433.8686 Email address jtitkanich(a;cocoafl.org Description of work WC Claims TPA, Medical Bill Review Total dollar value $50,000+annually Dates covering the term of the contract Established 2009 and remains active Prime contractor or subcontractor Prime Contractor Indicate whether Proposer assisted in disability, safety program, light duty / return -to -work program, etc. RTW Client City of Jacksonville Type of Entity Public Client contact person Twane Duckworth Phone number 904,630.2777 Email address twaned cc.coj.net Description of work Network Access. Medical Bill Review and Medical Only Claims Handling on an as needed basis Total dollar value $275,000+ annually Dates covering the term of the contract Established 2013 and remains active Prime contractor or subcontractor Prime Contractor Indicate whether Proposer assisted in disability, safety program, light duty / return -to -work program, etc. Page 17 Client Orange County Public Schools Type of Entity Public Client contact person Regina Cochrane Phone number 407,317.3918 Email address reaina.cochrane a ocps.net Description of work WC Claims TPA, Bill Review and Medical Management Total dollar value $400,000+ annually Dates covering the term of the contract Established 1996 and remains active Prime contractor or subcontractor Prime Contractor Indicate whether Proposer assisted in disability, safety program, light duty / return -to -work program, etc. RTW, Light Duty, Loss Control Client Palm Beach County Sheriff's Office Type of Entity Public Client contact person Hilda Gonzalez Phone number 561.688.3550 Email address gonzalezH(i bso.org Description of work WC Claims TPA, Bill Review, Medical Management Total dollar value $750,000+ annually Dates covering the term of the contract Established 2000 and remains active Prime contractor or subcontractor Prime Contractor Indicate whether Proposer assisted in disability, safety program, light duty / return -to -work program, etc. RTW, Light Duty Client State of Florida (DRNI) Type of Entity Public Client contact person Candy Janes Phone number 850.413.4827 Email address Candv.Janes@Tinvlloriclacto.com Description of work Intake/Triage Medical Management Total dollar value $9,000,000+ Annually Dates covering the term of the contract Established 2014 and remains active Prime contractor or subcontractor Prime Contractor Indicate whether Proposer assisted in disability, safety program, light duty / return -to -work program, etc. Page f 8 Client Volusia County Public Schools Type of Entity Public Client contact person Sandra Higginbotham Phone number 386.734.7190 Email address skhiggin(cr volusia.k 12. 11.us Description of work WC Claims TPA, Bill Review, Medical Management Total dollar value S250,000+ Annually Dates covering the term of the contract Established 2007 and remains active Prime contractor or subcontractor Prime Contractor Indicate whether Proposer assisted in disability, safety program, light duty / return -to -work program, etc. RTW, Light Duty Client Preferred Governmental Insurance Trust Type of Entity Public _ Client contact person Ann Hansen Phone number 321.832.1510 _ Email address ahansen@'.publicrisk.com Description of work Medical Bill Review, Medical Management (USIS /AmcriSys) Liability and Work Comp TPA (PGCS) Total dollar value Confidential Dates covering the tern of the contract Established 1999 and remains active Prime contractor or subcontractor Subcontractor for Medical Bill Review, Medical Management Prime Contractor for Liability and Work Comp TPA Indicate whether Proposer assisted in disability. safety program, light duty / return -to -work program, etc. Client Brevard County BOCC Type of Entity Public Client contact person Julie Jones Phone number 321.637.5446 Email address Julie.Jones a.brevardcounty.us Description of work Medical Bill Review, Medical Management (USIS /AmeriSys) Liability and Work Comp TPA (PGCS) Total dollar value S250.000+ annually Dates covering the term of the contract Established 2003 and remains active Prime contractor or subcontractor Subcontractor for Medical Bill Review, Medical Management Prime Contractor for Liability and Work Comp TPA Indicate whether Proposer assisted in disability. safety program, light duty / return -to -work program, etc. Page 19 Client Charlotte County Type of Entity Public Client contact person Raymond Carter Phone number 941.743.1334 Email address Raymond. Carter.i:charlottecountyll.gov Description of work Medical Bill Review, Medical Management (USIS /ArneriSys) Liability and Work Comp TPA (PGCS) Total dollar value S40,000+ annually Dates covering the term of the contract Established 2010 and remains active Prime contractor or subcontractor Subcontractor for Medical Bill Review, Medical Management Prime Contractor for Liability and Work Comp Indicate whether Proposer assisted in disability, safety program, light duty / return -to -work program, etc. Client City of Delay Beach Type of Entity Public Client contact person Eddie DeMicco Phone number 561.243.7150 Email address dernicco ci.'mydelraybeach.corn Description of work Medical Bill Review, Medical Management (USIS /AmeriSys) Liability and Work Comp TPA (PGCS) Total dollar value S50,000+ annually Dates covering the term of the contract Established 2013 and remains active Prime contractor or subcontractor Subcontractor for Medical Bill Review, Medical Management Prime Contractor for Liability and Work Comp Indicate whether Proposer assisted in disability, safety program, light duty / return -to -work program, etc. Client Leon County BOCC Type of Entity Public Client contact person Karen Melton Phone number 850.606.5120 Email address Meltonk@leoncountyfl.gov Description of work Medical Bill Review, Medical Management (USIS /AmeriSys) Liability and Work Comp TPA (PGCS) Total dollar value $50,000+ annually Dates covering the terns of the contract Established 2011 and remains active Prime contractor or subcontractor Subcontractor for Medical Bill Review, Medical Management Prime Contractor for Liability and Work Comp Indicate whether Proposer assisted in disability, safety program, light duty / return -to -work program, etc. Page 20 Client Preferred Governmental Claims Services Type of Entity Private Client contact person Ken Picton Phone number 800.237.6617 Email address kpietonla pizcs-tpa.com Description of work Medical Management, Bill Review Total dollar value Confidential Dates covering the term of the contract Established 2005 and remains active Prime contractor or subcontractor Prime Contractor for Medical Bill Review and Medical Management Indicate whether Proposer assisted in disability, safety program, light duty / return -to -work program, etc. Client Ferman Motor Car Company Type of Entity Private Client contact person Webb Bond Phone number 831 251.2765 Email address webb.bond@ferman.coin Description of work WC Claims TPA, Bill Review Total dollar value $20,000+ Annually Dates covering the teen of the contract Established 2011 and remains active Prime contractor or subcontractor Prime Contractor Indicate whether Proposer assisted in disability. safety program, Iight duty / return -to -work program, etc. RTW, Light Duty Client ' Halifax Health Type of Entity Private Client contact person Terry Martin Phone number 386.254.4048 Email address Terry.martini'halifax.org Description of work WC Claims TPA, Bill Review Total dollar value $75,000+ Annually Dates covering the term of the contract Established 2012 and remains active Prime contractor or subcontractor Prime Contractor Indicate whether Proposer assisted in disability, safety program, light duty / return -to -work program, etc. RTW, Light Duty Page 21 Client Health First, Inc. Type of Entity Private Client contact person Nancy Johnson Phone number 321.868.72.48 Email address Nancy.johnson@..health-lirst.org Description of work WC Claims TPA, Bill Review Total dollar value $125,000+ Annually Dates covering the term of the contract Established mid 1980's and remains active Prime contractor or subcontractor Prime Contractor Indicate whether Proposer assisted in disability, safety program, light duty / return -to -work program, etc. RTW, Light Duty Client Orlando Regional Health Systems Type of Entity Private Client contact person Christy Pearson Phone number 321.841.6104 Email address clu•isty.pearson( orhs.org _ Description of work WC Claims TPA, Bill Review _ Total dollar value $175,000+ Annually Dates covering the term of the contract Established 1996 and remains active Prime contractor or subcontractor Prime Contractor Indicate whether Proposer assisted in disability. safety program, light duty / return -to -work program, etc. RTW, Light Duty Client Parrish Medical Center Type of Entity Private Client contact person Roberta Chaildin Phone number 321.268.6333 Email address roberta.chaildinwparrishmcd.com Description of work WC Claims TPA, Bill Review Total dollar value $20,000+ Annually Dates covering the term of the contract Established 201 1 and remains active Prime contractor or subcontractor Prime Contractor Indicate whether Proposer assisted in disability, safety program, light duty / return -to -work program. etc. RTW, Light Duty Page 22 Client Ring Power Corporation Type of Entity Private Client contact person Cindy Acosta Phone number 904,737.7730 Email address Cindy,Acosta(r ringpower.com Description of work WC Claims TPA, Bill Review Total dollar value $40.000+ Annually Dates covering the term of the contract Established 20l I and remains active Prime contractor or subcontractor Prune Contractor Indicate whether Proposer assisted in disability, safety program, light duty / return -to -work program, etc. RTW, Light Duty Client _ FHM Insurance Company Type of Entity Private Client contact person Jack Lemine Phone number _ 800,329.4340 Email address jlernine@Thmic.com Description of work WC Claims TPA, Bill Review, Medical Management Total dollar value Confidential Dates covering the term of the contract Established 2003 and remains active Prime contractor or subcontractor Prime Contractor Indicate whether Proposer assisted in disability, safety program, light duty / return -to -work program, etc, Client Florida Citrus, Business industries Fund Type of Entity Private Client contact person Jim Emerson Phone number 863.660.5943 Email address jim,emerson48(i gmail.com Description of work WC Claims TPA. Bill Review, Medical Management Total dollar value Confidential Dates covering the term of the contract Established 2002 and remains open Prime contractor or subcontractor Prime Contractor Indicate whether Proposer assisted in disability, safety program, light duty / return -to -work program, etc. Page 23 Client Florida Rural Electric Self Insurers Fund Type of Entity Private Client contact person William Willingham Phone number _ 850.877.6166 Email address Bill(u FECA.Com Description of work WC Claims TPA, Bill Review, Medical Management Total dollar value Confidential Dates covering the term of the contract Established 2002 and remains active Prime contractor or subcontractor Priine Contractor Indicate whether Proposer assisted in disability, safety program, light duty / return -to -work program, etc. Client Florida Workers' Compensation Insurance Guaranty Association Type of Entity Private Client contact person Sandra Robinson Phone number 850.386.9200 Email address srobinson&gfgroup.org Description of work WC Claims TPA. Bill Review Total dollar value Confidential Dates covering the term of the contract Established 1998 and remains active Prime contractor or subcontractor Prime Contractor Indicate whether Proposer assisted in disability, safety program, light duty / return -to -work program, etc. Run off claims Client Sugar Cane Growers Cooperative of Florida Type of Entity Private Client contact person Carmen Abercrombi Phone number _ 561.996.4751 Email address cabercrotnbi@scgc.org Description of work WC Claims TPA, Bill Review Total dollar value Confidential Dates covering the term of the contract Established 2010 and remains active Prime contractor or subcontractor Prime Contractor Indicate whether Proposer assisted in disability, safety program, light duty / return -to -work program. etc. Page 24 11) Discuss in detail Proposer's qualifications and experience to provide general liability and automobile liability claims administration. Include, in the description, the Proposers thorough knowledge of all State Statutes and other applicable laws governing this RFP, to demonstrate a complete understanding of the work to be performed. N/A - This question pertains to Part I. 12) Discuss in detail Proposer's qualifications and experience to provide managed care services. Include the Proposer's thorough knowledge of all State Statutes and other applicable laws governing this RFP, to demonstrate a complete understanding of the work to be performed. Our experience in handling large public entity employers, such as your own organization, the City of Miami (2003 — 2011), as well as the Palm Beach County Sheriffs Office, Broward County Government and the State of Florida, makes us uniquely qualified to assist the City with its managed care program. Our experience providing the Occupational Medical Management program for Preferred Governmental Claim Services and Preferred Governmental Insurance Trust brings over 200 Florida public entity employers into our service program. Each of these customers has benefited from highly customized approaches developed by AmeriSys to meet its unique occupational medical management needs. AmeriSys has a thorough knowledge of all State Statutes and other laws governing this RFP from its 25+ years of experience in the Florida Medical Management marketplace. 13) Provide detailed background on the Proposer's proposed Manager/Supervisor to be assigned the City's account throughout the duration of the contract term, and whether Proposer agrees to City's terms for approval of future Manager/Supervisor, should proposed representative leave Proposer's firm during the contract term. Provide copies of current applicable licenses for work to be performed in the State of Florida. Cheryl Gulasa, RN, CPHMI, CCM, VP/AmeriSys, 800.444.9098 Ext. 6219 ehervl.aulasa a usis-tpa.com Cheryl is currently the Vice President for AmeriSys. Her primary responsibilities include overseeing the professional operations of AmeriSys Telephonic Case Management, Field Case Management, Provider Relations and Utilization Management, including Bill Review. Cheryl has 30 years' experience in nursing, the last 14 years in workers' compensation case management and utilization management. She has successfully implemented large public entity programs. Cheryl's experience coupled with her energy and leadership skills brings valuable assets to our organization. Jen White, RN, CCM, Program Manner/Supervisor, 800.444.9098 Ext. 6567 jen.white(iiusis-tpa.com Jen is currently Program Manager for AmeriSys in Florida. Jen is a Registered Nurse and Certified Case Manager. She has extensive workers' compensation experience including supervisor roles in large public entity programs. Jen joined AmeriSys in 2012 and has successfully enhanced program efficiencies and productivity while preserving customer service and satisfaction. Prior to joining AmeriSys, Jen worked for an international all lines insurance company as a telephonic case -manager for workers' comp claims in the states of Florida, North Carolina, Tennessee, New York, Rhode Island, New Hampshire, Massachusetts and South Carolina handling large national corporate accounts. Jen has clinical experience in Rehabilitation, Orthopedics, Neurology, and Emergency Room; with over 10 years in Quality Assurance and leadership positions. Amv Krietemever, RN, CCM, Field Case Manaeement Supervisor amv.krietemeyer(damerisys-info.com Amy is the Supervisor over Field Case Management. As Supervisor she is responsible for overall technical and quality oversight of field case management services. Primary duties include planning and directing field case -management services, assisting in development of long range plans for the department, Page 25 promoting staff education and development, meeting with current and prospective customers and clients as required, overseeing compliance with all governmental agencies as it relates to field case management services and day to day management of the field case -management departments. Amy also serves as a resource to all departments, assisting in the development of service proposals for prospective clients and certifying cases as catastrophic as indicated by state law and in-house procedures. Amy has over 24 years of nursing experience, 20 of which has been devoted to the Worker's Compensation industry. Please reference Attachment 5 - Resumes/Licenses. Since AmeriSys will be the employer- and AmeriSys/Brown & Brown could potentially be at risk for any perceived liability of wrongdoing in the hiring process, it would not be standard practice to accept an outside entity into our hiring processes. It is our intent to positively ensure that our equal employment opportunity philosophy, in accordance with federal, state, and local law, applies to all aspects of employment with USIS including recruiting, hiring, training, transfer/promotions, compensation and benefits, and termination. At USIS, handled through our own Human Resources Department we must ensure that our employment practices are free of discriminatory practices and that employment decisions are made on the basis of job -related qualifications, experience, including personal competence and potential for advancement. With that stated, we will he open and pleased to consider any recommendations or referrals of properly qualified staff that the City might provide or request. We will also be willing to share the resumes of the employee(s) hired or transferred internally to handle the City of Miami account. Once into the contract, should there be any staffing changes necessary, USIS would communicate with the City of Miami as soon as known. It should be noted that at AmeriSys we are committed to ensuring equal employment opportunity for all employees and applicants for employment. It is our goal to recruit, hire and develop the best employees using only job -related qualifications. We know that our people are the heart and soul of our enterprise and we recognize that our continued success depends on the full and effective recruitment. hiring and development of the very best employees, taking into consideration only job -related qualifications. regardless of race, color, religion, sex, age, national origin, marital status, disability, veteran status. genetic information and any other category protected by state or federal laws. AmeriSys strives to recognize the talents and job performance of all employees, and values the contributions that come from people with different backgrounds and perspectives. It is AmeriSys' desire to promote an environment that maximizes the potential of all of our employees, and to promote diversity throughout the Company because we believe that diversity is important to our ability to continue to excel in an increasingly diverse and dynamic marketplace. The Company does not permit discrimination or retaliation against qualified individuals with disabilities in regard to application procedures, hiring, advancement, discharge, compensation, training, or other terms, conditions. and privileges of employment. The Company will reasonably accommodate qualified individuals with a temporary or long-term disability so that they can perform the essential functions of a job. A job applicant who can be reasonably accommodated for a job, without undue hardship, is given the same consideration for that position as any other applicant. Page 26 14) Describe the experience, qualifications and other vital information, including relevant experience on previous similar projects (Part I or Part II), of all key personnel, who will be assigned to the City's contract. This information shall include the functions to be performed by the key individuals, and the caseload of each person assigned to service the account. Include copies of all licenses held by each individual, as all claims professionals must possess a current Florida adjuster's license. Provide copy(ies) of each adjuster's and Supervisor's Florida Adjusting License, or any other relevant licenses, if applicable. In addition, provide resumes, if available, with job descriptions and other detailed qualification information on all key personnel who will be assigned to the City contract. Cheryl Gulasa Vice President ArneriSys Jen White Program Manager/Super, isor Amy Krietemcycr Field Nurse Case Management Supervisor Eunice Romich Director Provider Services Please reference Attachment 5 - Resumes/Licenses. 15) Provide a complete list of all licensed claim's personnel that will handle City's claims, and/or managed care services, including the Proposer's proposed Manager/Supervisor, Supervising Adjuster, Adjusters, Supervising nurse Case Manager, Case Manager, Medical -only processors, or other individuals including clerical and or support staff detailing education, experience in the area of workers' compensation claims, in the area of managed care, and type of license(s). Include copies of all licenses held by each individual. Cheryl Gulasa Vice President AmeriSys Jen White Program Manager/Supervisor Amy Krieteineyer Field Nurse Case Management Supervisor Eunice Romich Director Provider Services Please reference Attachment 6 — Job Descriptions and Attachment 5 - Resumes/Licenses. Note: After qualification submission, but prior to the award of any contract or work order issued, as a result of this REP, the Proposer has a continuing obligation to advise the City of any changes, intended or otherwise, to the key personnel in its proposal submission. Page 27 16) personnel, services AmeriSys the For of $27,082,651 including, benefit the guidelines. In $9,534,227 procedures reviews assistance There employee calculated Proposer's Ability to Perform Required Services 28 Provide a complete list of all claims office locations and territory(ies) serviced with Proposer's current indicating the number of personnel of Proposer, and Proposer's ability to provide required to the City. Parent Company Corporate Office Home Office (City of Miami servicing office) AmeriSys Office Brown & Brown, Inc. PO Box 2412 Daytona Beach, FL 32113 #1 of Employees: 8,600 Nationwide USIS, Inc. PO Box 616648 Orlando, FL 32861-6648 Previously operated tinder United Self Insured Sc'rrices # of Employees: 88 AmeriSys 140 Alexandria Blvd, Suite H Oviedo, FL 32765 Medical Division of USIS, Inc. # of Employees: 30 State of Georgia Office State of Florida Office Preferred Governmental Claim Solutions (PGCS) 9 Dunwoody Park Suite 106 Dunwoody, GA 30338 #Employees: 40 240 E Central Parkway Suite 3020, 3rd Floor Altamonte Springs, FL 32701 #Employees: 77 615 Crescent Executive Court Lake Mary, FL 32746 Liability Unit - 14 Employees: 4 has over 200 employees who have a proven record Management services to clients throughout the State of Florida and ability of AmeriSys to provide the requested services. the calendar year 2015, USES/AmeriSys was able to offer its medical management approaches. As an organization we in case management savings. Case management but not limited to, fee negotiation, directing treatment from contracted rates, the recognition of non-compensable Maximum Medical Improvement goals for the claim prior to addition to the case management savings we were able to in Utilization Review Savings by the identification and/or procedures that are not causally related to the compensable are done in compliance with the standards set forth of physician advisors in issuing non -certifications. was an additional S5,823,500 in documented savings accomplished to work prior to the benchmarks set by the Official in accordance with the injured employee's average weeklong of providing the required Medical Georgia. The following results show customers savings achieved by a variety were able to demonstrate in excess of savings is achieved in variety of ways into the ancillary provider network to body parts or treatments and reaching the benchmarks set by the approved document in excess of � uraC of medically unnecessary injury. These -' by URAC and with the ACCREDITED by returning the injured Disability Guidelines. Days saved are wage. This also demonstrates the Page importance of a robust return -to -work program offering modified duty positions. In the processing of over 253,531 bills, the USIS/AmeriSys Bill Review Department in compliance with statute and rule, utilizing PPO networks, the skills of seasoned bill reviewers and utilization review nurses who specialize in retrospective bill review. reviewed total submitted charges of S215,386,620. We saved 55% on those submitted charges. The Fee Schedule Savings were 40% of that number with the remaining $32,529,040 resulting from our professional review and contracted savings. Our contracted savings average was 1 l .34° o below Fee Schedule. All of this totaling more than S I17,788,132 in documented savings collectively for our customer partners. U51S/AmeriSys Actual Results Based On 2015 Bill Volume of 253,531 Total Billed Charges: $215,386,620 Total Savings $117,788,132 • Fee Schedule Savings *Other Professional Savings ▪ PPO Savings Below Fee Schedule r Total Allowed 17) Describe where your main office is located, and the location where the primary work will be performed. Indicate location where the Successful Proposer, the Successful Proposer's Manager/Supervisor will be located. The main office for AmeriSys is located in Oviedo, FL. The location where the primary work will be performed is located in Orlando, FL, USIS, Inc. Corporate office. where the USIS Claims Unit would be located. Jen White, Program Manager/Supervisor, is located in the Orlando, FL location. Page 29 18) Discuss how the Proposer's office or unit will be staffed, and the level of supervision that will be provided. Discuss case assignments, including pending case load for each designated Adjuster and current number of monthly new assignments to each Adjuster, if applicable. Discuss case assignments, including pending case load for each designated nurse Case Manager and current number of monthly new assignments to each nurse Case Manager, if applicable. Under the overall direction of the Vice President of AmeriSys, the City of Miami will be directly supervised by a registered nurse who is also a certified case -manager. The Program Manager/Supervisor is responsible for the day to day activities on all claims. She is also responsible to ensure the standards set forth by the AHCA are upheld and maintained for the WCMCA accounts and there is adherence to the Florida Statute for those accounts who have opted out of managed care. Some of the standards include but are not limited to the monitoring of caseloads and ensuring diary protocols are followed. The supervisory duties also include the reviewing of internal audit scores, identifying issues pertinent to the City of Miami that require education and need reporting to the quality assurance committee. She will also track and trend the activity involved in the quality initiatives in which the City of Miami is participating. The Program Manager/Supervisor acts as an advisor and mentor to her staff members, and is the direct point of contact for both the claims adjusting team and the City of Miami Risk Management Department for any issues that are escalated and require an immediate response. It is our intention to staff the City of Miami designated unit with two (2) registered nurse case -managers. The team lead nurse case -manager will handle Medical Only and Lost Time tiles assigned by the adjusters. The second case -manager will be the cardiac case -manager, assigned to the oversight and management of the claims covered by the Heart and Lung Bill, specifically following the protocol of the BADGE program. The Telephonic Case Manager caseload average is 72 files and their maximum, is 80 files. These numbers are dependent on severity and complexity. While it is our intention to maintain this number of cases for the City of Miami case -managers, we understand this may fluctuate at times dependent on seasonal activity as well as any incidents involving multiple claims at one time. AmeriSys averages 10- 1 2 new files opened per Telephonic Case Manager per month. We also recognize that the number of new monthly assignments is directly affected by the number and type of newly reported injuries each month. We will distribute each type of claim to the appropriate case -manager. 19) Describe how Proposer will ensure managed care services by City employees residing in Miami -Dade, Broward, Palm Beach, and Monroe Counties, among other locales. AmeriSys currently has approximately 200 employees who service our customers. Those customers include Broward County Government and Palm Beach County Sheriffs Department as two large self - insured employers in the south east Florida area. In addition, the State of Florida is a customer with a large southeast Florida presence. We also have a number of smaller public entities as well as several insurance companies and three self-insurance funds, all of which have claims within the counties identified above, 20) Discuss whether the award of this contract necessitates an increase in Proposer's staff size to meet the City's staffing and caseload requirements, and whether staff will be in place by the start of the contract, which is estimated to be February 1, 2017. The City of Miami Part II: Medical Bill Review and Audit Services award of contract will not necessitate an increase in AmeriSys staff size. Telephonic Case Managers will be hired and trained prior to the start date of February 1, 2017. All staff will be in place by the start of the contract. Page 30 21) Explain the percentage of time the Proposers proposed Adjusters will be out of the office doing field work. If all of Proposer's proposed Adjusters are telephone Adjusters, indicate as such. Explain whether Proposer will utilize independent contracted Adjusters, and under what circumstances. Provide the name, address, phone, and contact person for independents you currently utilize. This question pertains to Part I. 22) Identify language capabilities (spoken or written) of Proposer's employees and those of the subcontractors or subconsultants. AmeriSys has staff within all areas ofthe Scope or Services that are bi-lingual. Page 3I Proposed Overall Approach to Performing the Services 23) Discuss in detail Proposers overall approach to the work to be performed. Describe Proposer's specific project plan and procedures to be used in providing the services, and how Proposer has applied the proposed project approach in comparable contracts. US[S/AmeriSys has an integrated approach to claims management which involves Telephonic Case Management, when required, as well as integration of the cost containment components of the program. AmeriSys is the medical management division of USIS and the telephonic case -managers work alongside the claims adjusters. Systems are integrated allowing the sharing of case documentation between the adjuster, case -manager (when assigned) and cost containment. AmeriSys also has contracts with Physician/Hospital networks as well as Ancillary Providers (Physical Therapy, Diagnostics, Home Health, etc.). These providers are contracted not only for significant pricing reduction but also performance related to the speed of establishing appointments, supplying reports and other standards that impact the overall cost of the claim, including lost time days. We belie\ e that the combination of aggressive claims handling, integration of cost containment and case management, preferred providers and strong experience dealing with public entities will positively impact the City of Miami's overall economic impact. USIS adjusters are well trained on when to recognize when a case is deteriorating and are instructed to control these claims as quickly as possible in any way we can in order to minimize litigation and lost time days and re-engage the injured worker and doctors. This may include use of Utilization Review and/or Independent Medical Examination or surveillance, if fraudulent activity is suspected. We may also consider use of tasking a RN Field Case -Manager to attend an appointment or conference with the doctor to question the treatment plan if applicable; this would be subject to City approval. Keeping in constant contact with the injured worker and employer is an extremely important part of adjusting and is strongly encouraged. USIS/AmeriSys routinely works with physicians, employers, and injured employees to identify barriers that prevent an individual from returning to work. Once the barriers are identified, a plan is then formulated in conjunction with the employer, physician and injured employee, to facilitate removal of the barrier, return the employee to work and thus resolve the case. Our system, allows us the ability to accurately track the Return -to -Work milestones based on the Official Disability Guidelines. This includes the release to full duty, restricted duty, and the employers' ability to accommodate the injured employee's restrictions. Catastrophic or large losses seldom occur but when they do they have a chilling impact on claims expense. Our experience with the construction industry and other industries has well acquainted us with serious claims involving traumatic brain injuries, spinal cord injuries, amputations and burns. These claims are complex from beginning to end. Rapid response in claims investigation, assignment of Catastrophic Case Management Providers and having a relationship with the facilities and providers likely to provide care for these claims is paramount to best outcomes. AmeriSys, our medical management division, has relationships in place with facilities such as Shepherd Center, ancillary providers for home health, durable medical equipment, as well as therapies that have been utilized many times on large and catastrophic claims bringing the City of Miami the experience, when necessary, to handle these claims efficiently and effectively. Page 32 We recognize that when these injuries occur, they are to your employees, your neighbors and often friends. We address these claims to offer not just the best economic outcomes but the best functional outcomes while striving to maintain the highest degree of compassion and service to that employee and his/her family. Recommendations for Assignments of Telephonic Nurse Case Management Upon receipt of the First Report of Injury, the claims adjuster reviews the nature and cause of the injury to determine the necessity for further intervention. At the direction of the claims adjuster (per client protocols), a referral for case management is initiated. Serious injuries will be assigned for telephonic case management immediately. The goal of early intervention is to provide aggressive case management with a focus on early return to work. The medical case -manager within the first 24 hours will make contact with the injured worker and complete an assessment of the initial medical treatment; evaluation of the treatment plan and assess the need for continued medical case management. If specific tasks need to be completed to assist the claims adjuster with the handling of the file, these can also be assigned, Telephonic case management is the systematic evaluation of medical services, procedures, facilities for medical necessity, appropriateness and efficiency. This promotes optimal patient outcomes, reduce period of disability and assure high quality of care while controlling costs. A nurse facilitates the medical activity on a file with the ability to individualize the plan of care and coordinate early return -to -work strategy with the employer and medical provider. The functions included • Coordination and referral to network medical providers • Coordination of the treatment plan with the provider • Working with the provider to establish functional abilities and conditional release to return to work • Discussion with the injured worker to clarify the worker's understanding of the diagnosis and treatment plan • Monitor the treatment compliance of the injured employee • Identify and assist in the resolution of problems with compliance to the treatment plan • Provide regular reports to the claims handler to assist them in the management of the claim • Recommend on -site case management and vocational services when needed • Work with the employer to identify a medically appropriate job Coordination and referral to network medical providers allows for the best network penetration. The channeling of the network providers will allow for the best network discounts. Page 33 The Telephonic Case -Manager acts as the center point of contact ensuring delivery and communication to all approved providers of PBM and appropriate parties, forwarding appropriate issues to the utilization review department as necessary and reporting outcomes to the AmeriSys Quality Assurance Committee. Adjuster Diagnostics Physical Therapy Home Health Case Mana!ement Employer Injured Employee Medical Case -Manager Case Management Plan - Assess Needs - Develop Plan - Implement Plan Items - Monitor Progress - Evaluate Outcomes - Re -Evaluate Pon DME Pharmacy Transportation & Languages ATP (Attending Treating Phystcian) Vocational and Feld Case Management CAT Sopptier Utit¢ation Review Prospective IPreCert} Concurrent Rat, espectrve We understand that it is imperative for both employee and customer satisfaction: we communicate promptly, which includes facilitating care and appointments properly. Prompt, accurate and complete communications are performance standards and measurements for our case management team. Page 34 Recommendation for Assignments of Field Case Management I. All catastrophic injuries. such as, but not limited to: • Spinal cord injuries • Head injuries ?. Neck injuries (except for minor strains) • Burns of face, hands or greater than 9% of the body • Amputations • Loss of hearing • Electrical shock • Multiple fractures 3. Any potential serious back injury: • Failed back syndrome • Multiple fractures in the back • Herniated disc with radiculopathy • Positive neurological findings • Any back injury with any degree of paralysis 4. Chronic Pain Cases 5. Claims with high potential for PT rating including, but not limited to: • Fractures in or near major joints or weight -bearing body parts • Crush injuries • [-land injuries, particularly of the dominant hand 6. Injured employees with a previous history of workers' compensation injury or injuries. 7. Difficult pre-existing medical or social problems • Diabetes • Heart disease • Psychiatric problems • Illiteracy • Mental retardation • Alcoholism and; or chemical dependency • Morbid obesity 8. Cases not fitting an expected recovery time frame: • Not responding to provided care • Time delays in getting appointments • Irregular appointment attendance • Disagreement with the course of treatment • Questionable or experimental treatment recommendations 9. Injured employees who are approaching 60 days without returning to work. The need for Re- employment Assessments is decided on a case -by -case basis. 10. Need for extended home care. 11. Hospital discharging requiring planning for home health and/or durable medical equipment. 1?. Location or communications barriers. (Injured employees in small rural areas with limited local facilities, or with language barriers who know limited or no English) 13. All new claims with an initial reserve established of S50,000 or greater. Page 35 AmeriSys has developed the following approach to receive, review, and re -price medical bills. AmeriSys has provided MBR services since 1988 and has re -priced an average of 250,000 bills annually the past five years. Since 1990 we have been handling medical bill review and claims services for FHM Insurance Company. FHM has set a benchmark of 20 days for bill review turnaround and payment. We have delivered timely results that have beaten the benchmark set. The average turnaround for FHM Florida claims has been 11 days from received to paid over the last 4 quarters with annualized bills reviewed exceeding 16,873. Automated bill review plays a major part in managing workers' compensation medical costs. Medical bill review is a cost containment tool that can show hard dollar reductions. Soft savings may be realized by the identification of utilization case management opportunities and reduced administrative costs. AmeriSys has trained analysts, professional nurses and/or physician advisors to review provider bills. Medical bills are adjudicated within the AmeriSys proprietary software, Corrus. We have implemented several reports by which the bill review supervisor is able to monitor the status of all bills to ensure completion according to contracted time limits. Our Corrus software imports and utilizes fees schedules from Optum for all states. Usual and Customary data is received and imported quarterly from Context Healthcare, and we also load the Medicare Fees schedules from CMS. Our adjudication process uses the place of service zip code and the jurisdiction state in determining the correct fee to apply. In addition we can accommodate multiple custom networks to handle contracts specific to the customer. The Corrus system incorporates multiple levels (automated, line item, duplicate) for rejecting bills. Bills that are identified as having missing or incorrect data are completely entered into the system and disallowed with an EOBR per State rules. A Corrus form letter for each returned bill is created and attached to the claim in the system identifying the bill being returned and the reason. If it is a duplicate, the original EOBR and payment reference is attached for the provider. Any questions regarding denied or returned bills can be viewed on the EOBR and letter history. The Con -us system has developed a daily download which produces a folder by claim number to contain PDFs of the original bill and notes, the EOBR and any letters associated with that bill. The folder can then be placed on a secure FTP for transmission. The design of our medical bill adjudication and related EDI to the DWC has incorporated effective and termination dates into State fee schedules, rules, and EOBR codes. All dates are captured on the bill and utilized during adjudication. This is to ensure that all re -pricing will be in compliance with all applicable rules and statutes on the basis of the date of accident for the claim and the date of service on the medical bill. Our Medical Bill Review services meet all audit, EDI and regulatory requirements for the State of Florida. Con -us has the capability of setting up custom networks for our clients which allow us to enter specific rates per provider contracts that will be applied to all bills for the City's claims. Providers can be set up for: Page 36 • Specific arrangements, such as discount percentage or any other agreements, according to the City's specifications. Netwerk Arrangements : Rate Type FerDiem Percentage Foe Effective lion 0.00% 118;10/2012 00/00/001:01 Per Diem % F15 % UC % Billed • Specific rates by billing code { Provider Fees Berries Fee Effective Expiration 21,11 $475.00 02f11/2000 02/01/2000 97700 $50.0D 11/26/1996 11/26/1996 99202 S4C.00 05129/1997 05/29/1997 29231 $2,525.00 09/27/1996 09/27/1996 99205 $400.00 09/1512005 0010010000 99201 $400010 09/15/2005 00100/0000 • Pricing arrangements that arc negotiated outside of standard contracting can be noted in Corrus Case Notes as a Bill Review note type on that claim. When any bill is reviewed on the specified claim a Notes icon is highlighted and the bill reviewer is prompted to review case notes for special pricing or authorizations. _I,aini ID/SSN: i-:1 I3f I]I I8E CJJurlwdlction: 1FL FI_ 7hdre are Bill Casentes L1II 3012N Do you want to see the Casenotes No The AmeriSys medical bill review system pairs professionally trained analysts with an automated cost containment system that has been developed specifically for Workers' Compensation claims, which will exceed your requirements. Our reviewers, along with a Registered Nurse when indicated, will identify un- bundling of surgical coding, hospital itemizations, over -utilization and medical necessity. The AmeriSys system is unique in that it has the ability to red flag the reviewer in the event that a provider has not billed in accordance with Fee Schedule rules. Our review process is indicated by the following criteria for each billing submitted. a. Identify up -coding b. Identify unbundling of outpatient, surgical, laboratory, or diagnostic procedures c. Application of State Fee Schedule d. Identification of Usual and Customary rates e. Identification of unnecessary services/procedures f. Identification of duplicate billings as well as possible duplicates gr. Identification of P PO discounts h. Verification of pre -certification criteria and/or length of stay i Adjudication of payment, denial or request for additional information within 3 days. Page 37 A nurse or physician review of medical billings is indicated on complex medical bills, as well as possible identification of over -utilization through billings. These billings are elected for further review by the adjuster, case manager, RMD or the bill reviewer based on the following criteria. The criteria can be customized to meet your specific needs. Nurse audit and review procedures are also outlined below: Nurse Review Procedures — criteria for bills eligible for RN review: • Multiple Surgical Coding • Surgical bill over $5,000 (or customer's specified limits) • Outpatient Hospital bills over $5,000 (or customer's specified limits) • In -Patient Hospital not subject to per diem rate • Questionable coding or procedures • Out of state hospital, ASC, anesthesia • Questionable overutilization • Question length of stay or causality • Initiate desk or on -site audit for appropriateness of charge RN audit and review procedures: • Apply correct modifiers to multiple surgery • Identify global services or "un-bundling" • Review billings for miscoding, apply proper CPT codes or request documentation • Record and itemization review of hospital bills/audit for appropriateness of what is billed related to documentation. Identify non -covered items, global, etc. • Apply appropriate Usual and Customary reimbursement, Fee Schedule or CPT rulings. • Review for over -utilization, length of stay or causality • Initiate desk or on -site audit for appropriateness of charges • Initiate peer or physician review when wan -anted. ALL data accumulated and stored in the COITUS system can be reported in various formats as specified by the City with reports developed by our in-house team of information specialists. The TPA/Adjuster have access to login to the AmeriSysiNet to approve bills. Please reference the following screenshots. Page 38 AmeriSys* t+Yn Hem r' 4143 Dn. oremy..y l.ylar.+aa-rsw:e Stews u Wert :Isom eiid•tI Wee: PiernY.#.1 Et 222 r . ufsw^ I.:e. 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I4 erre '3+Mv Page 39 Comparable Contracts Broward County Government — Cost Containment Services have been provided to the County, which once included the Broward Sheriffs Office (BSO), since 2007. Along with cost containment we have provided triage with escalation protocols as needed. case management both telephonic and field, and URAC Accredited Utilization Review Services. Before BSO split off in 2012, a cardiac disease state management program (BADGE Program) was utilized to help manage the cardiac illnesses of both the fire and police employees. The Medical Bill Review turnaround for Broward is 5 days and AmeriSys has consistently beaten the benchmark for over 6 years. Throughout the servicing of the contract, AmeriSys has been responsive to the evolution of Broward's Workers' Compensation program, including converting to a paperless electronic exchange system. Our experienced team has also taught the Broward adjusters how to use the AmeriSys Corrus system to approve medical bills. The AmeriSys Corrus system interfaces with the Broward CS STARS system on a regularly scheduled basis. MARTA — Under the regulations of the Georgia MCO, AmeriSys provides Managed Care Services including Cost Containment which includes medical bill review and network access to Coventry and PBM services through myMatrixx continually since 2003. Along with cost containment we have provided triage with on -call nurse services as needed, case management both telephonic and field, and URAC Accredited Utilization Review services. State of Georgia DOAS — Under the regulations of the Georgia MCO, AmeriSys provides Managed Care Services including network access to Coventry and PBM services through myMatrixx serving an employee population of greater than 150,000 employees. AmeriSys has been providing MCO services to the State of Georgia continually since 2002. Along with network access we have provided triage with on - call nurse services as needed, case management both telephonic and field. and URAC Accredited Utilization Review services. Palm Beach County Sheriff's Office — Claims and Cost Containment Services including medical bill review have been provided to the County since 2003. Along with cost containment we have provided triage with escalation protocols as needed, case management services both telephonic and field, and URAC Accredited Utilization Review Services. A cardiac disease state management program (BADGE Program) was initiated in 2003 to help manage the cardiac illnesses of both the fire and police employees. Rug. 4fl PGCS — Cost Containment Services have been provided to PGCS since 2005. This includes over 200 Public Entities. Along with cost containment we have provided case management services both telephonic and field, and URAC Accredited Utilization Review Services. A cardiac disease state management program (BADGE Program) was initiated in 2005 to help manage the cardiac illnesses of both the fire and police employees. The AmeriSys/myMatrixx partnership is in its 12th year since the inception of myMatrixx. Together we have provided quality medical management and pharmacy services to customers in the entire south-east region. AmeriSys and myMatrixx through their relationship have joined forces to face multiple challenges in the Workers' Compensation arena such as the escalation of the need for cardiac medications (BADGE Program). Currently we are working together in the development and roll -out of a Pain Management initiative called SECURE. The VP of AmeriSys is currently a member of the myMatrixx pharmacy and therapeutics committee which establishes the general protocols and formularies for this PBM. AmeriSys' SECURE is leading the way with quality -centered cost effective management of pain treatment programs. By joining forces with some of the industry`s leaders in pain treatment guidelines, pharmacy controls and alerts, functional restoration initiatives and specialized case -managers. AmeriSys has developed unique protocols and criteria for managing these complex and cost -driving claims. This program will maximize the injured employees' comfort level by working closely with physicians who practice according to nationally -approved standards. In utilizing these best practices, the risk of addiction is minimized and costs associated with the addiction are decreased. In doing this, not only do we benefit our industry but our community as well, The SECURE program's goals are to improve/enhance return -to -work outcomes, reduce disability duration; prevent unnecessary, dangerous and costly consequences of inappropriate or prolonged utilization of opioid medications while reducing the costs of handling pain management claims. Services for the Effective Control and Utilization of Rx through Evidence -based Criteria We believe in working closely and in conjunction with the claims administration staff We believe and hold to the philosophy and approach that the claims adjuster/supervisor is in control of the tile and our work should be complementary, supportive and assistive in that process. Please reference the following page for our workflow diagram. Please reference Attachment 7- Policies and Procedures. 41 Field Nurse Sample of Claims & Medical Management Injury Occurs Report Injury via phone, website, email or fax Triage Intake • Is Claim Medical Only, Lost Time. Large/Catastrophic? Claim Setup Medical Only Nurse oil l UR or Precert Closure Of File Medical Only Adjuster Receives New Set Ups 24-Hour Contact l Investigation 1 Compensability Determined File Reviews, Discussion and Disposition of Bills Closure Of File 1 Field Nurse Lost Time Nurse UR or Precert Closure Of File LT Adjuster 24-Hour Contact Investigation Compensability Determined Evaluation of Reserves — Adjuster & Supervisor File Reviews. Discussion, and Disposition of Bills Closure Of File New Claim Dinned to Adjusters & Supervisor for Handling Field Nurse Large/Catastrophic w Triage UR or Precert Achievement of Medical Stability Access needed for Continued FCM Involvement Access Rehabilitation Need Refer to Vocational Rehab Counselor Lost Time Adjuster 24-Hour Contact • Investigation Compensability Determined i Evaluation of Reserves — Adjuster & Supervisor $ File Reviews, Discussion, and Disposition of Bills Addressing MMIIPIR, PTD Status, Life Care Plan, Cost Projection, Excess Updates and if applicable, Medicare Set Aside ♦ - IClosure Of File I':iec 42 Medical Bill Review Flow Chart Incoming Mail Electronic Billing from PBM and Ancillaries Receive, review, index and scan medical Pitts and attached documents Biiisfdocuments attached as PDF copies to Corrus system file Bill Review (adjudication process is completed') EOB rs created automatically and held with attached documents pending authorization by adjuster Waiting period of 24-48 hours pending bill approval by Adjuster. Aging report is auto generated Medical Bill Review for clean non-complex bills Bill Review RN reviews Surgical. Hospital. ASC and UR considerations and Adjuster Requests Quality checking process by second reviewer and series of Corrus reports Transfer Data to Payment System Check 8 EOB sent to provider in 30 days or les, TPA Adjuster djusteT is notified o the needfor bill approval through mutually agreed protocols Review and approve bills on diary within 24-48 hours Bill is approved Bill is questioned Bill Review is notified and BR Manager may be diaried for further review ���. l 1 Automatic Process lManual Process TPA Amer Sys Pii!�e 4; 24) Describe Proposers ability to perform the services described in the Scope of Services, and describe Proposers specific policies, plans, procedures or techniques to be used in providing the services requested. The Proposer shall describe its approach to project organization and management, responsibilities of Proposer's management and staff personnel that will perform work in this Solicitation. • Administer one or more national Preferred Provider Organizations (PPO) that have negotiated contract rates with hospitals and providers, in an order or priority acceptable to Risk Management. Risk Management may, at its sole discretion, disallow the use of any PPO; AmeriSys is proposing DimensionComp for hospital and provider access, the AmeriSys Preferred Provider network for ancillary providers, and myMatrixx as the Pharmacy Benefit Manager. Although Dimension Comp is not a national Preferred Provider Organization, AmeriSys believes it best fits the need of the City of Miami. DimensionComp provides clients access to the one of the largest Workers' Compensation networks in South Florida. By maintaining strong relationships with the provider community, DimensionComp is able to offer clients superior network savings and greater access. In addition to using DimensionComp as the primary network due to its South Florida specific geogography; AmeriSys is prepared to offer the Coventry Preferred Provider network, which is a national provider, as a wraparound network to DimensionComp to capture the claims that do not fall within the primary network. USISIArneriSys employs a Director of Provider Services who will work closely with the City, DimensionComp, the adjuster and the case -manager. The Director of Provider Services will make recommendations as to what outcomes would be monitored as well as work with the City to determine the criteria that are important. DimensionComp is an affiliate of Dimension Health, Inc. DimensionComp provides clients access to the one of the largest Workers' Compensation networks in South Florida. By maintaining strong relationships with the provider community, DimensionComp is able to offer clients superior network savings and greater access. Provider credentialing and monitoring — All providers must have privileges at a participating Dimension Hospital, hold a current license in the state of Florida, Must be Board -Certified or Board - Eligible, hold an unrestricted DEA certificate and comply with the State in maintaining malpractice coverage. The Florida License is verified to ensure it is active and clear of sanctions. DimensionComp also verifies malpractice history. It also ensures the DEA license is cun-ent. Board Certification is verified through the American Board of Medical Specialties. Physicians agree to comply with all other provisions of Florida law applicable to a worker's compensation policy, plan, or program. Physicians have agreed to promote high standards of medical care and to control the cost and utilization of medical services, including, but not limited to, policies and procedures regarding quality assurance, utilization review, record keeping, billing, and grievances. Recredentialing is conducted every 3 years. Please reference Attachment 8 — Dimension Health Inc. Providers. Page 44 Under the 2003 -2011 managed care agreement, AmeriSys provided the City with a certified carve out version of Dimensions Health Care. The carve -out was modified to meet the specific needs of the City while meeting the requirements of the Agency for Healthcare Administration. The AmeriSys Network Manager established a strong rapport with Dimensions Healthcare; thus ensuring the prompt attention to specific provider needs of the City of Miami, including the recruitment of specialty physicians that are qualified to care for those individuals covered under the Heart and Lung Bill. The AmeriSys Preferred Provider Network is made up of a select group of vendors to perform the services referenced below. Every three (3) years AmeriSys undergoes a very detailed RFP process for Ancillary Medical providers that include transportation, translation/languages, physical therapy, diagnostics, home health and durable medical equipment. These organizations undergo due diligence and are then contracted. Contracting includes indemnification for customers, insurance coverage verification as well significant discounting for services. We believe this provides our customers with the best protection at the best price, creating best value. • Have a National pharmacy network; Matrix Healthcare Services, Inc., d/b/a myMatrixx, is a full -service pharmacy benefit management (PBM) and ancillary services company focused on workers' compensation. The AmeriSyslmyMatrixx partnership has existed 10+ years since the inception of myMatrixx. Together we have provided quality medical management and pharmacy services to customers in the entire south-east region. AmeriSys and myMatrixx through their relationship have joined forces to face multiple challenges in the Workers' Compensation arena such as the escalation of the need for cardiac medications (BADGE Program), and currently we are working together on the AmeriSys Pain Management initiative called SECURE. The Vice President of AmeriSys is currently a member of the myMatrixx pharmacy and therapeutics committee which establishes the general protocols and formularies for this PBM. myMatrixx provides: • Online portal for 24/7 access, management and real-time reporting of pharmacy claims data • No -risk First Fill program • Customizable workers' compensation formulary • Injured worker -centric adjudication platform • Streamlined, electronic prior authorization process • Out -of -network Rx management • Corporately -owned mail service pharmacy • Proactive clinical programs • Accurate electronic billing • Business intelligence and reporting myMatrixx has a national retail network of over 64,000 pharmacies, including all major chains as well as most regional and independent pharmacies. This represents access to 95.5°0 of retail pharmacies nationwide. Every pharmacy in our network is electronically connected to myMatrixx to facilitate real-time communications and to simplify and expedite authorization decisions. Examples of Pharmacy Chains in the myMatrixx Retail Network Walgreens CVS Health Walmart RiteAid Publix Target Kmart Albertson's Sam's Sayan Pharmacy Costco Winn Dixie Medicine Shoppe Pharmerica North Florida Pharmacy Buy Rite Drug Navarro Discount Pharmacy ContinuCare AHF Pharmacy AnieriDrug mvMatrixx Get Ahead of the Claim clinical program The myMatrixx information -based clinical program, Get Ahead of the Claim, provides a comprehensive approach to drug therapy management. with a special emphasis on reducing the use of opioids. Proactive clinical management enables us to inform and advise physicians and our clients regarding dangerous drug trends, prescribing practices, and high risk patient activity in order to modify or eliminate unsafe prescribing practices with the following tools and programs: • nivRisk Predictor® • Drug Regimen Review • One Drug Review • Peer to Peer (pharmacist to physician) Consultations • Step Therapy • Alert, Review and lv[4inage (ARM® myRisk Predictor is a proprietary, predictive modeling tool used to identify claims that post a higher risk for opioid abuse, misuse or fraud. By combining predictive modeling with historical data and unique algorithms developed by our clinical team, a customized risk score is produced for each injured worker. Identifying at -risk individuals early in the claims process provides an opportunity to intervene with proactive clinical programs designed to drive down pharmacy costs and improve patient outcomes. Step Therapy is also used to help control the costs and risks posed by the overuse and/or abuse of opioids and other prescription drugs. This step approach provides sound clinical options, such as initiating therapy with a lower dose or short -acting opioids and only "stepping, up" to agents like OxyContin if the injured patient does not experience relief from pain. This program focuses on managing opioid use and can have a significant impact on cost control for our clients, as well as improving the care and outcome for their injured workers. Alert, Review and Manage (ARM) is a proprietary, customizable program that uses business intelligence to monitor injured worker populations for areas of concern. The myMatrixx ARM program flags prescription claims where targeted intervention with the physician, retail pharmacy, and/or injured worker may be warranted —to assist in changing prescribing patterns based on the alert. Following review of the ARM alert, these cases are managed in a manner consistent with ACOEM or Official Disability Guidelines (ODG). Clients receive an alert when an injured worker should be referred for case management, drug screening, One Drug Review, detailed Drug Regime;; Review and/or patient -provider agreement (PPAs/opioid contracts). Page 46 In addition, as part of their clinical outreach program, myMatrixx pharmacy staff has created a series of customizable opioid intervention letters that are intended to be sent at specified intervals. The myMatrixx pharmacists follow up on the letters with the prescribing physician with a peer to peer teleconsultation. Please reference Attachment 9— myMatrixx. • Have the ability to interface with Risk Management Information System (RMIS); 4)Be available twenty-four (24) hours, seven (7) days a week; AmeriSys currently interfaces with multiple clients RMIS through a secure FTP connection. The Information systems department is available via email or 800 number 24/7. • Proposer's staff nurses (telephonic and onsite) shall have a minimum of five (5) to seven (7) years of experience; The AmeriSys qualification for staff nurses is to have a minimum of 3-5 years of experience in a related field such as orthopedics, neurology or rehabilitation. AmeriSys will comply with the City of Miami's requirements of 5 to 7 years of experience. • Must comply with Florida Agency for Health Care Administration guidelines; Rule Chapter 59A-23; The City of Miami opted out of Certified Managed Care however, AmeriSys is in compliance with all the AHCA guidelines and can provide MCA services. f�. N. • Be required to have Utilization Review Accreditation Commission (URAC) accreditation, as of the proposal due date; AmeriSys is URAC Workers' Compensation Utilization Management accredited. URAC is the nationally recognized certifying body for these programs and services. urac ACCREDITED • Telephonic Case Manager (TCM)/Nurse Case Manager (NCM)are subject to continuing education; In-house seminars and/or webinars are offered by medical providers and defense counsel to assist the TCMINCM in expanding their knowledge and keeping current on medical and legal updates. Classes are also given by providers, physicians, specialty vendors and attorneys to assist the case managers with meeting their continuing education requirements. Page 47 • Own, management and control PPO networks (can add, remove provider at will); USIS/AmeriSys employs a Director of Provider Services who coordinates provider nominations with DimensionComp. She will work closely with Risk Management, DimensionComp, the adjuster and the Telephonic Case -Manager to meet the needs of the City of Miami. DimensionComp has a formal nomination process in place and encourages/welcomes client provider nominations for inclusion into the network. DimensionComp may receive nominations via on-line website, e-mail and/or fax. When its client services team receives an eligible provider nomination, the provider is logged and forwarded to the network development team to begin the contracting process. DimensionComp will make every effort to obtain a contract with the nominated provider. Since AmeriSys maintains this network within our own Con -us Systems, we can eliminate or remove any provider upon request. Medical Network Access DimensionComp Dimension Health providers understand and respond to patients' concerns about being able to receive excellent medical care promptly and efficiently. At Dimension Health quality and access are emphasized. Dimension's local presence means that questions from insurers, employers and covered employees can often be answered on the spot. Page 48 • Have a mechanism to oversee physician/provider performance via scorecard; USIS has a fully implemented Provider Services Department provider dedicated to managing our relationships in the provider community, ensuring the cost effectiveness of those services offered, monitoring the outcomes achieved and providing education where necessary. Within our quality assurance program, there are multiple initiatives in place related to monitoring the outcomes of the providers so that improvements can be made where it is necessary and as well as having the ability to identify physicians of excellence. The results are then communicated to our clients to allow them to make the most appropriate selections for their panels. Please see the following Provider Report Card implemented to monitor the outcomes of our Primary Care Physicians. Primary Care Providers Performance Evaluation 1. Provider Information Physician Name: Practice Name and Address: Office Number: Date of Service: II. Claimant Information Claimant Name: Claim #: Diagnosis: Customer Account: Ili. Provider/Practice Evaluation Key Performance Indicators (KPIs) for Providers Key: 5 — Strongly Agree, 4- Agree, 3- Neutral, 2- Disagree, 1-Strongly Disagree Categories Rating Comments/Goal Results Initial appointment scheduled within 24 hours of request Work Status received within 48 hours of office visit Office notes received within 1 week from date of office visit Claimant seen at scheduled appointment time. If no, how long was the wait Professional/cooperative office staff Facility and equipment well maintained and properly functioning Availability of worker's comp contact Requests for any type of prepayments prior to scheduling initial office visit Page 49 • Official Disability Guidelines (ODG)/American College of Occupational and Environmental Medicine (ACOEM) schedules must be integrated into the rule engine of the Proposer; and AmeriSys integrates ODG guidelines into its Corrus system's rule engine. AmeriSys associated physician advisors may utilize ACOEM standards in rendering decisions related to determinations of medical necessity and/or causal relationship issues during the Utilization Review process. The followings screen shot shows the NCM current Retun-to-Work benchmark tracking. ' Darby oa the RTP; Repasts Date Foot 1fxtti? :Q{^', - Qcepaatxs Clan Date:. dC C 1 j 2016 Educator hleDay of Disabdity ; 0000 000O '• Average ll'eekiv ;'Cage Projected Raaatato•AodDier • Sotave `fit CompeasatranRate Projeeted!l®berdLest Days: i 62 Rena640-abrkR•aee. 00 Full Wens Cana Tr Released to sad ends Restscoam: , 0 0 - 1 Release to Full Tine: i 00 00 0. G0 Retran to tataat lsositCtd Duey Sure 100 00. 11&003 catitRJeorn4o-RueaDate- Protected Reim ced to nodded Rel at.To-Cled Lon T>oe wont with Duty is Return To Work Modified Dar: Released to Dec Date Dave Reim End Daas Re tt, as UnasmtnLle Beam End Data Full Jun: 1 1 �+i fi ,,?r.7 � €2 F00 00 0000 J 1 00-00 WOO f01 E.1:016 11 Oa 1. =016 !i l t}5.:!: :016 . L2 l 0. 3; 6 -. Cammenta1 •..5 ± 85 06 :' i16 10' 11 :016 j 15 f O' 11 _G 16 1.1,L F 10' 11 .Olio MI 10 2a 2016 Zj 106 110 :::0:6 _ Coaanans gees surax.' ptoj. Nus LT Days: I 1a: Lots Twee Calendar Dais 15 Mod Drum is Cnat-ail ]Cod Duty Calendar Dn's [ 111 Lost Time Work Days (DMA) 11 0.:od Duey Went Days 0514.i)• . SS Clntrens Rerwss-To-Wott Sareertga PotennalAddmanat tndeevrty Satiny Prot lira. LT Calendar Camp • Current !CM Restncud T. Comp • LT Days Days Rate Sags rs 1:rreyoir ie Rate (f; 1 .. 15 )'T)•Il�ia3 -€ 9.3 f 1 -)• i733 . 1 ODD The detael* Comp Rate oar used le talrelste the Carreto RTTC Savings • Own, manage, and control Utilization Review (UR) services. AmeriSys" provides proprietary Utilization Review (UR) services. AmeriSys is URAC Workers' Compensation Utilization Management accredited. 25) Provide projected caseloads per employee of Proposer assigned to City account. AmeriSys Telephonic Nurse Case Managers per employee caseload maximum will be 80. 26) Describe Proposer's staffing plan to demonstrate that Proposer can be adequately staffed with trained personnel to handle the City's full caseload and have the capability to recruit such staff. It is our intention to staff the City of Miami designated unit with (1) Nurse Case Manager Supervisor, (2) Telephonic Nurse Case -Managers (TCM), (1) Field Case Manager Supervisor, and Field Case Managers who will be assigned to the City of Miami. The team lead TCM will handle Medical Only and Lost Time files assigned by the adjusters. The second TCM will be the cardiac case -manager, assigned to the oversight and management of the claims covered by the Heart and Lung Bill, specifically following the protocol of the BADGE program. AmeriSys Medical Bill Review staffing consists of 1 Quality Controller, 1 Supervisor and 11 personnel who currently process over 250,000 bills annually for these clients. This team consistently meets and exceeds all benchmarks established or required of them. AmeriSys has the capacity to recruit the Telephonic Nurse Case Managers and 1 additional Medical Bill staff needed. Our experienced team has the ability to meet and exceed the requirements set forth. Page 50 27) Include a statement that at east thirty (30) days prior to replacement of key personnel, Proposer will notify the City's Project Manager, in writing, that replacement employees will possess qualifications and experience equal to or greater than personnel being replaced. AmeriSys agrees that at least thirty (30) days prior to replacement of key personnel, AmeriSys will notify the City's Project Manager, in writing, that replacement employees will possess qualifications and experience equal to or greater than personnel being replaced. 28) Provide a detailed timetable identifying significant milestones for the smooth transition of the operations. Proposer shall identify the necessary support that shall be required from City staff during that transition. AmeriSys has created a proposed implementation plan which includes the activities and tasks, along with the date and resource assigned for each activity. The implementation plan may be modified upon successful award of the contract based on initial meeting discussions between AmeriSys and the City. The implementation plan also demonstrates the information that will be needed from the City in order to begin the implementation. Please reference Attachment 10 — Transition Plan. 29) Discuss in detail exactly how all services reflected in the Scope of Work will be accomplished. Include a complete approach Proposer will take to meet all responsibilities expected of Proposer by the City. Include any and all information regarding affiliated physicians, other medical personnel, locations to provide said services, and other related information regarding the provision of such services for the City. USIS/AmeriSys has an integrated approach to claims management which involves Telephonic Case Management, when required, as well as integration of the cost containment components of the program. AmeriSys is the medical management division of USIS and the telephonic case -managers work alongside the claims adjusters. Systems are integrated allowing the sharing of case documentation between the adjuster, case -manager (when assigned) and cost containment. AmeriSys also has contracts with Physician -Hospital networks as well as Ancillary Providers (Physical Therapy, Diagnostics, Home Health, etc.). These providers are contracted not only for significant pricing reduction but also performance related to the speed of establishing appointments, supplying reports and other standards that impact the overall cost of the claim. including lost time days. We believe that the combination of aggressive claims handling, integration of cost containment and case management, preferred providers and strong experience dealing with public entities will positively impact the City of Miami's overall economic impact. USIS adjusters are well trained on when to recognize when a case is deteriorating and are instructed to control these claims as quickly as possible in any way we can in order to minimize litigation and lost time days and re-engage the injured worker and doctors. This may include use of Utilization Review and/or Independent Medical Examination or surveillance, if fraudulent activity is suspected. We may also consider use of tasking a RN Field Case -Manager to attend an appointment or conference with the doctor to question the treatment plan if applicable; this would be subject to City approval. Keeping in constant contact with the injured worker and employer is an extremely important part of adjusting and is strongly encouraged. USIS/AmeriSys routinely works with physicians, employers. and injured employees to identify barriers that prevent an individual from returning to work. Once the barriers are identified. a plan is then formulated in conjunction with the employer, physician and injured employee, to facilitate removal of the barrier, return the employee to work and thus resolve the case. Our system, allows us the ability to Pans! 5 I accurately track the Return -to -Work milestones based on the Official Disability Guidelines. This includes the release to full duty, restricted duty, and the employers' ability to accommodate the injured employee's restrictions. Catastrophic or large losses seldom occur but when they do they have a chilling impact on claims expense. Our experience with the construction industry and other industries has well acquainted us with serious claims involving traumatic brain injuries, spinal cord injuries, amputations and bums. These claims are complex from beginning to end. Rapid response in claims investigation, assignment of Catastrophic Case Management Providers and having a relationship with the facilities and providers likely to provide care for these claims is paramount to best outcomes. AmeriSys, our medical management division, has relationships in place with facilities such as Shepherd Center, ancillary providers for home health, durable medical equipment, as well as therapies that have been utilized many times on large and catastrophic claims bringing the City of Miami the experience, when necessary, to handle these claims efficiently and effectively. We recognize that when these injuries occur, they are to your employees, your neighbors and often friends. We address these claims to offer not just the best economic outcomes but the best functional outcomes while striving to maintain the highest degree of compassion and service to that employee and his/her family. Recommendations for Assignments of Telephonic Nurse Case Management Upon receipt of the First Report of Injury, the claims adjuster reviews the nature and cause of the injury to determine the necessity for further intervention. At the direction of the claims adjuster {per client protocols), a referral for case management is initiated. Serious injuries will be assigned for telephonic case management inunediately. The .goal of early intervention is to provide aggressive case management with a focus on early return to work. The medical case -manager within the first 24 hours will make contact with the injured worker and complete an assessment of the initial medical treatment; evaluation of the treatment plan and assess the need for continued medical case management. If specific tasks need to be completed to assist the claims adjuster with the handling of the file, these can also be assigned. Telephonic case management is the systematic evaluation of medical services, procedures, facilities for medical necessity, appropriateness and efficiency. This promotes optimal patient outcomes, reduce period of disability and assure high quality of care while controlling costs. A nurse facilitates the medical activity on a file with the ability to individualize the plan of care and coordinate early return -to -work strategy with the employer and medical provider. The functions included • Coordination and referral to network medical providers • Coordination of the treatment plan with the provider • Working with the provider to establish functional abilities and conditional release to return to work • Discussion with the injured worker to clarify the worker's understanding of the diagnosis and treatment plan Page 52 • Monitor the treatment compliance of the injured employee • Identify and assist in the resolution of problems with compliance to the treatment plan • Provide regular reports to the claims handler to assist them in the management of the claim ▪ Recommend on -site case management and vocational services when needed • Work with the employer to identify a medically appropriate job Coordination and referral to network medical providers allows for the best network penetration. The channeling of the network providers will allow for the best network discounts. The Telephonic Case -Manager acts as the center point of contact ensuring delivery and communication to all approved providers of PBM and appropriate parties, forwarding appropriate issues to the utilization review department as necessary and reporting outcomes to the AmeriSys Quality Assurance Committee. Adjuster Diagnostic. Case Mana;tement Employer figured Employee Medical Case -Manager Case Management Plan - Assess Needs Develop Plan - Implement Plan Items - Monitor Progress - Evaluate Outcomes - Re -Evaluate Plan DME Pharmacy Transportation 8 Languages ATP (Attending Treating Physicani Vocational and Field Case Management CAT Supplier Utilization R2WBW Prospective lPreCertl Concurrent Retrospective We understand that it is imperative for both employee and customer satisfaction; we communicate promptly, which includes facilitating care and appointments properly. Prompt, accurate and complete communications are performance standards and measurements for our case management team. l Recommendation for Assignments of Field Case Management E. All catastrophic injuries, such as, but not limited to: • Spinal cord injuries • Head injuries 2. Neck injuries (except for minor strains) • Burns of face, hands or greater than 9% of the body • Amputations • Loss of hearing • Electrical shock • Multiple fractures 3. Any potential serious back injury: • Failed back syndrome • Multiple fractures in the back • Herniated disc with radiculopathy • Positive neurological findings • Any back injury with any degree of paralysis 4. Chronic Pain Cases 5. Claims with high potential for PT rating including, but not limited to: • Fractures in or near major joints or weight -bearing body parts • Crush injuries • Hand injuries, particularly of the dominant hand 6. Injured employees with a previous history of workers' compensation injury or injuries. 7. Difficult pre-existing medical or social problems • Diabetes • Heart disease • Psychiatric problems • Illiteracy • Mental retardation • Alcoholism and/or chemical dependency • Morbid obesity 8. Cases not fitting an expected recovery time frame: • Not responding to provided care • Time delays in getting appointments • Irregular appointment attendance • Disagreement with the course of treatment • Questionable or experimental treatment recommendations 9. Injured employees who are approaching 60 days without returning to work. The need for Re- employment Assessments is decided on a case -by -case basis. 10. Need for extended home care. 11. Hospital discharging requiring planning for home health and/or durable medical equipment. 12. Location or communications barriers. (Injured employees in small rural areas with limited local facilities, or with language barriers who know limited or no English) 13. All new claims with an initial reserve established of $50,000 or greater. PacLe 54 AmeriSys has developed the following approach to receive, review, and re -price medical bills. AmeriSys has provided MBR services since 1988 and has re -priced an average of 250,000 bills annually the past five years. Since 1990 we have been handling medical bill review and claims services for FHM Insurance Company. FHM has set a benchmark of 20 days for bill review turnaround and payment. We have delivered timely results that have beaten the benchmark set. The average turnaround for FHM Florida claims has been I 1 days from received to paid over the last 4 quarters with annualized bills reviewed exceeding 16,873. Automated bill review plays a major part in managing workers' compensation medical costs. Medical bill review is a cost containment tool that can show hard dollar reductions. Soft savings may be realized by the identification of utilization case management opportunities and reduced administrative costs. AmeriSys has trained analysts, professional nurses and/or physician advisors to review provider bills. Medical bills are adjudicated within the AmeriSys proprietary software, Corrus. We have implemented several reports by which the bill review supervisor is able to monitor the status of all bills to ensure completion according to contracted time limits. Our Corrus software imports and utilizes fees schedules from Optum for all states. Usual and Customary data is received and imported quarterly from Context Healthcare, and we also load the Medicare Fees schedules from CMS. Our adjudication process uses the place of service zip code and the jurisdiction state in determining the correct fee to apply. In addition we can accommodate multiple custom networks to handle contracts specific to the customer. The Corrus system incorporates multiple levels (automated, line item, duplicate) for rejecting bills. Bills that are identified as having missing or incorrect data are completely entered into the system and disallowed with an EOBR per State rules. A Corrus form letter for each returned bill is created and attached to the claim in the system identifying the bill being returned and the reason. If it is a duplicate, the original EOBR and payment reference is attached for the provider. Any questions regarding denied or returned bills can be viewed on the EOBR and letter history. The Corrus system has developed a daily download which produces a folder by claim number to contain PDFs of the original bill and notes. the EOBR and any letters associated with that bill. The folder can then be placed on a secure FTP for transmission. The design of our medical bill adjudication and related EDI to the DWC has incorporated effective and termination dates into State fee schedules, rules, and EOBR codes. All dates are captured on the bill and utilized during adjudication. This is to ensure that all re -pricing will be in compliance with all applicable rules and statutes on the basis of the date of accident for the claim and the date of service on the medical bill. Our Medical Bill Review services meet all audit, EDI and regulatory requirements for the State of Florida. Corrus has the capability of setting up custom networks for our clients which allow us to enter specific rates per provider contracts that will be applied to all bills for the City's claims. Providers can be set up for: Page 55 • Specific arrangements, such as discount percentage or any other agreements, according to the City's specifications. Network „rrangementis wr Rate Type Per Da= Percentage 0 0090 Per diem %F/S %13C % Bille d • Specific rates by billing code Fee Effective Espiratir3n 01/10)2012 00/1 / Provider Fees Service Fee Effective Farriration 41 $475.00 08/01/2000 08/01/2000 97700 $50.00 11/26/1996 11/26/1996 99202 $40.00 05/29/1997 05/29/1997 29881 $2,525.00 09/27/1996 09/27/1996 99205 $400.00 09/15/2008 00/00/0000 99201 $400.00 09/15/2008 00/O00000 • Pricing arrangements that are negotiated outside of standard contracting can be noted in Corrus Case Notes as a Bill Review note type on that claim. When any bill is reviewed on the specified claim a Notes icon is highlighted and the bill reviewer is prompted to review case notes for special pricing or authorizations. . __.. 2Iain-1 WC/Jurisdiction: FL FL There are Bi0 Review Casenates L1€03012N Do you want to see the Castrate; No The AnieriSys medical bill review system pairs professionally trained analysts with an automated cost containment system that has been developed specifically for Workers' Compensation claims, which will exceed your requirements. Our reviewers, along with a Registered Nurse when indicated, will identify un- bundling of surgical coding, hospital itemizations, over -utilization and medical necessity. The AmeriSys system is unique in that it has the ability to red flag the reviewer in the event that a provider has not billed in accordance with Fee Schedule rules. Our review process is indicated by the following criteria for each billing submitted. a. b. c, d. e. f. h. Identify up -coding Identify unbundling of outpatient, surgical, laboratory, or diagnostic procedures Application of State Fee Schedule Identification of Usual and Customary rates Identification of unnecessary services/procedures Identification of duplicate billings as well as possible duplicates Identification of PPO discounts Verification of pre -certification criteria and/or length of stay Adjudication of payment, denial or request for additional information within 3 days. Page 56 '1 A nurse or physician review of medical billings is indicated on complex medical bills, as well as possible identification of over -utilization through billings. These billings are elected for further review by the adjuster, case manager, RMD or the bill reviewer based on the following criteria. The criteria can be customized to meet your specific needs. Nurse audit and review procedures are also outlined below: Nurse Review Procedures — criteria for bills eligible for RN review: • Multiple Surgical Coding • Surgical bill over S5,000 (or customer's specified limits) • Outpatient Hospital bills over $5,000 (or customer's specified limits) • In -Patient Hospital not subject to per diem rate • Questionable coding or procedures • Out of state hospital, ASC, anesthesia • Questionable overutilization • Question length of stay or causality • Initiate desk or on -site audit for appropriateness of charge RN audit and review procedures: • Apply correct modifiers to multiple surgery • Identify global services or "un-bundling" • Review billings for miscoding, apply proper CPT codes or request documentation • Record and itemization review of hospital bills/audit for appropriateness of what is billed related to documentation. Identify non -covered items, global, etc. • Apply appropriate Usual and Customary reimbursement, Fee Schedule or CPT rulings. • Review for over -utilization, length of stay or causality • Initiate desk or on -site audit for appropriateness of charges • Initiate peer or physician review when warranted. ALL data accumulated and stored in the Corrus system can be reported in various formats as specified by the City with reports developed by our in-house team of information specialists. The TPA/Adjuster have access to login to the AmeriSysiNet to approve bills. Please reference the following screenshots. c 5' A,xeriSvs * Mon Mem Cuero lawn ame meo n Sq„(1, 0 U.26.11 pvy PIL..:(Ia:FTf Po 9r2 »13 UM= *A Ow* aa*w kdilwna VIr7Anig NAM 4143 111 222 i21 222 n: aP` kit PPALIPP; pya. Beh Wr6rq n{rfwkl +emat PY.e•t.n a.w.fr ;rasa Stw.ur•. 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S44f W ..r,treet •KfKKYP PYI.Jn S6 III R4+Yn Sar1 iYa-'N Page 58 Comparable Contracts Broward County Government — Cost Containment Services have been provided to the County, which once included the Broward Sheriff's Office (BSO), since 2007. Along with cost containment we have provided triage with escalation protocols as needed, case management both telephonic and field, and URAC Accredited Utilization Review Services. Before BSO split off in 2012, a cardiac disease state management program (BADGE Program) was utilized to help manage the cardiac illnesses of both the fire and police employees. The Medical Bill Review turnaround for Broward is 5 days and AmeriSys has consistently beaten the benchmark for over 6 years. Throughout the servicing of the contract, AmeriSys has been responsive to the evolution of Broward's Workers' Compensation program, including converting to a paperless electronic exchange system. Our experienced team has also taught the Broward adjusters how to use the AmeriSys Corrus system to approve medical bills. The AmeriSys Con -us system interfaces with the Broward CS STARS system on a regularly scheduled basis. MARTA — Under the regulations of the Georgia MCO, AmeriSys provides Managed Care Services including Cost Containment which includes medical bill review and network access to Coventry and PBM services through myMatrixx continually since 2003. Along with cost containment we have provided triage with on -call nurse services as needed, case management both telephonic and field, and URAC Accredited Utilization Review services. State of Georgia DOAS — Under the regulations of the Georgia MCO, AmeriSys provides Managed Care Services including network access to Coventry and PBM services through myMatrixx serving an employee population of greater than 150,000 employees. AmeriSys has been providing MCO services to the State of Georgia continually since 2002. Along with network access we have provided triage with on -call nurse services as needed, case management both telephonic and field, and URAC Accredited Utilization Review services. Palm Beach County Sheriff's Office — Claims and Cost Containment Services including medical bill review have been provided to the County since 2003. Along with cost containment we have provided triage with escalation protocols as needed, case management services both telephonic and field, and URAC Accredited Utilization Review Services. A cardiac disease state management program (BADGE Program) was initiated in 2003 to help manage the cardiac illnesses of both the fire and police employees. PGCS — Cost Containment Services have been provided to PGCS since 2005. This includes over 200 Public Entities. Along with cost containment we have provided case management services both telephonic and field, and URAC Accredited Utilization Review Services. A cardiac disease state management program (BADGE Program) was initiated in 2005 to help manage the cardiac illnesses of both the fire and police employees. The AmeriSys/myMatrixx partnership is in its l2th year since the inception of myMatrixx. Together we have provided quality medical management and pharmacy services to customers in the entire south-east I'awe 5` region. AmeriSys and myMatrixx through their relationship have joined forces to face multiple challenges in the Workers' Compensation arena such as the escalation of the need for cardiac medications (BADGE Program). Currently we are working together in the development and roll -out of a Pain Management initiative called SECURE. Our Manager of Medical Services is currently a member of the myMatrixx pharmacy and therapeutics committee which establishes the general protocols and formularies for this PBM. AmeriSys' SECURxE is leading the way with quality -centered cost effective management of pain treatment programs. By joining forces with some of the industty's leaders in pain treatment guidelines, pharmacy controls and alerts, functional restoration initiatives and specialized case -managers, AmeriSys has developed unique protocols and criteria for managing these complex and cost -driving claims. This program will maximize the injured employees' comfort level by working closely with physicians who practice according to nationally -approved standards. In utilizing these best practices, the risk of addiction is minimized and costs associated with the addiction are decreased. In doing this, not only do we benefit our industry but our community as well. The SECURE program's goals are to improve/enhance return -to -work outcomes, reduce disability duration, prevent unnecessary, dangerous and costly consequences of inappropriate or prolonged utilization of opioid medications while reducing the costs of handling pain management claims. Services for the Effective Control and Utilization of Rx through Evidence -based Criteria We believe in working closely and in conjunction with the claims administration staff. We believe and hold to the philosophy and approach that the claims adjuster/supervisor is in control of the file and our work should be complementary, supportive and assistive in that process. Please reference the following page for our workflow diagram. Please reference Attachment 7- Policies and Procedures. Page 60 Field Nurse Sample of Claims & Medical Management injury Occurs Report Injury via phone, website, email or fax Triage Intake Is Claim Medical Only, Lost Time, Large/Catastrophic? Claim Setup Medical Only Nurse UR or Precen Closure Of File Medical Only Adjuster Receives New Set Ups Ai 24-Hour Contact Investigation Compensability Determined 4, File Reviews, Discussion and Disposition of Bills Closure Of File Field Nurse Lost Time Nurse UR or Precert Closure Of File LT Adiuster 24-Hour Contact Investigation Compensability Determined New Claim Diaried to Adjusters & Supervisor for Handling Large/Catastrophic Field Nurse Evaluation of Reserves — Adjuster & Supervisor File Reviews, Discussion. and Disposition of Bills Closure Of File Triage Nurse UR or Precert Achievement of Medical Stability Access needed for Continued FCM Involvement Access Rehabilitation Need Refer to Vocational Rehab Counselor Lost Time Adjuster 24-Hour Contact Investigation Compensability Determined 4 Evaluation of Reserves — Adjuster & Supervisor File Reviews, Discussion, and Disposition of Bills Addressing MMIIPIR, PTD Status, Life Care Plan. Cost Projection. Excess Updates and if applicable, Medicare Set Aside i Closure Of File Medical Bill Review Flow Chars Incoming Mail Electronic Billing from PBM and Ancillanes Receive. review, index and scan medical bills and attached documents Bitts/documents attached as PDF copies to Corrus system file Bill Review (adjudication process fs completed) EOB is created automatically and held with attached documents pending authorization by adjuster Waiting period of 24-48 hours pending bill approval by Adjuster. Aging report is auto generated Medical Bill Review for clean non-complex buts Bill Review RN reviews Surgical. Hospital, ASC and UR considerations and Adjuster Requests TPA Adjuster djuster is notified o the need for bill approval through mutually agreed protocols Review and approve bills on diary within 24-48 hours Quality checking process by second reviewer and series of Corrus reports Transfer Data to Payment System Check & EOB sent to provider in 30 days or less Submit EDI to CPS Cortect any rejections within 3 days Re -submit Bit/ is approved Bill is questioned: Bill Review is notified and BR Manager may be diaried for further review OAutomatic Process 0 Manual Process TPA ■ AmeriSys Page 62 The AmeriSys office location servicing the City of Miami is below. Home Office (City of Miami servicing office) USIS, Inc. PO Box 616648 Orlando, FL 32861-6648 Prei 7 ux1r operated tmcler Ur7itcd Sellinsur ed Sen ices # of Employees: 88 30) Provide a description of the standard loss reports, as well as provide a sample and descriptions of any additional reports to be utilized. Our software incorporates a variety of predefined reports available through Menu selection with access limited by the system's security levels. The parameters for these reports are easily modified and include the ability to filter, sort and summarize the data as well as the ability to save the report in different formats such as Excel, .csv or .txt for retrieval by another system. AmeriSys can provide monthly reports as required detailing Claim Status, Return -to -Work Status & Savings, Medical Bill Activity with Savings as well as additional reports as requested by Risk Management such as OSHA data, pharmacy rankings by provider and drug. EDI exceptions and medical bill turnaround reports. With our in-house programmers we are able to create a report with any of the data in our system to be used as a standard monthly report or query specific data for a one-time analysis. Please reference Attachment 11— AmeriSvs Sample Reports. 31) Explain whether Proposer currently file state and excess insurance forms on behalf of Proposer's clients, and attach copies of the forms used. This question pertains to Part I. 32) Describe Proposers methodology for evaluating and determining savings as expected within this RFP. Include in detail the mechanisms Proposer would use to track whether proposed savings goal has been met, and methods to meet those goals. Indicate if Proposer is willing to accept the incentive or penalty as indicated, should savings not result. To determine the potential savings achieved on behalf of the City, AmeriSys would first reference our Medical Bill Review Activity reports from 2011 when we performed these services for the City. We would also reference performance reports for other clients in the same geographic area. We make every effort to achieve the highest level of savings possible within the Florida Statutes and Rules, while establishing and ensuring rapport within the provider community. We recognize the potential significance of the City's claims due to the occupational hazards the employees possess. Quality physicians must be available to render care. USIS is agreeable to accepting a mutually agreeable incentive or penalty as indicated, should savings not result. Page 63 33) If proposed, describe in detail Proposer's computerized on-line claims management system and software to be utilized during the performance of the scope of work reflected herein. Detail functionality, transition from current system, and if a cost is proposed, indicate in Proposer's Fee Proposal. AmeriSys utilizes proprietary case management software for integrated medical case management and medical bill review. The application provides for detailed tracking of case notes, diaries, claim contacts, provider utilization and letters as well as a complete medical bill repricing system for efficient and effective adjudication of medical bills. Our computer system allows us to enter claim information based on dates of injury or occurrences and allows for multiple claims per claimant. All facets of case management from the Notice of Injury to the MMI, PIR and RTW are tracked. Through our Diary System, users organize tasks associated with cases and prioritize those tasks as Urgent, High or Medium. Supervisors have access to these diaries to monitor the status of these tasks. Users cannot delete a diary once it is entered. Cancelled diary entries are retained in the system as a "cancelled entry" which is also subject to review. Original User Case Notes can only be edited on the day during which they were entered and only by the individual making the original entry. Both the diary and case note systems allow for sorting and filtering by subject, user or If injured employees are referred to physicians through a PPO network all bills can be adjudicated to multiple schedules (i.e. State fee schedules/ PPO Discounts/ U&C) with resultant savings reported by case, provider or network. The bill review staff is trained to perform first line review claim date, diagnosis, medical providers and has access to the internal and imported case notes types as allowed in the security setup. Our software incorporates a variety of predefined reports available through Menu selection with access limited by the system's security levels. The parameters for these reports are easily codified and include the ability to filter, sort and summarize the data as well as the ability to save the report in different formats such as Excel, .csv or .txt for retrieval by another system. Reports for bill review savings, outcomes to identify high or low utilization by providers, open or closed cases are just a few of the reports available. At present AmeriSys is using this software to interface with several different systems as well as producing EDI extracts for the state. Importing claims history into the system and exporting current data is a daily function handled by interfaces at all of our locations. Access to our system is available through several means: • Direct internet connection to our secured web site allows for viewing and entering of Case Notes and Diaries • Secure Citrix connection directly to ColTus allows full access to the system Please reference Attachment 10 — Transition Plan. 34) Detail any procedures, equipment, and/or costs necessary to connect with the City's hardware and software, particularly related to conductivity with Risk and Finance, at the time of this RFP and should the City's system be modified or replaced during the Contract term. Should there be associated costs; indicate those costs, the reasons for the same, and who will pay those costs. Costs, if any, shall be detailed in the Fee Proposal Section. Page 64 The City and/or Claims Administrator/TPA can access all claim information within the AmeriSys Corrus system via a direct Citrix connection for which the client software will be provided by AmeriSys at no cost to the City. There is also a web application, Corrus Inet, which provides access to Claim Demographics. Case Notes and Diaries within the Corrus system. This web site is secured by VeriSign and available only to users granted access by AmeriSys. AmeriSys will download all bill review, payment and other requested information directly into the chosen claims system in the specified electronic format at no additional cost. 35) Estimate Proposer's minimum start-up time from date of contract award to the date Proposer's network would be available to Risk Management. What specific requirements does the Proposer have to initiate set-up, and please explain any additional costs involved. USIS would prefer a sixty day start -time from the date of the contract award. This would allow for proper data conversion, program setup, configuration, training and more. Initial Load of Electronic data files snatching all file layouts • Claim/ claimant demographics • Claim notes data file/ attachments / medical records • List of Critical claims and up coining procedures • List of litigation claims • Any other Files • Bill Review / EOB History Data if possible 36) Explain any options which the Proposer's system has that will permit the City to generate reports from, and to make direct inquiries into the Administrator's data base by on-line access. Proposer must clearly identify in its Proposal the costs of providing any special conversion systems, license and software costs for accessing the system, and the party(s) responsible for the payment of those costs, if any. (Costs shall be fully detailed in Fee Proposal Section). The AmeriSys web application houses web available to our clients. Ad -hoc reports may also be requested and we will publish it via the web portal. Additional reports may be generated from one of our internal staff members and emailed to the City if preferred. We currently staff 7 in-house programmers who can create client -defined purpose -specific reports or data extracts in a client -specified format. AmeriSys can accommodate numerous report types as part of our web services site. Our user friendly site allows you to pull reports straight to your printer or download claims data directly to your PC. 37) Provide sample reports describing information such as type of accident, accident site, department, date and time, cause of accident, injury, and part of body. Proposer shall describe in detail any safety/loss control reports that are provided by the system, and shall submit a listing of the variety of claims reports available, and provide sample copies of formats that may be requested by the City. The RFP refers to the TPA handling claims reporting and an assumption is being made that AmeriSys will receive an immediate email of the FROI if triage is needed without waiting for data to interface from the claims system. AmeriSys has the capability of taking the First Report of Injury either within our Corrus system for phone-in reports or via a web reporting application should the City decide to opt for this approach. The reports listed above arc usually provided by the Claims Administrator but AmeriSys does have the capability to produce these reports if requested. Please reference Attachment 11 — AmeriSys Sample Reports. 38) Provide the methodology and List of allocated or anticipated expenses to employ outside professionals such as surveillance, rehabilitation, experts, attorneys and others to assist in the investigation and adjustment of claims. We would utilize Field Case Management in accordance with the following criteria: External case management will be considered for assignment in the following situations (all referrals for field case management (FCM) shall be requested and approved by the claims adjuster): All catastrophic injuries, such as, but not limited to • spinal cord injuries • head injuries • severe sensory or motor disturbances • severe communication disturbances • severe complex integrated disturbances of cerebral function • severe episodic neurological disorders • other severe brain and closed head injury conditions • neck injuries (except for minor strains) • burns of face, hands or greater than 5% of the body and second or third degree burns of 25% or more of the total body surface amputations • loss of hearing • electrical shock • multiple fractures Any potential serious back injury: • failed back syndrome • multiple fractures in the back • herniated disc with radiculopathy • positive neurological findings • any back injury with any degree of paralysis Chronic Pain Cases Claims with high potential for PT rating including, but not limited to,: • Fractures in or near major joints or weight -bearing body parts • Crush injuries • Hand injuries, particularly of the dominant hand Claimants with a previous history of workers' compensation injury- or injuries Difficult pre-existing medical or social problems: • Diabetes • Heart disease • Psychiatric problems • Illiteracy Page 66 • Mental retardation • Alcoholism and/or chemical dependency • Morbid obesity Total or industrial blindness Cases not fitting an expected recovery time frame: • not responding to provided care • time delays in getting appointments • irregular appointment attendance • disagreement with the course of treatment • questionable or experimental treatment recommendations Claimants who are approaching 60 days without returning to work. The need for Re-employment Assessments are decided on a case by case basis. Need for extended home care. Hospital discharging requiring planning for home health and/or significant durable medical goods. Location or communication barriers. Claimants in small rural areas with limited local facilities or claimants with language barriers who know limited or no English. All new claims with an initial reserve established of $50,000 or greater and those where the nature and severity of the injury would qualify the injured worker to receive disability income under Title II or supplemental security income benefits under Title XVI of the Social Security Act that existed on July 1,1992. The external case -manager intact with the injured worker • be a qualified rehabilitation provider • communicate with the internal case -manager, the employer and the insurer representative • submit reports as required Please note, there will be no assigning of Field Case NIanagernent (Medical or Vocational) without the express consent of the City. 6 39) Provider shall provide its most recent audited certified business financial statements (or unaudited if audited is not available) as of a date not earlier than the end of the Proposer's preceding official tax accounting period, together with a statement in writing, signed by a duly authorized representative, stating that the present financial condition is materially the same as that shown on the balance sheet and income statement submitted, or with an explanation for a material change in the financial condition. A copy of the most recent business income tax return will be accepted if certified financial statements are unavailable. Brown & Brown, Inc 220 South Ridgewood Avenue (32114) P.O. Sox 2412 •Daytona Beach, FL 321 15 385/252-9601 • FAX 386/239-5723 Mect Line. (346j 239.5751 ■ (No) 877- '69 Ext. 5152 bireci fax_ (386)239.7293 RO[BERT W. LLOYD rEreemrar t"1cY P,esfrdeyl & General C"eru,sel November 18, 2016 Daniel J. Alfonso City \$anm2er City of Miami 44'1 SW 2" `1 Avenue Miami, FL 33130 Re_ USIS, Inc. - Request for Proposal Dear Mr. Aifon Pursuant to the RFP request, USIS, a subsidiary. of Brown & 13rowtt, Inc., provides its current financial statement an www.bhinsurance.com. In addition, we have provided you with Brown & Brown. Inc.'5 most recent Annual Report This will confirm that the present financial condition of the company is materially the same as that shown on the balance sheet and income statement submitted. If you have any questions, please contact me. R WL/stp USIS, Inc. dba AmeriSys is a wholly owned subsidiary of Brown & Brown, Inc. Please reference Attachment 1 - Brown & Brown 2015 Annual Report. Page 68 Fee Proposal 40) Submit a guaranteed, all-inclusive annual fee as previously detailed in Section 2.17. This fee shall represent all claims, administrative, and loss data fees, and shall be guaranteed annual fees for the initial three (3) years, and the two option to renew years, as opposed to per claim time and expense or any other fee proposal. Proposals not containing an all-inclusive guaranteed annual fee for three (3) years, and the two option to renew years, for all specified services, will not be considered. The pursuit of subrogation and recovery from the Special Disability Fund is to be included in the Proposers Annual Fee. Clearly indicate any charge not included in the proposed annual fee. The all-inclusive fee pertains to Part I. Please review the fee proposal attachment for Medical Management pricing. 41) As the City is interested in a program which will generate savings over the current expenditures in the workers' compensation area, the proposed fee structure should address the mechanism for achieving a minimum of 15% net savings with an escalating incentive bonus for savings that exceed the minimum and a penalty for a shortfall in the desire net savings. NA — Pertains to Part I 42) Submit a separate quote(s) for existing claims, and a separate quote(s) for prospective claims; pricing on a "per claim" basis for both existing claims and prospective claims, and a breakdown of the cost between lost time vs. medical. In addition, provide a per claim cost vs. flat dollar cost. Include any other charges not included in pricing. Price Proposal must contain rates based on the "life of relationship basis," namely for those prospective claims, and the City's inventory of open files. Provide separate quotes for the assumption of prior claims and for prospective claims commencing on the commencement date of the Contract. N/A - This question pertains to Part I. 43) Include any relevant services or products that will be provided to the City which are not priced in Proposer's Proposal, but which will enhance the acquisition process. It is our assumption that the City has first responders/badged officials that are in your employment which experience presumption and cardiac claims. Please reference BADGE Program Attachment 2 - Cardiac - Exposure Protocol. We believe that the Heart/Lung public presumption claims represent one of the most significant economic exposures to closing claims and the anticipation that most of those claims will deteriorate as the employee ages. David E. Perloff, MD, FACC, FACT, is the AmeriSys BADGE Program Cardiac Medical Director. He has many years of experience in Cardiology and over 10 years of that in dealing with workers' compensation related to the Heart/Lung Presumption Bill. It is also our assumption that the City has injured employees who are prescribed opioids. Please reference Attachment 3 - Innovative Programs for information related to the SECURE program. AmeriSys has developed unique protocols and criteria for managing these complex and cost -driving claims. The program's goals are to improve/enhance return -to -work outcomes, reduce disability duration: prevent unnecessary, dangerous and costly consequences of inappropriate or prolonged utilization of opioid medications while reducing the costs of handling pain management claims. Page 69 It is this position and approach of innovation and efficiency that characterizes our organization. Whether it is unique types of claims, unusual working conditions or locations with special information needs, we strive to customize our program to address those unique and individual needs. Our commitment to innovation and efficiency is also coupled with 25+ years of proven experience in providing cost effective and quality -oriented medical care management. It is the careful blend of innovation with proven, tested experience and success that allows for the best in functional and economic outcomes. AmeriSys stands ready to work with your leadership team to identify, develop and implement a program that is best suited to your claims and informational needs, 44) Indicate the cost, if any, of assuming prior claims and data conversion and whether it is a one-time charge or an annual charge. Include in Proposer's proposed price, costs for the provision of an enhanced system and for the conversion of any data necessary. Please reference Attachment B2 - Managed Care Price Proposal for the one time data conversion charge. 45) Provide a performance guarantee (may be negotiated with the City). AmeriSys will agree to a mutually agreeable Performance Guarantee. 46) Provide any, and all additional costs, item by item, as identified by Proposer, in any other area not previously discussed herein, and detail what those additional costs, if applicable, would entail. Include whether Proposer, or the City will be responsible for payment of those additional costs. Itemized costs are outlined in Attachment B2 Managed Care Price Proposal. ATTACHMENT A Supplemental Proposer Questionnaire ATTACHMENT A SUPPLMENTAL PROPOSAL QUESIONNAIRE Proposer shall respond to each Section in its entirety, in the same format presented. A copy of Attachment A may be requested in Word Format. 1. INFORMATION ABOUT THE PROPOSER Please include the following in your response: 1. Demonstrate your expertise and experience in claims handling that would relate directly to the City's operation. USIS, Inc. is a full service Third -Party Adtninistrator (TPA) providing specialized, client designed, professional service programs for All -Lines Claims Administration as well as Medical Management Systems/Programs and Loss Prevention Services and Programs. USIS, Inc. has been in business for 34 years and was established in June of 1982 as a division of Brown & Brown, Inc. In April of 2006 USIS was incorporated as a wholly owned subsidiaty of Brown & Brown, Inc. (NYSE stock symbol BRO). B&B is one of the nation's largest insurance brokerage organizations. This provides our organization with the size and economic strength, stability and resources to handle a program such as the City of Miami' Workers' Compensation program. Please reference Attachment 1 — Brown & Brown, Inc. Annual Report. The culture statement for B&B is as follows: "Brown & Brown is a lean, clecentralhed, highly competitive sales and sen'/ce organization comprised of people of the highest integrity and quality, hound together- by clearly defined goals and priclefirl relationships. " Although we are decentralized by design, that culture permeates USIS/AmeriSys. AmeriSys is a regional medical management managed care organization founded in 1985, and operated under its previous name ERS until 1995, a regional disability management company which had built a ten year success in Florida, Georgia, the Carolinas, and other southeastern states. As of April 1, 2000, AmeriSys was acquired by Brown & Brown Insurance Services, Inc., and folded into USIS, Inc. AmeriSys is URAC Workers' Compensation Utilization Management certified. URAC is the nationally recognized certifying body for these programs and services. USIS, the claims handling side of our organization, is completely integrated with AmeriSys. AmeriSys is a division of USIS rather than a separate company. As such, we have common executive leadership for assuring continuity and compliance, while having separate technical leadership making certain that we excel professionally in all aspects of the claims adjudication service to our customer partners. ACCREDITED t. IVI,:,wm N.euuernrni In MI - We provide our services to commercial carriers, self-insurance funds, risk pools and trusts, as well as self -insured employers in the private and public sectors of the market. rage 71 Our flexibility allows us to deliver a complete claims administration program that is tailored to the unique needs of the client. All or part of our services may be utilized, depending on the client's individual requirements. Our innovative, quality administrative services include: Multi -Line Claim Administration Medical Management and Certified Managed Care Programs Third Party Recoveries Full Spectrum Risk Management Progressive Claim -Reporting Procedures Cost Containment/Medical Bill Auditing and Review/EDI transmission State -of -the -Art Information Systems Multi -State Capabilities Our organization is customer -centric. Our excellent reputation comes from recognizing that each employer/insured is unique in systems and philosophies. We stand ready to customize our services to best complement the current program by designing unique and customized service programs that allow our customers to "own" their claims service program. This incorporates our customers' strengths while augmenting their programs with design, support and expertise in the areas that will drive the greatest improvement in outcomes. We also recognize that these services and programs are dynamic and require ongoing assessment, evaluation and modifications to remain current with statute and rule as well as technology, medical advances and other efficiency -related information and techniques. Our policies and procedures focus on quality, professional, superior service; with numerous controls and safeguards in place to ensure compliance with State rules and regulations, client procedures and Sarbanes-Oxley standards. We understand that the services we would be providing on your behalf are for your employees, your colleagues, and very often friends. We recognize that we must treat each injured employee with respect and genuine interest in his/her well-being and recovery. We do this while also making sure that we protect the financial and human resources that are paid for by the hard earned tax dollars of your county's citizens. We have a stewardship obligation and commitment to the injured employees and the City of Miami. Our staff of almost 250 personnel includes a dynamic and experienced leadership and management team, experienced adjusters in All -lines of claims management, RN medical case -managers and other support professionals to promote efficient, timely and technically -sound claims and medical management. 2. List all external providers/vendors your company's partners with to provide adjusting, managed care, bill review, or other required services on an ongoing or occasional basis. Describe these services and the exact relationship between your company and those providers vendor. Preferred Provider Network AmeriSys is proposing DimensionComp for hospital and provider access, the AmeriSys Preferred Provider network for ancillary providers, and myMatrixx as the Pharmacy Benefit Manager. USIS/AmeriSys employs a Director of Provider Services who will work closely with the City, DimensionComp, the adjuster and the case -manager. The Director of Provider Services will make recommendations as to what outcomes would be monitored as well as work with the City to determine the criteria that are important. DimensionComp is an affiliate of Dimension Health, Inc. DimensionComp provides clients access to the one of the largest Workers' Compensation networks in South Florida. By maintaining strong relationships with the provider community, DimensionComp is able to offer clients superior network savings and greater access. Please reference Attachment 8 — Dimension Health Inc. Providers. Coventry Health Care Workers' Compensation, Inc. Coventry provides clients access to the largest national provider network offering in the workers' compensation industry. By maintaining strong relationships with the provider community, Coventry is able to offer clients superior network savings and greater access. Pharmacy Benefit Manager USIS/AmeriSys contracts with myMatrixx for PBM services. Matrix Healthcare Services, Inc., dfbia myMatrixx, is a full -service pharmacy benefit management (PBM) and ancillary services company focused on workers' compensation. Please reference Attachment 9 — Overview of myMatrixx PBM Services. The AmeriSys/myMatrixx partnership has existed 10+ years since the inception of myMatrixx. Together we have provided quality medical management and pharmacy services to customers in the entire south-east region. AmeriSys and myMatrixx through their relationship have joined forces to face multiple challenges in the Workers' Compensation arena such as the escalation of the need for cardiac medications (BADGE Program), and currently we are working together on the AmeriSys Pain Management initiative called SECURE. The Vice President of AmeriSys is currently a member of the myMatrixx pharmacy and therapeutics committee which establishes the general protocols and formularies for this PBM. Ancillary Network Access AmeriSys Preferred Provider network • The AmeriSys Preferred Provider Network is made up of a select group of vendors to perform the services referenced below. • Every three (3) years AmeriSys undergoes a very detailed RFP process for Ancillary Medical providers that include transportation, translation/languages, Physical Therapy, Diagnostics, Horne Health and Durable Medical Equipment. These organizations undergo due diligence and are then contracted. Contracting includes indemnification for customers, insurance coverage verification as well significant discounting for services. We believe this provides our customers with the best protection at the best price. creating best value. Page 73 AmeriSys Preferred Provider Network Spreemo Spreemo provides a diagnostic network through the AmeriSys Preferred Provider Network Orchid MedicalOrchid Medical provides a Diagnostic, DME and Home Health network services through the AmeriSys Preferred Provider Network Streamline Streamline provides a diagnostic network through the AmeriSys Preferred Provider Network One Call Care Management / Align Networks One Call / Align provides Diagnostic, DME and Horne Health network and Physical Therapy services through the AmeriSys Preferred Provider Network Priority Care Solutions Priority Care Solutions provides DME and Home Health network services through the AmeriSys Preferred Provider Network Speakeasy Translation & Transportation Speak Easy provides Transportation and Translation network services through the AmeriSys Preferred Provider Network ProCare ProCare provides Transportation and Translation network services through the AmeriSys Preferred Provider Network JNJ Services J&J provides Transportation and Translation network services through the AmeriSys Preferred Provider Network lntrepreters Unlimited lntrepreters Unlimited provides Transportation and Translation network services through the AmeriSys Preferred Provider Network SPNet SPNet provides Physical Therapy services through the AmeriSys Preferred Provider Network Therapy Direct Therapy Direct provides Physical Therapy services through the AmeriSys Preferred Provider Network Dental`j'orks USA Dental Works provides dental network services through the AmeriSys Preferred Provider Network. NuQuest Bridge Point NuQuest provides Medical Set Aside services (a Brown & Brown, Inc. company) --- Field Case Management AmeriSys hires independent FCM subcontractors under the direction of AmeriSys' ECM Supervisor. All subcontracted FCM's are contracted to adhere to the standards of quality set forth by AmeriSys. Physician Advisor Services for UR Dane Street, LLC Debbie Hill, MSN, RN, CCM, Director of Account Management 891 Centre Street • Boston, MA • 02130 951.543.1627 561.206.0659 (fax) dhill@danestreet.com w-ww.daneStreet.com Dane Street provides Workers' Compensation Peer Reviews to Managed Care Organizations, Third Party Administrators, Utilization Review Organizations and Employers. Licensed in all mandatory UR states, with an active Regulatory and Compliance group which interfaces with the appropriate State workers' compensation Boards and Departments of Insurance. Dane Street is a URAC-accredited review organization and the reviews are delivered according to all URAC, jurisdictional and client requirements. They understand the importance of state -specific medical treatment guidelines, turnaround tinges, match requirements —and track any changes across these categories in their rules -based PeerAccess platform. Page 74 3. List all external providers/vendors/governmental organizations your company has electronic data systems interface with. Describe the system interface in detail. USIS reports all claim data to the State of Florida via electronic data interchange (EDI) according to and complying with the standards of IAIABC current requirements. Claim forms are transmitted to the State daily. The adjusters review the State forms the next business day in the online data warehouse. Any rejected forms are resubmitted immediately. USIS has not had any major deficiencies or issues with State compliance. Additionally, USIS has electronic system interface with: • All ancillary vendors where we receive electronic bill records for adjudication and payment, and provide a file in return with the detailed data. Several of our clients where we send/receive the following: claims data. bill data. electronic documents (.pdf, and tiff files), eligibility files, case notes, and more. Some of these clients include the State of Florida, Broward County, Palm Beach Sherrif'Fs office, and more. • We currently have interfaces with the following RMIS platforms: Risk Master, Stars. Origami, IVoss 4. Fully describe how your company perceives that your company's claims administration services differ and set your company apart from your companies' major competitors. Although USIS/ArneriSys is located in the Greater Orlando area. USIS/AmeriSys services many clients throughout Florida. We work with over employers in the City of Miami area including State of Florida employees. The Claims Manager has worked at USIS for 28 years. most of this time handling self -insured public entity accounts. Terri is extremely involved in ensuring a culture of excellent customer service throughout the department. Terri and many of the adjusters have worked with Volusia County and Orange County school boards for over 20 years, taking great pride in their long term successful relationships. The adjusters handle each claim as though it is their money being spent. They live up to our motto "Service Beyond the Contract'', and exemplify our SSE! campaign in the day to day claims handling process. S UPERIORITY T IMELINESS 4?s, ESPONSIVENESS I NITIATIVE V IRTUE E NERGY BE BETTER THAN OUR COMPETITORS PROVIDE PROMPT CUSTOMER SERVICE SHOW SENSE OF URGENCY GO ABOVE AND BEYOND MAINTAIN ETHICAL COMPASS DEMONSTRATE PASSION AND ENTHUSIASM SER t7CE BEYOND THE CONTRACT® Our promise is to work for you -- to manage your program effectively and efficiently by delivering the highest quality, most cost-effective service. We are constantly improving and implementing programs to Page 75 help you contain costs and reduce fraud. An efficient claims system allows for effective claims administration. Software from leading vendors within the Workers' Compensation and medical management field, supplemented with programs and components developed by in-house programmers, provides an environment tailored to the special needs of the client. • Employers have online access to all claim information through database and document utilities. • Support services include all up-to-date office management tools • Comprehensive management reports are provided online or via email • Remote access from a client site is available by multiple portal protocols, such as internet or VPN • In-house programmers are able to develop customized reports where client special needs exist • Claims data is available via USISiNet for use in client spreadsheets, word processing and/or database programs. • A web -based claim reporting system is in place for easy on-line access by clients • USIS developed and utilizes a secure. state-of-the-art web portal warehouse (USISiNet). All claim data within the system is viewable online and able to be downloaded into an Excel format directly from the website. Features include First Report of Injury reporting; check registers; loss reports; all account and claimant statistical data under multiple search parameters. Our energetic staff is motivated to constantly search for ways to control overall insurance costs and to provide cost-effective solutions best suited to the client's situation. Our service commitment is to make our client's job easier. You will be able to rely on our licensed claims adjusters to handle all the details of each claim on your behalf. Our policies and procedures focus on quality, professional, superior service; with numerous controls and safeguards in place to ensure compliance with State rules and regulations, client procedures and Sarbanes-Oxley standards. USIS has an integrated approach to claims management which involves Telephonic Case Management when required as well as integration of the cost containment components of the program. AmeriSys is the medical management division of USIS and the TCMs work alongside the claims adjusters. Systems are integrated allowing the sharing of case documentation between the adjuster, case -manager (when assigned) and cost containment. AmeriSys also has contracts with Physician/Hospital networks as well as Ancillary Providers (Physical Therapy, Diagnostics, Horne Health, etc.). These providers are contracted not only for significant pricing reduction but also performance related to the speed of establishing appointments, supplying reports and other standards that impact the overall cost of the claim, including lost time days. We believe that the combination of aggressive claims handling, integration of cost containment and case management, preferred providers and strong experience dealing with public entities will positively impact the County's overall economic outcomes. Employee Performance Management System Staff performance evaluations are done quarterly and annually. The Core Values of the company are 'graded' on a quarterly basis, along with Key Performance Indicators relative to each position. A more in-depth performance evaluation is also done annually. Of course, any time more training or direction Page 76 is required; it is handled at that time. USIS/AmeriSys promotes a team atmosphere in which employees can talk freely with members of leadership. Employees are encouraged to openly discuss with their Department Leader any issues so that appropriate action can be taken. Adjusters During the transition the adjusters will be trained on the ERIC RMIS to demonstrate proficiency with the use of the standardized documentation/case notes, how to utilize the color -coded prioritized diary system for more efficient claims handling and how to use each individual screen to have a complete claim history and action plan. The adjusters will be instructed in the USIS/AmeriSys phone, electronic fax and email systems and demonstrate proficiency in all. The adjusters will receive our Claims Procedure Manual for review and training. The adjusters will be trained extensively in our culture, policies and procedures, specific client requirements, utilization of the computer system and various software prograrns, The adjusters will be educated on client -specific Policies and Procedures as well as the USIS/AmeriSys Quality Assurance program and auditing requirements. He/she will be expected to demonstrate proficiency in executing and exceeding these requirements during orientation. The adjusters will be trained on the Return-to-Work/Stay-at-Work Policies and Procedures emphasizing communication with the City of Miami and with the medical providers to assist the injured employees in returning to work as quickly as possible. The adjusters will demonstrate proficiency in such areas as the management of a Lost Time claim, Medical Only claim, large/catastrophic claim and litigated claim. Scenarios for various situations will be presented during orientation for training on acceptable practices. Medical Management Staff USIS/AmeriSys employs nurses who will provide the telephonic ease management services; experienced at hire to include three to five years (five to seven years for the City of Miami) in areas of Workers' Compensation, occupational health and/or neuromuscular/orthopedic medicine. All persons involved in the case management process will be trained in the statutes, rules, principles and standards pertaining to their job description. This training will occur prior to the staff assuming their assigned roles and responsibilities. This will include but is not limited to training related to: • Confidentiality and the signing of the Confidentiality statement • Utilization Management and the Quality Assurance Manual • Grievance procedures and tirne frames associated with this process • Satisfaction surveys • Monthly education is provided in related areas and the policy and procedure manual will be reviewed with each person responsible for this activity annually. Education sessions are recorded and reported at the quarterly QA meetings, Our orientation program consists of an educational approach with the case -manager building on his/her current strengths while he/she is familiarized with the policies procedures and protocols of the account to which they will be assigned. Page 77 5, Provide a list of your company's current client within the public entity sector USIS/AmeriSys has over 30 years of experience working with Florida governmental entities. Public entities make up 30% of USIS/AmeriSys total clients. Our extensive experience with public entities such as, city and county governments, fire and police districts, school districts, and two state governments provide us with unique experience and expertise to handle the City of Miami's Workers' Compensation program. Each of our customers has benefited from highly customized approaches developed by USIS/AmeriSys to meet their unique claims and automated utilization management service needs. Our proprietary medical bill review system pairs professionally trained analysts with an automated cost containment system that has been developed specifically for Workers' Compensation claims, which will exceed your requirements. A cardiac disease state management program (BADGE Program) was initiated in 2003 to help manage the cardiac illnesses (Presumption claims) of both the fire and police employees. Please reference Attachment 3 — innovative Programs. Page 78 USIS currently provides services to the following Florida governmental entities. Client Bay County BOCC Services Provided WC Claims TPA Medical Bill Review Broward County BOCC Intake / Triage Network Access Medical Bill Review City of Cocoa WC Claims TPA Medical Bill Review City ofJacksonville Network Access Medical Bill Review Medical Only Claims Handling * on an as needed basis Orange County Public Schools WC Claims TPA Medical Bill Review Medical Management Palm Beach County Sheriff's Office WC Claims TPA Medical Bill Review Medical Management Preferred Governmental Insurance Trust (200+ governmental members) Medical Bill Review Medical Management State of Florida Intake / Triage Medical Management Votusia County School Board WC Claims TP Medical Bill Review Medical Management Georgia WC Claims TPA Bill Review Managed Care Organization Columbus Consolidated Government ** State of Georgia (DOAS) Triage Managed Care Organization **Reference Attachment 12 — Risk and Insurance, Revitalizing the Program Award Winner. - Teddy Page 79 6. Provide details including a brief summary and status of any pending claims, or lawsuits involving your company and/or its' subsidiaries, which may affect performance or bring about negative publicity for the City. USIS/AnieriSys has not been party to lawsuits, administrative actions or litigation related to fraud, theft, breach of contract, misrepresentation, safety, or wrongful death. However in the normal course of doing business related to workers' compensation claims handling, USIS/AmeriSys was made party to litigation related to the servicing of workers' compensation claims (5) on behalf of its clients. All but one was resolved in our favor, and that one is recent and still pending. Brown & Brown, Inc. (the parent of USIS, Inc.) is publicly traded on the NYSE, is regularly subject to suits and claims that arise in the ordinary course of its business, and is required by law to make periodic filings with the Securities and Exchange Commission, which are publicly available and which contain additional information concerning Iegal matters. 7. Provide a copy of your company's current SSAE 16/SOC 1 & SOC 2. USIS/AnieriSys receives an annual SSAE 16 audit and is currently in compliance with all items. A copy of the report will be provided upon completion of an executed contract between USIS and the City of Miami. Please reference Attachment13 — SSAE 16 excerpt. 50C 2. CLAIMS REPORTING The City desires internet reporting capability, FAX, and a twenty-four (24) hour, seven (7) days -a- week, telephonic claims reporting service. Demonstrate your company's ability to meet the following criteria, detail how your company would meet the requirement, and any qualification or stipulation that applies to any response for the following: 1. Ability to answer a call routed from the City provided 1-800 number dedicated phone line with a customized the City script. NIA - This question pertains to Part I. 2. Capability for internet, phone, and fax reporting. N/A - This question pertains to Part I. 3. Ability to utilize tape feed for: a) The City employee information and demographics, via secure FTP in the reporting system using employee ID. N/A - This question pertains to Part I. Receive tape feed via FTP of the City (or related entity) vehicle information with the ability to look up vehicles by VIN, Tag or the City Number. N/A - This question pertains to Part I. c) Ability to provide the City immediate contact upon the receipt of claims involving certain crteria to be established by the City. N/A - This question pertains to Part I. However. AnieriSys has the ability to provide bi-directional data feeds via secure FTP. 4. Ability to electronically send claim data to adjuster and nurse, no later than two hours after entry/receipt of claim, by any of the reporting methods outlined above. N A - This question pertains to Part I, Page 3U 5. Ability to provide automatic First Reports of Injury via e-mail, immediately after system entry to the City designated recipients. NIA - This question pertains to Part I. 6. Ability to customize the intake screen to automatically inform the interviewer of the location's physician panel or recommended injury clinic, so the interviewer can inform the caller (Note: The City may wish to contract separately with a Preferred Provider): N/A - This question pertains to Part I. a) Ability to automatically notify the City regarding reserve updates that breach the Administrator's reserve level. N/A - This question pertains to Part I. b) System that can accommodate the use of form letters composed with input from the City. AmeriSys would be able to add any letters from the City in our Cones System. c) Capabilities to provide various scheduled reports along with custom client -defined reports. AmeriSys has the capabilities to provide custom client -defined reports that can be scheduled at various times and delivered to designated users. d) Client access to create ad -hoc reports and standard reports. The CorrusiNet has the ability to share Ad -Hoc reports with the City once designed by our internal programmers. e) Ability to customize data fields as per the City requirements. N/A - This question pertains to Part I. 7. Describe your company's technology infrastructure for your company's first report system (claims intake, database management, application language, hardware, telephone, switch, etc.). With our proprietary software (Cones) and access to multiple provider networks, AmeriSys assists its customers in complying with the provision of Occupational Managed Care for both Certified and Non - Certified programs which includes medical bill review services as a part of the product service mix. This Windows -based and internet-friendly and internet-enabled program allows for secure, readily accessible information as well as easy transfer of data and information among other systems and platforms. It allows for real time access to notes, bill review information, scanned medical documentation and diary activity. The web portal is available to clients 24/7, which is built on a MS .NET platform and MS -SQL database. There is not a charge for access, and it does not require special software. Access is granted to clients based on authority level and permissions dictated by the client via user id/password. The web portal contains reports that be directly accessed by the client. The portal is a highly customizable application that was built to directly meet the needs of our clients and partners. Unlike, the 'out of the shelf' tools, our web portal allows for client flexibility. Access is granted to clients based on authority level and permissions dictated by the client via user ID/password. The web portal and our Corrus back -end system are fully integrated in real-time. The claim intake is done on the web portal and once finalized by our processing department, it is then immediately available in the system for the internal users. Hardware: AmeriSys partners with NEC for its telephony solution. The SVS 100 is a comprehensive NEC system which provides the necessary agility for today's ever -changing work environment. It enables USIS to tailor its communication needs to our specific business partners plus have total control over how, when and where you choose to be reached. This is a VOIP system with full redundancy built on the PBX as well as on the Voice Mail systems. In the event of a failure, USIS has the ability to fail over to one of our other redundant systems minimizing any down time. Our telecommunications vendors have a strong partnership which eliminates the need for USIS to deal with multiple vendors in the event of troubleshooting a problem. The SV8100 streamlines communication for the entire organization with its diverse suite of features and applications, It enables individuals, departments and locations to work more efficiently by ensuring seamless internal and external communications. PC Assistant — gives users the ability to manage and operate desktop phones from their PCs; and Softphones provide convenient, cost-effective mobility for remote employees. Our systems are secured both externally with multiple firewalls and internally with Kaspersky Antivirus and multiple layer security on all software. We operate with firewalls, routers and server banks at each of our locations that are integrated via MPLS and Metro Ethernet. Our equipment is constantly evaluated and upgraded or replaced as needed and we audit compliance with all software licensing agreements. Our systems operate in Windows platforms with relational databases in MS SQL and Sybase SQL. Page 82 3. EMPLOYEE/LOCAL OPERATIONS COMMUNICATIONS Excellent employee and customer communications regarding reporting and process requirements, rights under workers' compensation, and recommended primary care providers, are paramount to an effective claims management program for the City. Please demonstrate your company's ability to meet the following criteria, and detail how your company would meet the requirement, and any qualification or stipulation that applies to any response for the following: 1. An effective process and framework for communication supported by state of the art technology. AmeriSys has an open communication philosophy between our team members and clients as well as between our team members and Unit leaders. Our technology also plays a large part in the efficient flow of information throughout our organization. Our RMIS system and Medical Management system are integrated and allow for a diary process to manage the flow of a claim from intake through the closing of a claim. Information is communicated in a number of ways, including: system documentation (viewing access available on the CorrusiNet), phone calls, letters, faxes, diaries and e-mails. AmeriSys will provide weekly and/or monthly standard reports based on client criteria. Each Unit has at a minimum a weekly huddle to discuss issues that arise through the work week. The Leadership team lead by Ron Warble is in constant communication with each other to keep our programs working smoothly. The adjusters and nurse case manager will work together as a cohesive team which will allow for immediate discussions on issues that arise from the day to day handling of claims and communication with Risk Management. 2. A process to provide and disseminate to the City and its locations, claims reporting media (i.e. posters, telephone stickers, employee cards, etc.,) to best communicate how to report claims under varying circumstances [Would prefer one central number that would accept all types of the City claims]. N/A - This question pertains to Part I. 3. Production and delivery of statutory posters for each location (New locations and changes in preferred providers would require new communications) N/A - This question pertains to Pail I. 4. Introductory and at least annual continuous improvement meetings with the City coordinated by the designated adjusters AmeriSys will participate in the continuous improvement meetings with the City coordinated by the designated adjusters. i�,�,� g, 5. Please describe how your company would meet the above requirements, and provide an outline of your company's proposal for communications. The USIS/AmeriSys standard is that the adjuster and Telephonic Nurse Case Manager (TCM) is expected to have continual communication and interaction with the client and injured workers. Information is communicated in a number of ways, including: system documentation (viewing access available on the USISiNet / AmeriSysiNet), phone calls, letters, faxes, diaries and e- mails. USIS/AmeriSys will provide weekly and/or monthly standard reports based on client criteria through the USISiNet / AmeriSysiNet. Often with large volume accounts, there would be daily communication. Each of our customers has specific preferences for contact. It is our intent and approach to assure that we provide service, and therefore, communication consistent with your organization's needs and preferences. All staff members are trained extensively in our culture, policies and procedures, specific client requirements, utilization of the computer system and various software programs. Our overall philosophy is customer -centric and excellent customer service is trained and re-trained at all levels, The adjusters and TCMs are educated on client -specific policies and procedures to ensure constant communication with the client on all claims -related matters, as well as the USIS/AmeriSys Quality Assurance program and auditing requirements. They are fully familiar with any Return -to -Work policy and procedure emphasizing communication with the customer, and with the medical providers. to assist the injured employees in returning to work as quickly as possible. With a reputation borne of commitment to service, our competent team is dedicated to serving our customers. Our focus is on quality. professional, superior service. This service -driven philosophy, conveyed throughout the organization, means dedicated individuals with the client's best interests at heart, constantly reinforcing the corporate mission — Service Beyond The Contract. 6. Outline and provide samples of communication materials your company have that promote and facilitate injury management (i.e. posters, website etc.). N/A Refers to Part I. i',,g+2 84 4. CLAIMS MANAGEMENT The City requires a team approach for quickly establishing and executing an aggressive claims resolution and injury management strategy on each claim. Individual members and The City have roles in reporting and investigating injuries, communicating with employees, claimants, and supervisors, and in returning employees to work. The City expects the Successful Proposer to facilitate a relationship with the City's locations, contacts, and resources and to work with them as a team in the claims management process. The Successful Proposer should understand and subscribe to the City's commitment to best practices and continuous improvement. Please respond to the following requests for information, demonstrate your company's ability to meet the outlined criteria, detail how your company would meet the requirement, and any qualification or stipulation that applies to any response: 1. Provide a flowchart of your company's claims management process, indicating in detail, the flow of information, decision points, supervisor intervention, etc. for all lines of business outlined in Section One. US1S AmeriSys will develop, in consultation with the City. Claim Handling Requirements for workers' compensation claims assigned by the City to USISIAmeriSys. At a minimum, such requirements will include the Claim Handling Requirements set forth in the RFP. Once developed the requirements will be subject to revision and modification by the parties, provided that no such revisions or modifications are inconsistent with the Contract. Please reference the following Life of a Claim flow chart. Field Nurse Injury Occurs Reporl injury via Plena. websile, email or fax Claim Selup New Clam Owed ro rin usiers S Suoe,isor !Or. Handimg I Triage I Is Claim Medical Only. Loral Time. Large/Catastrophic? Medics; Only "Nurse TCM Assessment Closure Of File Medical Only Adjuster Receives New Set Ups 24-Hour Contact Investigation Compensabdily Determined File Reviews. Discussion and Disposition of Bills Closure Of File Field Nurse Lost Time 1 Nurse UR or Pieced Closure Of FJe 'Field Nurse will be assigned to claims based upon City triggers. "TCM will be assigned to claims based upon City triggers. LT Adj ster 24-Hour Canter Invesfigalimr Compensabilily Determined LargeCateslroots, Field Nurse Evaluation of Reserves— ' Adjuster 5 Supervisor File Reviews, Discussion. and Disposition of Bills Closure Of File Tri Nurse IUR er Precert I 1 Acfi,evement of Medical Stability Acrees needed for Continued FCM Involvement Access Rehabilitation Need Refer Io Vocational Rehab Counselor Drat Time Adjuster immediate Contact investiyatiGn COmfiensabdity Determined Evaluation of Reserves — Adjuster & Superssor Fie Reviews, Discussion, and Dispasitwn of Bills Addressing MMtiPIR =' t States. Life Care Plan. Cost Protection. Excess Updates and if applicable. Medicare Sel Aside i Cetera Of Fi Page: 85 2. Specifically detail the locations of your company's claim operations that would be handling the City claims, the number of employees in each office, the overall organizational structure of the office, and when the respective offices were established. Home Office City of Miami servicing office USIS, Inc. PO Box 616648 Orlando, FL 3 286 1 -6648 Prerioitsh• operated under United Self Insured Services. # of Employees: 88 Estahlished 1982 AmeriSys Office AmeriSys 140 Alexandria Blvd, Suite H Oviedo, FL 32765 :Medical Division of USIS, Inc. # of Employees: 30 Evtahlished 1985 - Merged 2000 USIS/AmeriSys management and claim technical teams are composed of high level, dynamic claim and medical professionals. These teams thoroughly understand the challenges related to the unique operational needs of individual clients. Our personnel includes a dynamic and experienced leadership and management team, experienced adjusters in All Lines of claims management, RN medical case -managers and other support professionals to promote efficient, timely and technically -sound claims and medical management. 3. Attach a map of your claims offices statewide, and list which offices handle what types of claims (workers' compensation or liability). Confirm if you have any plans to consolidate, reorganize, relocate any of these offices, or any personnel within these offices, to facilitate the administration of the City's claims. If so, please provide details to the extent they are known/available. AmeriSys does not intend to relocate any employees to facilitate administration of the City's claims. We may engage employees who live within the Miami area to work on this program and telecommute. It is USIS intention to handle Workers' Compensation claims out of our Home Office - Orlando and Liability claims out of our 1.akc I.Iary office Etna Otllce Workers' Compensation and Liability Claims Lake Mary Service Mee Liability Claims 4. Outline normal work hours and workdays, provide a list of your company's holidays, and discuss any optional/flexible work arrangements currently in use in your offices, or contemplated for administering the City's claims. Servicing Office — USIS/AmeriSys 5728 Major Blvd., Suite 450 — Orlando, Florida 32819 8-5 p.m. Monday to Friday for Customer Service Unit Nonnal business hours are 8-5 p.m. Monday to Friday. AmeriSys 2017 company holidays are listed below: New Year's Day (observed) Martin Luther King, Jr. Day Memorial Day Independence Day Labor Day Thanksgiving Christmas Day Telephonic Nurse Case Management weekend/holiday/evening coverage for emergencies will be maintained by a rotating on -call schedule. 5. Discuss your proposal for handling emergency issues during and/or after normal working hours, including identifying what personnel, by title, will be involved in those activities. 24/7 staffing — our claims management team is always available for consultation regarding emergency claim issues after hours. In a case of emergency, a field nurse ease -manager would be expedited to the hospital. Account -specific handling requirements are followed. Cheryl Gulasa, will be the Account Executive. She will be the City's main point of contact for Claims Reviews and Service Issues ensuring a high quality of service and support. 6. Provide an organizational chart of those persons who would be involved in providing claim services to the City, listing the experience and qualifications of the key individuals who would be involved in the account by title, and identify those specific individuals if they are currently with your organization. All key personnel includes all principals, owners, parties, directors, managers, senior and other professional staff who will perform work and or serves in the specific category of services (Part I & II). AmeriSys is a wholly owned subsidiary of Brown and Brown Insurance. Ron Warble is the Executive Vice President for USIS, Inc. dba AmeriSys. Ron Warble was the previous owner of AmeriSys prior to the Brown & Brown acquisition. Please reference Attachment I - Brown and Brown Annual Report for a complete list of officers and directors. Please reference the following Proposed Organizational Chart which would be for Part I and Part II if USIS/ AmeriSys were selected for both proposals. Mule 87 Proposed Organizational Chart RON WARBLE EXECUTIVE VICE PRESIDENT AneriSys * MICHELLE COTTO Accounting Manager JENNY ROSS Project Manager Intake and Processing Departments CHERYL GULASA, RN Vice President (Account Executive) Jen White, RN Program Manager/ Supervisor (2) Telephonic Case Manager TBD Amy Krietemeyer Field Nurse Case Manager Supervisor FCM Subcontractors Logan Warble MBR Supervisor/ Analyst Medical Bill Review Dept. Eunice Romich Director of Provider Services Norma Torres MBR Quality Controller VIVIANE RUIZ Vice President of Business Integration IT Department Programmers and Developers I'it g 8 Management Experience for AmeriSys Ron Warble, Executive Vice President, Ext. 6503 ron.warblc cr usis-tpa.corn Mr. Warble serves as Executive Vice President of USIS and is responsible for oversight of claims.. medical management and overall operations within USIS. He has 33 years of experience in the Workers' Compensation arena. He previously owned and managed his own company which was acquired by USIS in April of 2000. That experience has allowed him to develop skills and expertise in many areas and is now being utilized to assist USIS' customers in providing quality and relevant programs on behalf of their injured employees. Additionally, Mr. Warble has had the honor and privilege to serve on the Georgia Chairman's Advisory Council for Workers' Compensation since 2008 and currently serves as the Chairman of the Medical Committee in that group. Chervl Gulasa, RN, CPHM, CCM, Vice President/AmeriSys, Ext. 6219 chery1.gulasa(ciusis- tpa.com Cheryl is currently the Vice President for AmeriSys. Her primary responsibilities include overseeing the professional operations of AmeriSys Telephonic Case Management, Field Case Management. Provider Relations and Utilization Management, including Bill Review. Cheryl has 30 years' experience in nursing, the last 14 years in workers' compensation case management and utilization management. She has successfully implemented large public entity programs. Cheryl's experience coupled with her energy and leadership skills brings valuable assets to our organization. Jen White, RN, CCM, Program Manager/Supervisor, 800.444.9098 Ext. 6567 ien.white( usis-tpa.com Jen is currently Program Manager for AmeriSys in Florida. Jen is a Registered Nurse and Certified Case Manager. She has extensive workers' compensation experience including supervisor roles in large public entity programs. Jen joined AmeriSys in 2012 and has successfully enhanced program efficiencies and productivity while preserving customer service and satisfaction. Prior to joining AmeriSys, Jen worked for an international all lines insurance company as a telephonic case-rnanager for workers' comp claims in the states of Florida, North Carolina, Tennessee, New York, Rhode Island, New Hampshire, Massachusetts and South Carolina handling large national corporate accounts. Jen has clinical experience in Rehabilitation, Orthopedics, Neurology. and Emergency Roorn; with over I0 years in Quality Assurance and leadership positions. Amv Krietenrever, RN, CCM, Field Case 1 Ianagenreut Supervisor anrv.krietemever i anierisys-info.eom Amy is the Supervisor over Field Case Management. As Supervisor she is responsible for overall technical and quality oversight of field case management services. Primary duties include planning and directing field case -management services. assisting in development of long range plans for the department, promoting staff education and development, meeting with current and prospective customers and clients as required, overseeing compliance with all governmental agencies as it relates to field case management services and day to day management of the field case -management departments. Amy also serves as a resource to all departments, assisting in the development of service proposals for prospective clients and certifying eases as catastrophic as indicated by state law and in- house procedures. Amy has over 24 years of nursing experience, 20 of which has been devoted to the Worker's Compensation industry. Page 89 Eunice Ronaich, RN, Director of Provider Services, Ext 3118 eunice,romich(a;amerisys-info.com Eunice is currently the Director of Provider Services at AmeriSys. Primary responsibilities include managing and coordinating issues involving provider networks utilized by AmeriSys, and educating and training case managers and staff regarding utilization, access, and grievances for network providers. Prior to this role, she was the telephonic case manager supervisor at AmeriSys. Eunice is also the Quality Assurance Coordinator and she ensures all medical management services are in compliance with statutory regulations, and the deliverance of quality care to all injured employees. She has 13 years of nursing experience, with the last 6 working in the workers' compensation field. Background nursing experience consists of cardiology, orthopedics, and surgery while working in both hospital setting and outpatient surgical setting institutions. Prior to joining AmeriSys in 2014, Eunice worked for an international all lines insurance company in Alpharetta, Georgia, as a telephonic case -manager for workers' comp claims in the states of Georgia and Alabama. Norma Torres, MBR Quality Controller, Ext. 3128 norma.torres(wamerysis-info.com Norma joined AmeriSys in 2008, bringing with her 20+ years' experience in Workers' Compensation Bill Review and Fee Schedule analysis. Her primary responsibilities include Bill Review Quality Assurance and Fee Schedule analysis. As a liaison between the IT and the Bill Review staff, Norma works with the IT department to ensure continual improvements to the quality of the bill review system, actively participating in the implementation of WC Fee Schedule update changes and in the training of Bill Review staff and customers. Prior to AmeriSys, Norma worked as a Fee Schedule Business Analyst responsible for Workers' Compensation Fee Schedule implementation and analysis for 15 jurisdictions including Liability: working directly with developers and State representatives. Norma offers a wealth of knowledge to our Bill Review program ensuring excellent outcomes and reductions for our customers. Logan Warble, Bill Review Supervisor/Analyst, Ext. 6561 logan.vv arbleiii amerisys-info.com Logan is the Bill Review Supervisor. His primary responsibilities include managing and coordinating bill review stafff, process improvement, and troubleshooting customer and provider issues. In Logan's previous leadership role, he served as department manager with a 55 member staff. His experience and skill set in analytics and performance irnprovement includes production, quality, and outcomes. He is a Pre-Med graduate of UCF and has obtained a certification in Lean Six Sigma process improvement methodology. Logan's leadership experience, client -centered interpersonal skills, and data -driven process improvement mentality are valuable, and even critical components for a successful bill review program. Viviane Ruiz, MBA, MIS/HIS, Vice President of Business Integration, Ext. 3109 viviane.ruiz(usis-tya.com Viviane Ruiz joined the Brown & Brown team in 2007 and is the Vice President of Business Integration for USIS. She is responsible for an IT staff of web developers, system analysts, database administrators, network administrators, technicians, and computer operators. Viviane has exceptional skills in Project Management and is an excellent liaison between the IS staff and the business staff. She takes pride in meeting deadlines and sets a high priority on quality of work. Viviane is responsible for maintaining current systems, and ensuring the implementation of all state and medical rules guidelines, as well as leading new initiatives and keeping USIS/AmeriSys on the cutting edge of technology. Viviane has a Bachelor's Degree in Computer Information Systems, a Master's Degree in Business Administration, and a Master's Degree in Information Systems with concentration in Health Infonnation Technology. Prior to USIS, Viviane had nine years of experience teaching Information Systems as well as business courses for undergraduate and graduate students. She is fluent in Portuguese and Spanish. Page 90 Michelle Cotto, Accounting Manager, Ext. 6213 michelle.cotto(a usis-ttra.com Michelle Cotto obtained a Bachelor of Science degree in Accounting from the University of Central Florida in 2007 and has been with USIS for 7 years. Responsibilities include Sarbanes-Oxley oversight for Accounting and IT environments, oversight of internal controls (SSAE 16), excess reimbursement filing, and interface with excess carrier representatives and auditors. Ms. Cotto's duties at USIS extend beyond accounting; she also leads a team dedicated to quality control and oversees the performance audit of each adjuster. Her department is also charged with the responsibility of maintaining bank accounts for each customer and securing funding from the customers for timely claim payments. 7. Describe your structural approach to claim services (i.e. dedicated unit, supervisor and unit manager, whether one adjuster will be assigned for the life of the claim or will the claim transition as the status changes). USIS proposes to provide a dedicated unit with (1) Work Comp Supervisor and (6) Work Comp Adjusters (5 Lost Time 1 Medical Only. The Work Comp Adjusters will be assigned for the life of the claim during the contract. The Liability Unit will have (1) working Supervisor and (2) Liability Adjusters. The designated Unit Manager will also manage other USIS Florida clients. The designated AmeriSys Medical Management Unit will consist of (1) Nurse Case Manager Supervisor, (2) Telephonic Nurse Case Managers, (1) Field Case Manager Supervisor, and Field Case Managers who will be assigned to the City of Miami. Medical Bill Review Department has (1) Supervisor, (1) MBR Quality Controller, 11 Medical Bill Review Specialists and support staff. 8. Provide the average caseload for your adjusters by line of business. a) Specify the caseload by BI/PD/Indemnity, Medical Only, and Record Only claims;. The AmeriSys Telephonic Nurse Case Manager average caseloads is 72 with a maximum caseload of 80 files. b) Explain how the caseloads are monitored, noting the frequency with which managers review each level and/or category of claim; The supervisor reviews new claims on a daily basis as the FNOI are received and ensures that they are assigned to the appropriate case manager based on the type of claim current caseload distribution and acuity of the claim Overall caseload totals and acuity are reviewed on a weekly basis for total number of files and types for each case manager and any adjustments needed are completed at that time More in depth file reviews and audits are completed on a monthly basis to ensure that the caseloads and acuity levels for each case manager are maintained at an appropriate level. Files are also reviewed by the supervisor at any time needed at the request of adjuster. employer, case manager should an issue arise to ensure that the appropriate case manager is assigned to the tile c) State the average number of new claim assignments per adjuster per week/month; and AmeriSys averages 10- 1 2 new tiles opened per Telephonic Case Manager per month. We also recognize that the number of new monthly assignments is directly affected by the number and type of newly reported injuries each month. Page 91 d) Provide statistics on your closing ratio and closing lag; N/A - This question pertains to Part I. 9. Provide the average number of cases your supervisors adjust personally. N/A - This question pertains to Part 1. 10. Provide your current and average adjuster turnover ratio by level of examiner. USIS hires well recommended, customer service -orientated individuals looking for long term commitments. We run background checks as part of our oversight to ensure the security of our clients' finances. Our policies and procedures focus on quality, professional, superior service; with numerous controls and safeguards in place to ensure compliance with State rules and regulations, client procedures and Sarbanes-Oxley standards. Our turnover in our claims operation is historically very minimal. Employees like working here! USIS/AmeriSys turnover for the past three years: 2013 — 17.83% 2014 — 26.36% 2015 — 21.76% USIS historically averaged turnover in the single digit range. Two factors are driving the increased turnover in the past three years. First, due to the large number of long term employees USES has had many retirements. Second, USIS/AmeriSys was awarded the State of Florida Medical Management contract and hired approximately hire 70 employees in a short period of time. A large part of our turnover in 2014-2015 has come from turnover on this account - approximately 5% relocation out of state; about 5% personal family issues; some had advancement opportunities that were not available with us in that short period of time, and some were not able to support our high standards and culture of excellent customer service and work ethic. The core group of initial new hires is still with us and exceling. The State of Florida is extremely satisfied with our work and we have maintained at 98% or higher score on the monthly performance standards every single month since January 2014. The Management/Supervisory team (30) has been with USIS an average of 13 years. The Management team (11) has been with USIS an average of 17.6 years. 11. Explain the career path provided for examiners. N/A - This question pertains to Part I. 12. Provide your current supervisor to adjuster ratio. Outline your protocol for supervisor involvement, including fixed diary requirements. Program Manager/Supervisor to Telephonic Nurse Case Managers = 1:7. Supervisor diary reviews: Diaries are set for supervisor review one week after the file has been activated to case management to ensure file has been appropriately activated. Supervisor will then set follow up diary on the file based on file acuity, status and red flags for either 30 or 60 days. All files that are inactivated to case management have diary set for supervisor to ensure that file is appropriate to be inactivated and that all items have been appropriate addressed and closed out. All files are reviewed by supervisor or designee after the 2nd and 3rd opioid fill notification from the pharmacy to ensure that medication management plan is in place on the file Page 92 13. Provide the average years of experience by position. Position Average Years of Experience Program/Manager Supervisor 10+ years Telephonic Nurse Case Manager 12+ years Medical Bill Review Staff 10+ years 14. Outline education and experience requirements by position. Position Telephonic Case -Manager Experience Requirements by Position 3-5 years clinical experience (medical - surgical, orthopedic, neurological, ICCU, industrial or occupational.) Please reference Attachment 6 — Job Descriptions. 15. Outline adjuster diary schedule and requirements. N/A - This question pertains to Part 1. 16. Outline ongoing training and development programs. AmeriSys employs nurses who will provide the telephonic case management services; experienced at hire to include three to five years (five to seven years for the City of Miami) in areas of Workers' Compensation, occupational health and/or neuromuscular/orthopedic medicine. All persons involved in the case management process will be trained in the statutes, rules, principles and standards pertaining to their job description. This training will occur prior to the staff assuming their assigned rotes and responsibilities. This will include but is not limited to training related to: • Confidentiality and the signing of the Confidentiality statement • Utilization Management and the Quality Assurance Manual • Grievance procedures and time frames associated with this process • Satisfaction surveys • Monthly education is provided in related areas and the policy and procedure manual will be reviewed with each person responsible for this activity annually. Education sessions are recorded and reported at the quarterly QA meetings. Our orientation program consists of an educational approach with the case -manager building on his/her current strengths while he/she is familiarized with the policies procedures and protocols of the account to which they will be assigned. We provide in-house CEU classes on a variety of topics for our Nurse Case Managers. We generally offer 3 to 5 classes per month on law, ethics. fraud. medical terminology. etc. Classes are Given by providers, physicians, specialty vendors and attorneys. Some examples of recent training classes include: Page 93 • Insurance fraud • Knee injuries • Medicare Set Asides • Limiting PTD claims • Shoulder injuries • Case law issues and updates • Brain injuries • Changes to 440 rules • Vocational assessments • Adjuster ethics • Ethical issues of surveillance • MRSA (Methicillin Resistant Staphylococcus Aureus) • Pain management • Dental trauma 17. The City requests that your company's adjusters participate in periodic meetings with the City. Indicate your company's agreement. AmeriSys will be available for meetings when requested. 18. The City also requires quarterly loss reviews and periodic claim reviews on categories to be identified by the City. Indicate your company's agreement to these requests and provide any additional charge for these reviews. AmeriSys will be available for loss reviews when requested. 19. The City requires dedicated/designated adjusters with a minimum of three (3) years' experience directed by a supervisor with at least five (5) years' experience. Indicate your company's agreement. N/A - This question pertains to Part I. 20. Provide information and documentation regarding your company's current training program, available to your adjusters to further develop their knowledge base and adjusting skills. Specify what annual requirements your company has for continuing education beyond that required for the maintenance of their licenses. Our orientation program consists of an educational approach with the case -manager building on his/her cun.ent strengths while he/she is familiarized with the policies procedures and protocols of the account to which they will be assigned. We provide in-house CEU classes on a variety of topics for our Nurse Case Managers. We generally offer 3 to 5 classes per month on law, ethics, fraud, medical terminology, etc. Classes are given by providers, physicians, specialty vendors and attorneys. Some examples of recent training classes include: • Insurance fraud • Knee injuries • Medicare Set Asides • Limiting PTD claims • Shoulder injuries • Case law issues and updates Page 94 • Brain injuries • Changes to 440 rules • Vocational assessments • Adjuster ethics • Ethical issues of surveillance • MRSA (Methicillin Resistant Staphylococcus Aureus) • Pain management • Dental trauma AmeriSys provides all the above training for Nurse Case Managers to maintain their licenses. Training is also provided to educated the nurses on current industry trends i.e., Zika, Opioid epidemic etc. 21. Confirm your company's agreement to provide the company's claims staff to present and participate at claims workshops, and on -site injury management training throughout the year. AmeriSys agrees to provide staff to present and participate at claims workshops, and on -site injury management training throughout the year. 22, The City may request that your company hire specified adjusters who are currently handling their claims. The City will need your company's written agreement that the City and/or any subsequent claims administrator, will also have the option to hire your company's adjusters at the termination of the agreement. Please provide your company's agreement. N/A - This question pertains to Part 1. 23. Commit that your company's employees, including but not limited to, the adjusters, will return all phone calls within twenty-four (24) hours. AmeriSys agrees that employees will return all phone calls within twenty-four (24) hours. 24. Agree that your company's adjusters will initiate three (3)-point contact within twenty- four (24) hours. Describe how your company currently monitors compliance, and how that monitoring will be done to assure compliance to this standard on an ongoing basis. Provide an example of a management report that measures this requirement. N/A - This question pertains to Part I. 25, Provide your company's definition of a BI/Indemnity case and Medical Only case. Detail how, and when, a Medical Only claim would escalate to an Indemnity case, and any fast track claims handling alternatives. Once a claim escalates from a Medical only to an Indemnity claim, advise how the City is able to see, and track the change. N'A - This question pertains to Part I. 26. Describe the current subrogation process. Provide sample reports of how your company monitors subrogation/SITF activity and recovery. N/A - This question pertains to Part I. 27. Describe your company's current process for identifying claims having fraud potential, including your company's process for referring those claims for investigation. Describe the parameters of that investigatory process. Describe how these claims and their related Pagc ,�; investigations are monitored, the parameters, and any proposed changes to that process for monitoring this activity and its performance. N• A - This question pertains to Part I. 28. Describe your company's quality assurance policy and procedures, Provide copies of your company's current policy. Include: a) Internal Quality Control processes and current reporting designed to monitor Quality b) System prompts requiring supervisor attention c) Criteria for supervisor intervention related to QA deficiencies d) Criteria for measuring adjuster performance e) Discuss reports addressing Quality issues and proposals for improvement AmeriSys has an established UR/QA proLgrain that exceeds national guidelines! standards. A QA work plan is developed in the fourth quarter of each year to address the scopes of practice to be addressed the following year. The QA committee reviews and approves the plan prior to its initiation. At the end of the year a report is compiled to document the results of the plan, Please reference Attachment 7 — Policies and Procedures WC 1 - WC 15a. 29. Please provide a copy of your company's claim handling practices (Best Practices). These Best Practices should at a minimum, include your company's standards on: a) Initial Contact (3-point on WC and Auto); b) Recorded statements, including scripts that have been designed for various types of statements to be taken; c) Claim Investigation; d) Scene Investigation; e) Follow-up Contact, including requirements for all parties; f) Diary requirements and requirements for the completion of claim strategy/action/resolution plans; g) SITF/Subrogation; h) Indexing; i) Reserving practices; j) Explain your reserving philosophy, policies, and practice. (Le. ultimate probable exposure v. worst case); k) Outline the specific deadlines applicable to appropriate reserving; I) Describe any reserving software or modules that are used; m) Describe how you identify and report reserving performance and overall trends; n) Confirm if reserves are set on Medical -only files; o) Outline your company's controls to achieve consistent and appropriate reserving among various adjusters. Describe how your company's monitor reserving performance and overall reserving trends; p) Medical Management; q) Pre-Settlement/Settlement procedures; r) Confirm your company's agreement to obtain settlement authority prior to any settlement; s) Confirm your company's agreement to provide the City with a reserve advisory/consult on all claims that have a reserve set at $25,000 or greater or are changed/increased by $25,000 or greater and category claims with quarterly updates; t) Confirm your company's agreement to submit the proper filings to all required states on the City's behalf; u) Confirm your company's willingness to allow the City to select and/or approve defense counsel; v) Confirm your company's agreement to allow audits by the City or consultants with Page 96 appropriate notice. Outline your company's audit protocol; w) Confirm your company's willingness to provide regular stewardship/report cards to the City measuring your company's performance on their services and outcomes of their services. Provide a sample stewardship report; x) Confirm your company's agreement to adhere to the City's Client Service Instructions, and to adhere to your company's claim handling Best Practices with the City's Client Services Instructions, taking a primary position to any of your best practices; Please reference Attachment 7 —Policies & Procedures. 5. LITIGATION MANAGEMENT 1. Confirm your company's agreement to notify the City of all legal dates including hearings, trial dates, settlement conferences, deposition, etc. with enough advance notice to allow attendance if desired. N A - This question pertains to Part I. 2. Confirm your company's agreement to maintain a litigation calendar to ensure all deadlines are met. N A - This question pertains to Part I. 3. Identify whether your company's claims handling system can generate alerts to internal and external persons related to specific deadlines. NIA - This question pertains to Part I. 4. Describe and provide examples of the periodic status reports your company will provide to the City online/via e-mail. N'A - This question pertains to Part I. 5. Describe your company's internal process for the oversight of major claims, identifying by whom such claims will be overseen. N'A - This question pertains to Part I. 6. Provide several Plans of Action (POA) examples, noting specific action -oriented goals. NIA - This question pertains to Part I. P;ig 97 6. CLAIMS MANAGEMENT AND MANAGED CARE SERVICES The City believes management of the medical component is key to returning employees back to work and facilitation of WC claim resolution. The City has the following expectations relating to medical: 1) a provider who actively and aggressively manages medical; 2) a network of physicians specializing in Return to Work; and 3) a claims management team approach whereby the team understands and works as partners in the RTW/Transitional-duty efforts. The City is very interested in the Successful Proposer's philosophy on utilization of TCM & FCM within their claims management model, with the understanding that The City may elect to use a separate managed care vendor. USIS/AmeriSys has an integrated approach to claims management which involves Telephonic Case Management, when required, as well as integration of the cost containment components of the program. AmeriSys is the medical management division of USIS and the telephonic case - managers work alongside the claims adjusters. Systems are integrated allowing the sharing of case documentation between the adjuster, case -manager (when assigned) and cost containment. AmeriSys also has contracts with Physician/Hospital networks as well as Ancillary Providers (Physical Therapy, Diagnostics, Home Health. etc.). These providers are contracted not only for significant pricing reduction but also performance related to the speed of establishing appointments, supplying reports and other standards that impact the overall cost of the claim, including lost time days. We believe that the combination of aggressive claims handling, integration of cost containment and case management, preferred providers and strong experience dealing with public entities will positively impact the City of Miami's overall economic impact. The adjusters are well trained on when to recognize when a case is deteriorating and are instructed to control these claims as quickly as possible in any way we can in order to minimize litigation and lost time days and re-engage the injured worker and doctors. This may include use of Utilization Review and/or Independent Medical Examination or surveillance, if fraudulent activity is suspected. We may also consider use of tasking a RN Field Case -Manager to attend an appointment or conference with the doctor to question the treatment plan if applicable; this would be subject to City approval. Keeping in constant contact with the injured worker and employer is an extremely important part of adjusting and is strongly encouraged. USIS routinely works with physicians, employers. and injured employees to identify barriers that prevent an individual from returning to work. Once the barriers are identified, a plan is then formulated in conjunction with the employer, physician and injured employee, to facilitate removal of the barrier, return the employee to work and thus resolve the case. Our system, allows us the ability to accurately track the Return -to -Work milestones based on the Official Disability Guidelines. This includes the release to full duty. restricted duty, and the employers' ability to accommodate the injured employee's restrictions. Catastrophic or large losses seldom occur but when they do they have a chilling impact on claims expense. Our experience with the construction industry and other industries has well acquainted us with serious claims involving traumatic brain injuries, spinal cord injuries, amputations and burns. These claims are complex from beginning to end. Rapid response in claims investigation, assignment of Catastrophic Case Management Providers and having a relationship with the facilities and providers likely to provide care for these claims is paramount to best outcomes. AmeriSys, our medical management division, has relationships in place with facilities such as Page 98 Shepherd Center, ancillary providers for home health, durable medical equipment, as well as therapies that have been utilized many times on large and catastrophic claims bringing the City of Miami the experience, when necessary, to handle these claims efficiently and effectively. We recognize that when these injuries occur, they are to your employees, your neighbors and often friends. We address these claims to offer not just the best economic outcomes but the best functional outcomes while striving to maintain the highest degree of compassion and service to that employee and his/her family. Recommendations for Assignments of Telephonic Nurse Case Management Upon receipt of the First Report of Injury, the claims adjuster reviews the nature and cause of the injury to determine the necessity for further intervention. At the direction of the claims adjuster (per client protocols), a referral for case management is initiated. Serious injuries will be assigned for telephonic case management immediately. The goal of early intervention is to provide aggressive case management with a focus on early return to work. The medical case -manager within the first 24 hours will make contact with the injured worker and complete an assessment of the initial medical treatment: evaluation of the treatment plan and assess the need for continued medical case management. If specific tasks need to be completed to assist the claims adjuster with the handling of the file, these can also be assigned. Telephonic case management is the systematic evaluation of medical services, procedures, facilities for medical necessity, appropriateness and efficiency. This promotes optimal patient outcomes, reduce period of disability and assure high quality of care while controlling costs. A nurse facilitates the medical activity on a tile with the ability to individualize the plan of care and coordinate early return -to -work strategy with the employer and medical provider. The functions included • Coordination and referral to network medical providers • Coordination of the treatment plan with the provider • Working with the provider to establish functional abilities and conditional release to return to work • Discussion with the injured worker to clarify the worker's understanding of the diagnosis and treatment plan • Monitor the treatment compliance of the injured employee • identify and assist in the resolution of problems with compliance to the treatment plan • Provide regular reports to the claims handler- to assist them in the management of the claim • Recommend on -site case management and vocational services when needed • Work with the employer to identify a medically appropriate job Coordination and referral to network medical providers allows for the best network penetration. The channeling of the network providers will allow for the best network discounts. The Telephonic Case -Manager acts as the center point of contact ensuring delivery and communication to all approved providers of PBM and appropriate parties, forwarding appropriate issues to the utilization review department as necessary and reporting outcomes to the AmeriSys Quality Assurance Committee. Adjuster Dragnost!cs Physical Therapy Home Health Ilse Management Emproyer Intured Em„poyee Medical Case -Manager Case Management Plan - Assess Needs - Develop Plan - Implement Plan Items - Monitor Progress - Evaluate Outcomes - Re -Evaluate Plan ME Pharmacy Transportaticn B Languages A`P iArrenderg Treating Physician' Vocational and Field Case Management CAT Supplier Utilization Review Prospective iPreCerll Concurrent Retrospective We understand that it is imperative for both employee and customer satisfaction; we communicate promptly, which includes facilitating care and appointments properly. Prompt, accurate and complete communications are performance standards and measurements for our case management team. Page 100 Recommendation for Assignments of Field Case Management I. All catastrophic injuries, such as, but not limited to: • Spinal cord injuries • Head injuries 2. Neck injuries (except for minor strains) • Bums of face, hands or greater than 9% of the body • Amputations • Loss of hearing • Electrical shock • Multiple fractures 3. Any potential serious back injury: • Failed back syndrome • Multiple fractures in the back • Herniated disc with radiculopathy • Positive neurological findings • Any back injury with any degree of paralysis 4. Chronic Pain Cases S. Claims with high potential for PT rating including, but not limited to: • Fractures in or near major joints or weight -bearing body parts • Crush injuries • Hand injuries, particularly of the dominant hand 6. injured employees with a previous history of workers' compensation injury or injuries. 7. Difficult pre-existing medical or social problems • Diabetes • Heart disease • Psychiatric problems • Illiteracy • Mental retardation • Alcoholism and/or chemical dependency • Morbid obesity S. Cases not fitting an expected recovery time frame: • Not responding to provided care • Time delays in getting appointments • Irregular appointment attendance • Disagreement with the course of treatment • Questionable or experimental treatment recommendations 9. Injured employees who are approaching 60 days without returning to work. The need for Re-employment Assessments is decided on a case -by -case basis. 10. Need for extended home care. 11. Hospital discharging requiring planning for home health and/or durable medical equipment, 12. Location or communications barriers. (Injured employees in small rural areas a ith limited local facilities, or with language barriers who know limited or no English) 13. All new claims with an initial reserve established of S50,000 or greater. Please outline and discuss the following: 1. Organization and work/flow process for the provision of medical management care services including: a) Process of notification from reporting center; Upon receipt of the First Report of Injury, the claims adjuster reviews the nature and cause of the injury to determine the necessity for further intervention. At the direction of the claims adjuster, a referral for case management is initiated and approved by the City. Serious injuries will be assigned for telephonic case management immediately, The goal of early intervention is to provide aggressive case management with a focus on early return to work. The medical case -manager within the first 24 hours will make contact with the injured worker and complete an assessment of the initial medical treatment; evaluation of the treatment plan and assess the need for continued medical case management. If specific tasks need to be cornpleted to assist the claims adjuster with the handling of the tile, these can also be assigned. b) Decision points for intervention; Early Intervention - The goal of early intervention is to provide aggressive case management with a focus on early return to work. The medical case manager upon assignment by the adjuster will within the first 24 hours of a reported injury conduct a 3 or 4-point contact. An assessment of the initial medical treatment: evaluation of the treatment plan and the need for continued medical case management will be evaluated. This is the first step in the aggressive return to work coordination. A Telephonic Nurse Case -Manager will be utilized based on the approval criteria set by the City of Miami and USIS/AmeriSys. The Telephonic Nurse Case -Manager would provide Quality Care in a Cost Effective Manner focusing on early Return -to -Work. During the transitional phase USIS/AmeriSys will develop protocols with the Risk Management staff that would trigger triage and nurse case management. Early Intervention Criteria: • Severe lacerations, especially tendons and muscles • Server eye injuries • Back injuries with anticipated lost time exceeding statutory waiting period • Knee injuries with anticipated lost time exceeding statutory waiting period • Cumulative trauma (including carpal tunnel syndrome and tendonitis) • Concussion, severe head injuries • Chemical inhalation/poisoning • Severe sprains, strains (major body area such as ankle, shoulder or wrist) • Dislocations (major body area such as ankle. shoulder, wrist) • Rotator cuff injuries • Second/third degree burns not considered catastrophic • Injuries involving immediate inpatient hospitalization • Psychological claims/stress claims • History of protracted recovery from prior Indies or illnesses • Repeater claimants if prior claims involved the same body part and same or similar type of injury Page 102 • Any type of injury with lost time exceeding statutory waiting period • Cases with multiple providers • Crush injuries • Fractures • Amputations Aggressive Return to Work Coordination An early return to work alter an illness or injury benefits a patient: physically, psychologically, financially, and socially, preserves a skilled and stable workforce for the employer. c) Frequency and duration of case manager intervention; The frequency and duration of case manager intervention will be based upon the City of Miami and AmeriSys agreed upon criteria. d) Decision points and process reflecting integration of pre -certification and utilization review with the case management process; Utilization Review Utilization review is the evaluation of appropriateness in terms of both the level and the quality of health care and health services provided a patient. UR is based solely on medically accepted standards. Utilization file review is the 1 urac cornerstone of identifying potential quality assurance issues. Prospective, Concurrent and Retrospective reviews can be conducted. ACCREDITED . rk.rs'Cuu1Nt"wc Ongoing utilization review throughout the process of adjusting health care billings is required to identify issues and initiate corrective action as early as possible. I."•nlriatrrrr 41,mugvtnerev F%rire.n4 fi! 201 Prospective Utilization Review This review is conducted prior to the delivery of the services requested. Prospective reviews may be for inpatient or outpatient services. Prospective review facilitates the prompt timely authorization of prescribed services and the documentation of authorized services which must be recorded in a consistent manner. Pre -Certification of Procedures Pre -certification is the timely authorization of medical/surgical services before treatment is rendered based on established third party guidelines, practice parameters and accepted standards in the medical community. An experienced nurse specialist completes all reviews and utilizes peer review physicians when the decision to certify cannot be made. Page 103 Pre -certification services address. • Appropriateness of setting (inpatient versus outpatient) j • Appropriateness of surgical procedure, or treatment tarescribed 'agnostic stu 0 • Appropriate length of stay or treatment pre -certification services \ Pre -certification of hospital admissions 410• Reduce unnecessary hospitalizations J . Reduce the length of stay (especially where per diem reimbursement is established for hospitals) • Foster a shift from inpatient to outpatient care • Provide a mechanism for timely identification of patients who require discharge planning and case management A properly licensed nurse will obtain the demographic data and relevant information to the clinical conditions to be treated and procedures to be performed from the provider. The nurse reviewer will consult acceptable established guidelines - established and accepted Practice Parameters such as McKesson's InterQual, or the Length of Stay by Region. It' the data provided meets these criteria the request for service will be determined as medically necessary. If the data does not meet the criteria, the request is referred to our medical director or a physician advisor for a. determination. All parties are notified of decisions by telephone, fax or mail and the carrier is kept informed at all steps. ConcurrentReview for Continued Stay or Services Concurrent review is a review of the clinical information and coordination, assessment, planning and follow-up procedures during the course or treatment to determine medical necessity. This review is performed while the injured employee is still hospitalized and or services are being provided. Concurrent review also occurs with the request for additional physical medicine. If the data does not meet the criteria, the request is referred to the USIS/AmeriSys medical director or physician advisor. The medical director will review all available data from the provider and review the established criteria and may contact the attending physician requesting the services. The medical director may consult a peer physician of the same specialty as the requesting provider for further investigation and decision on the service. All parties are notified of decisions by telephone, fax or mail. Page 104 Retrospective Utilization Review This review is performed after the requested service or procedure has already occurred. This includes random and focused reviews, which are quantified and evaluated by senior staff and or physician advisors. Problems identified from these reviews are addressed through an action plan in-house or with the provider. Utilization review is also conducted on medical billings to identify over -utilization of a particular service as well as review of multiple surgical procedures, questionable CPT coding, review of related to level of service, relatedness, as well as all Hospital billings over a pre -determined dollar amount. All Retrospective reviews are conducted by a Registered Nurse. Medical and hospital hill audit USIS/AmeriSys services are a combination of automation with manual oversight and verifications. Manual reviews are performed on multiple surgical billings and hospital bills over $5000 by an Utilization Review Nurse Specialist prior to entry. Bills are also reviewed against pre -determined criteria, which indicate that a more in-depth review is indicated. These criteria include: • Hospital bills which indicate inpatient stays for procedures normally performed on an outpatient basis • Hospital bills with lengths of stay which exceed the 50th percentile of the normal length of stay • Hospital bills which show multiple diagnostic tests or diagnostic tests not usually related to the injury • Hospital bills which contain unidentified detail charges • Hospital bills which contain duplicate charges, data entry errors, or unidentified charges posted after the discharge date • Hospital bills which note unrelated diagnosis or procedures on the UR-04 • Provider bills which meet the indicators of potential abuse (double billing, common referrals, cross billing, fragmented billing, missing modifiers, over -charging, over - itemization, over -prescribing, overutilization, prolonged follow-up, self -referrals, services not rendered, substandard care, or upcoding) • Provider bills which indicate more than two modalities of therapy per visit • Provider bills which show an excessive number of diagnoses for the same condition/injury • Provider bills accompanied by narratives which do not meet CPT guidelines, or appear to be duplicates or computer -generated • Provider bills which show an excessive amount of surgical or other supplies of medications Unbundling The UR Nurse Specialist identifies procedure codes that are individually billed that are included or should be billed using a single procedure code. The codes are verified if they are included in other CPT codes and should not be billed separately. This procedure is consistent with outpatient, surgical, laboratory and diagnostic procedures. If additional documentation is needed it is requested. Page 105 Peer Review Peer review is a process where a physician evaluates an individual physician's medical treatment of at least one patient in order to assess the quality of care provided by that physician. This will include documentation of care (medical audit), diagnostic steps used, conclusions reached, therapy given, appropriateness of utilization and reasonableness of charges claims. A specialized nurse will conduct a preliminary file review to assess appropriateness/cost-effectiveness of peer review service. Files may be reviewed for: Appropriateness Availability Timeliness Effectiveness Continuity • relevance to clinical need issues of under -utilization or over -utilization • most beneficial or necessary timeframes • achievement of expected outcomes • coordination across the care continuum The RN will obtain any missing medical records, prepare questions/issues to be addressed and coordinate referral to an independent, specially -matched physician. The physician, acting as advisor to the RN, will decide upon the questions and issues arising from the chart review. The Peer physician will review all available medical records and will provide an unbiased, constructive opinion of all medical activity documented on the case. The Peer physician may contact the provider for further information, clarification or discussion of the case. A detailed written report will be prepared to include specific reasons supporting conclusions reached and suggested approaches to corrective action. e) Processes for bill review, approval and payment detailed in flowchart; Upon receipt of paper billings, the bills, along with any corresponding documentation, are scanned and attached to individual claimant files within the COITUS system. Medical bills may also be submitted electronically via HIPAA compliant X 1? 5010 standard files. A bill record is then created corresponding to the scanned/imported document/bill. Simultaneously the adjuster is diaried as to the presence of the bill for electronic review and approval. After approval by the adjuster, the bill record, along with scanned document/bill, is transferred to a user bill list for the bill reviewer to examine and prompt the system adjudication to apply fee schedule limitations/rulings and MRA. As the adjudication system validates data, the bill review analyst must respond to any "Review Messages" prior to finalizing the bill. During this process the bill review staff will also be alerted to any reimbursement issues identified from the adjuster review via Corrus notes that are accessible by all parties involved with the claim. The Corrus database maintains a complete history of all medical bill processing including the payment information and EDI results. The data stored within our database includes original Page rli6 bill data as entered, plus scanned copies of the documents: vendor information; reduction information and EOBR codes assigned; allowed codes and amounts; payment date, amount and check number: all dates relevant to receipt, processing and external transmission: EOBR comments from the bill reviewers; EDI control numbers and status. Please reference the Medical Bill Review Flow Chart below. We recognize that each client has unique needs, requirements and expectations. The utilization of USIS services will be tailored to the City of Miami's individual needs, expectations and requirements. Medical Bill Review Flow Chart Incoming Mail Electronic Baling from PBM and Ancrllanes Receivereview. index and can medical bills and attached documents Bdlsedocuments attached as P©F copies le Corms system fife Bill Review (adjudication process Is completed) EOB is created automatically and he with adached documents pending authorization by adjuster Wog period of 24-48 hours pending OM approval try Adjuster. Aging report is auto generated r Medical Bill Review for clean non-complex bills Bill Review RN reviews Surgical, Hospital. ASC and UR considerations and Adjuster Requests luster is notified e the need for WI approval through mutually agreed protocols Review and approve brats an diary within 24-48 hours Quality checking process by second reviewer and series of Corrus reports $71 a approspd BSI is questioned Bill Review is notified and BR Manager may be diaried far further review 0 Automatic Process Manual Process 11 Claims El Cost Containment Page l07 Cost Containment Analytics are also performed by an internal tool that allows USIS to view the historical trends by provider type, claimant demographics, billing codes; or zoom in on a particular claim. It also allows us to review claim outcomes for over/under utilization or possible duplicates and to break out trends or review a particular claim by diagnosis or procedure codes. .y hum Con Anayac Vierer 19L0.0371- €Adhac Cube Qua yi Cub. Andras. em,rg,:rmn %Soda. About '' 5 -oil Dad nerd m she P,vo15nd novae at SO ,9:a Cex and ai Dateid Seen COX Rd rear ,was. 10,06 bebeeee dew 5lipn: { Foes Sea 7 [o wn ,Yea LL fear E Rar Area tither Defer Loyaut lbdaae F Cato Mea Clod Cara Mee Toni abMeB 7otaI ... 3 ',',ear - Caoor>a b Come Cott 84y 7atel '600aed Totd ap 66 said -Cn+*: 3:ra'o;ai cowed'vss f7e'pressen 28 325,779.99 307.990.31 1.896.35 29 •k6,262,42 C,d•24,6 ',.., beed. .. 359 5,04,961.11 2,562,367.69 3,144.01 325 4,427,530.72 2,©66.'7::,: hear: irtaewe 112 3,496,770.16 1,403,554.85 7.7152.99 121 1, 264,906.67 770,05 YP Neriveaan 1,554 12,392,362.12 6,117,509.02 2,292.06 1,112 10,001,395.66 4,771,37',.: lrve7!]i9esfe _l 21 154,035.87 74,556.79 3, 106.53 25 229,437.27 B8,31=.io Wvtrd Ouorevs 13 23,319,20 17,433.% 792.45 10 96, 156.35 5,055.33 Nene 14,539 10-,066,441.23 50,192.17_3_12 292.75 13,551 105,135,3.14.61 52,296.601,50 Global, 229 2,213,312.20 1,033,63"0.39 2,312.78 231 2,367,596.53 1,091,96, Wei 150 672,002.19 316,934.23 1,015.31 90 797,407.17 358,31:3..,. Ptlennarr 13I 1,441,615.42 641,948.74 A297.40 111 1,291,934.71 SA'S.27 .-.-: 0.errd Oseese _ 50 2,703,296,07 1,530.145-12 7,-r6a,12 38 515,495.85 313,2.5 -' 1 Grand Toted 14,623 123,075.929,13 59,532,910.05 331.40 13,523 121,382,046.60 59,8 L3,79.. Page 108 For the calendar year 2015, USIS/AmeriSys was able to offer its customers savings achieved by a variety of medical management approaches. As an organization we were able to demonstrate in excess of $27,082,651 in case management savings. Case management savings is achieved in variety of ways including. but not limited to, fee negotiation, directing treatment into the ancillary provider network to benefit from contracted rates, the recognition of non-compensable body parts or treatments and reaching the Maximum Medical Improvement goals for the claim prior to the benchmarks set by the approved guidelines. urac ACCREDITED In addition to the case management savings we were able to document in excess of $9,534,227 in Utilization Review Savings by the identification of medically unnecessary procedures and/or procedures that are not causally related to the compensable injury. These reviews are done in compliance with the standards set forth by URAC and with the assistance of physician advisors in issuing non -certifications. There was an additional $5,823,500 in documented savings accomplished by returning the injured employee to work prior to the benchmarks set by the Official Disability Guidelines. Days saved are calculated in accordance with the injured employee's average weeklong wage. This also demonstrates the importance of a robust return -to -work program offering modified duty positions. In the processing of over 253,531 bills, the USIS/AmeriSys Bill Review Department in compliance with statute and rule, utilizing PPO networks, the skills of seasoned bill reviewers and utilization review nurses who specialize in retrospective bill review. reviewed total submitted charges of $215,386,620. We saved 55% on those submitted charges. The Fee Schedule Savings were 40% of that number with the remaining S32,529,040 resulting from our professional review and contracted savings. Our contracted savings average was 11.34% below Fee Schedule. All of this totaling more than $117,788,132 in documented savings collectively for our customer partners. U515/AmeriSys Actual Results Based On 2015 Bill Volume of 253,531 Total Billed Charges: $215,386,620 Total Savings $117,788,132 • Fee Schedule Savings ■ Other Professional Savings PPO Savings Below Fee Schedule • Total Allowed Page IQ9 f) Unique software and/or other knowledge resources utilized, and the value they add; Corrus is the primary Case Management and Bill Review/Cost Containment Information System at USIS. It is interactive with customer data imports and exports, and the extensive database provides the data for reports requested by a client. The application provides for detailed tracking of case notes, diaries, claim contacts, provider utilization and letters as well as a complete medical bill re -pricing system for efficient and effective adjudication of medical bills. Our computer system allows us to enter claim information based on dates of injury or occurrences and allows for multiple claims per claimant. Additionally. Risk Manager (ERIC) is used as the primary claims system at USIS. Corrus and ERIC are fully integrated systems which provide advanced claims handling capabilities in order to maximize technical efficiency. On a daily basis we exchange many different types of information with claim systems, ancillaries, and our customers, including EOBs, claims, invoices, and eligibility data via secured methods. Corrus and ERIC are synched via live data feeds. Adjusters primarily work out of ERIC for their daily functions. diaries, and case notes. The Cost Containment staff primarily works out of Corrus for the adjudication and review of bills. The authorization and/or denial of bills are done in Corrus by the adjusters and a business work Clow is built into the system to move the bill to the next step. Vendors have access to the review the status of bills via our provider portal. The portal currently has the ability to track and display the status of each step of a bill. The portal shows if a bill has been approved, adjudicated, sent for payment, under review, denied, EDI and more. This allows providers, at their convenience, to view the current status of their bills. This feature significantly reduces medical provider phone calls seeking information regarding their bill status. EOB Search Tool . ted&lit Lei e.r.a Fvderton Daito r a,a,xs JH.rsrereeadr eiasoea AmeriSys Provider EOB Search -a2:4CeleC d is :,'J'L 2 c as so.* 4eF 4a,a 67,==d. sic y ;awah...r ,. ,. harrier Tedeeeildi Raaerad Soma Fields ar•••a w Nose Lee a adt<d 23e r Ono Kobe' thete.r Seed erred. SeT Savor Due end Sr. tt DMe To male wear and urrrnt d eov>litrM. *Mt rnaeeo.ia4 lot iYr•ineYnra• Shonoradrre d+ecoma rum deeearaaadnt eV dada OM, She tide r ae ataae•Y vas Miaow aid"( 'ar mapraar a graft Wadttd Sere, Page 110 Cost Containment analytics are also performed by an internal tool that allows USES to view the historical trends by provider type, claimant demographics, billing codes, or zoom in on a particular claim. It also allows us to review claim outcomes for over/under utilization or possible duplicates and to break out trends or review a particular claim by diagnosis or procedure codes. „1 Ctwn Ca51 analysis Yuwer (43 as 371- [Adam Cube Query( Q Cabe A601 of Ca4✓6rpos.on W claw About 11s Jwi De0nun 10 the Mvotr„d S Ogle Ofseoece 88 Dete5ed 0atelst seem 83 DC6 Rd Yew C3a4 MAI between cress Wax: ?Fite, M6a ,",..71CaLeen Area Sae " '�POSTax Row Am Cw+vbditr l2•ftr 14bAF1 2. 54t4 Area Clam Court I21 36ed TOW 121 Maned lace Sae 1305 rer 3013 I. 2014 Ilan Coml 09ed To1M Allowed Total Avg 61 Cast Own Cant Elea Tori Lik-ed Tate 2 375,779.89 207,447,31 1,646.35 29 •10,262.42 .24.62,2 61 Claean 343 3,326,96 1.11 3.567.367.59 3,14401 325 .3.427,333.71 7,066,73172 rleerSOep�e 112 3,45.6.770.16 4403.556.33 3.762.59 121 1,264,906.67 770,034.93 Heperhnetn 1,054 12, 392, X2.12 6,117,5 0.67 2,392.06 1,012 10,771,395.86 4,771,371.41 LNc Name 21 154.035.37 74,556.74 3,106.53 26 224,43727 48.314,96 *99360Claatders 13 23,339.20 17,433.96 79245 10 46.105.35 5,055.05 *re 14,539 104,065.641..23 50,192,123.122 29275 13.451 103,305,344.61 52,*.i5.603.60 Mode 329 Z313,312.30 1.033.6,35.39 431236 231 2,367,506,53 1,012,963.24 area 110 672.007.29 116,234.23 1,015.81 90 797.407.17 158,310.4,4 PUlec ary01e6.. 132 1,443,615.42 663;9451.74 2.297.40 111 1.41,936.71 520,379.49 Reml.Crere 50 2,703,298.07 1,534245.12 7,464. L2 38 815,495.05 113.240.43 Grad Total 14.623 123075.929.18 53,532,840.65 330.40 13,R0 121.362.646,60 59,813,750.24 Listed below are some of the software capabilities (not exhaustive): • Software Availability Access to our system is available through several means: 1. Direct internet connection to our secured web site allows for viewing and entering of Case Notes and Diaries, viewing bills. running reports. and more. 2. TSWeb connection to a specified computer via a VPN allows full access to the system 3. VPNIODBC connection allows for full usage of the system if our software is installed at the remote site. • SFTP Site (Secure File Transfer Protocol) A FTP site will be hosted and maintained by AmeriSys to allow transfers of data and or/reports required by client. The site will be accessible by client and with proper authorizations. Pip: l 1 g) Decision criteria for assignment and discontinuance of field case management and vocational rehabilitation; Field Case Management The purpose of Field Medical Case Management is to provide services that allow for more specific and detailed information regarding care, home situations, family dynamics and employee job site. This manner of delivery is important for establishing rapport with the injured worker and/or family, particularly with high risk or severe injury situations. Medical Case Management includes, but is not limited to, coordinating physical rehabilitation services such as medical, psychiatric, or therapeutic treatment for the disabled individual. These services have proven to be of assistance in the resolution of workers' compensation cases, auto, general and product liability cases, Long Term Disability and Catastrophic Case Management cases. Recommendation for Assignments of Field Case Management Recommendation for Assignments of Field Case Management I . All catastrophic injuries, such as, but not limited to: • Spinal cord injuries • Head injuries ?. Neck injuries (except for minor strains) • Burns of face, hands or greater than 9% of the body • Amputations • Loss of hearing • Electrical shock • Multiple fractures 3. Any potential serious back injury: • Failed back syndrome • Multiple fractures in the back • Herniated disc with radiculopathy • Positive neurological findings • Any back injury with any degree of paralysis 4. Chronic Pain Cases 5. Claims with high potential for PT rating including, but not limited to: • Fractures in or near major- joints or weight -bearing body parts • Crush injuries • Hand injuries, particularly of the dominant hand 6. Injured employees with a previous history of workers' compensation injury or injuries. 7. Difficult pre-existing medical or social problems • Diabetes • Heart disease • Psychiatric problems • Illiteracy • Mental retardation • Alcoholism and/or chemical dependency • Morbid obesity E'age 112 8. Cases not fitting an expected recovery time frame: • Not responding to provided care • Time delays in getting appointments • Irregular appointment attendance • Disagreement with the course of treatment • Questionable or experimental treatment recommendations 9, Injured employees who are approaching 60 days without returning to work. The need for Re-employment Assessments is decided on a case -by -case basis. 10. Need for extended home care. 11. Hospital discharging requiring planning for home health and/or durable medical equipment. 12. Location or communications barriers. (Injured employees in small rural areas with limited local facilities, or with language barriers who know limited or no English) 13. All new claims with an initial reserve established of $50,000 or greater. .Activities also include. but are not limited to: •Providing health training to the injured party and family •Monitoring the disabled individuals recovery kill*Consulting with treating physicians to develop an appropriatee individual written rehabilitation plan •Gathering medical information if needed •Documentation of findings with recommendations on a monthly basis 111 •Home Assessments l\ •Coordination of referrals and delivery of services 1 Vocational Services Ergonomic Job Analysis & Job Description With the ever-increasing demands of today's occupations and new legislation governing the workplace, the ergonomic job analysis is necessary in the prevention and management of injury and disability. This is accomplished by matching worker capabilities with occupational demands and providing this information in a manner consistent with systems developed by the Federal Government. Our Nationally Certified Consultants visit each worksite to observe and gather data regarding the job being performed. This information can be utilized in the recruitment, promotion, job modification, training, performance evaluation and safety program development. P,i2c [13 Providing these in an Essential Function format demonstrates the employer's understanding of the basics and the desire for compliance with guidelines of the ADA. Activities Include ✓ Essential Function Identification and Analysis ✓ Physical Demands Analysis ✓ Environmental Conditions Analysis ✓ Worker Characteristic Components Analysis Benefits ✓ Prevention of workplace injuries ✓ Facilitates early return to work • Identification of transitional work opportunities ✓ Useful in the recruitment, placement and promotion of employees ✓ Identification of training needs ✓ Compliant with The Americans with Disabilities Act h) Management of provider networks, including utilization of credentialing and/or outcomes management; AmeriSys is proposing DimensionComp for hospital and provider access, Coventry PPO as the secondary or "wrap" network, the AmeriSys Preferred Provider network for ancillary providers, and myMatrixx as the Pharmacy Benefit. Manager. USIS/AmeriSys employs a Director of Provider Services who will work closely with the City, DimensionComp, the adjuster and the case -manager. The Director of Provider Services will make recommendations as to what outcomes would be monitored as well as work with the City to determine the criteria that are important. DimensionComp is an affiliate of Dimension Health, Inc. DimensionComp provides clients access to the one of the largest Workers' Compensation networks in South Florida. By maintaining strong relationships with the provider community, DimensionComp is able to offer clients superior network savings and greater access. Provider credentialing and monitoring — All providers must have privileges at a participating Dimension Hospital, hold a current license in the state of Florida, Must be Board -Certified or Board -Eligible, hold an unrestricted DEA certificate and comply with the State in maintaining malpractice coverage. The Florida License is verified to ensure it is active and clear of sanctions. DimensionComp also verifies malpractice histoiy. It also ensures the DEA license is current. Board Certification is verified through the American Board of Medical Specialties. Physicians agree to comply with all other provisions of Florida law applicable to a worker's compensation policy, plan, or program. Physicians have agreed to promote high standards of medical care and to control the cost and utilization of medical services, including, but not limited to, policies and procedures regarding quality assurance, utilization review, record keeping, billing. and grievances. Recredentialing is conducted every 3 years. Please reference Attachment 8 — Dimension Health, Inc. Providers. Page 114 Under the 2003 -201 1 managed care agreement, AmeriSys provided the City with a certified carve out version of Dimensions Health Care. The carve -out was modified to meet the specific needs of the City while meeting the requirements of the Agency for Healthcare Administration. The AmeriSys Network Manager established a strong rapport with Dimensions Healthcare; thus ensuring the prompt attention to specific provider needs of the City of Miami, including the recruitment of specialty physicians that are qualified to care for those individuals covered under the Heart and Lung Bill, Ancillary Network Access AmeriSys Preferred Provider network • The AmeriSys Preferred Provider Network is made up of a select group of vendors to perform the services referenced below. • Every three (3) years AmeriSys undergoes a very detailed RFP process for Ancillary Medical providers that include transportation, translation/languages, Physical Therapy, Diagnostics, Home Health and Durable Medical Equipment. These organizations undergo due diligence and are then contracted. Contracting includes indemnification for customers. insurance coverage verification as well significant discounting for services. We belie~ c this provides our customers with the best protection at the best price, creating best value. i) Utilization of physician review, IME, and other ancillary services; USIS!AmeriSys provides utilization/peer review services in accordance to the standards set forth by URAC. Our accreditation period is current through March of 2017, Utilization Review issues are identified and the file is referred to a Utilization Review Specialist. The UR specialist will conference with members of the case management and claims team to determine the issues to be addressed and the most appropriate utilization review approach. The UR specialists have access to multiple third party guidelines, including, but not limited to, InterQual, Medical Disability Advisor and Official Disability Guidelines. The review can be performed as a Prospective, Concurrent or Retrospective Review. In the Prospective or Concurrent format, the UR specialists can review the issues requested and communicate their findings to both the case - manager and claims team. In the Retrospective format, the file can be reviewed and the UR specialists will formulate questions to be posed to a "peer" physician. Once the "peer review' is returned, the physician's determination is communicated to both the case -manager and claims team. The decisions are defended by confirming the process was in compliance with URAC standards, the peer physicians are also functioning within URAC standards and the guidelines utilized have been approved. As always, it is the claims adjuster's decision to utilize the determination to best serve the claim and the injured worker. In conjunction with our performance standards for our Preferred Physical Therapy providers as it relates to adherence to evidenced -based guidelines, all providers have set up processes for Utilization Management. These processes are routinely utilized in the services provided for USIS/AmeriSys customers. Pace 115 See an example below from one of our Preferred Partners: SAL€GN •A N NEowaRIM {.040 3.4.4ASO REVIEW ++. m..a..wwv,wwwww.e.'...ww.rvw—..w:WwW, .nnn'.r+si+.w, wawuw.u'+M Yr,..as .W N.n... N.pryW ka rl.411 Nw,t.r' WCaa.rar h , f,Fatl.Favcs, %a.m. u:.6ac4mrr Y.,. rn.q. *so. rap IwIPMPIIII cyv.emY i; S+s,i vw..eaw.exmws raw ..ww.d. PW ye9'zA: Y..../ . m.. . f arrux:t w«F.e.....a... ra u asuaralad . ,*mood, 'moment R«,Yr.t.Aauwi emcn..rnrni..mrt.ttv.n.xe,.in.a tt.r Arai s,mA,ary e P.e,ia,+[azyw:l-00 IP efts. waviun+'Seca,'..: •rl4vs.:aa. n.®eeYs2h tl.M.k 4n eltai 'mamma — Car .....V.rm rta.f06Y (6d,rir, l,n1.1WPWW1 trezmom _LVILlYiStYtYm lcrd..�,. w 3J®_ .wW J_?ySil s .Pn....-, w.it-- ldWtbrNu ,ret[vc_ ... c.w.wrr e®.ee...wti—.ems. .trwwww14 tw.ww Wren... ALIGN AYNiive: +.a0ipVWratt. UW. NP Eer' W(a[eaM R;y¢YV-%23613,3Sx Ienpws.a.a�r.�w...Yew w.�ev=rn N Sawry W.W.I ra 4...Y.ec MP two .me c ,.p a.n, VW. .o..<w rig f p..y1ILaartUt .11.1.1.91P, P.*. wash.. w.P,h Meade t.. etes-aerl Lenwwww few, IS DWI! ,r�tty P.X. ww/I Farrow. C/ww kw. CIWS.1.19.,...wiNd/WIWAPti PM !WWI 40 r.�..,,.o-,m..,. m...w,....ws. .r,anima. Owe, NOV paposaw,wey meet. n....aw/wwwn,w1.6,110141,1.4. WWI., WIWI@ WA WV Ww1WWWWWIwert. C. sr+awae.rhn x+nwwn.om.n., wa attPna..a.xmf s. Should the nurse reviewer determine that request for care or treatment is in variance to the evidenced -based guidelines or statutory guidelines, that request is forwarded to a peer of a like specialty to review. If resolution cannot be achieved by a non -physician reviewer, the review is escalated to a peer physician of a like specialty. Through our Physician Advisor organizations and as well as our physical therapy partners, non -physician review consultants are available for use for ambulatory care review, such as chiropractic and physical therapy specialists. AmeriSys works with Dane Street for Physician Advisor services. Physician Advisor Services for UR Dane Street, LLC Debbie Hill, MSN, RN, CCM, Director of Account Management 891 Centre Street • Boston, MA • 02130 951.543.1627 561.206.0659 (fax) dhillirt danestreet.com www.daneStreet.com Dane Street provides Workers' Compensation Peer Reviews to Managed Care Organizations, Third Party Administrators, Utilization Review Organizations and Employers. Licensed in all mandatory UR states, with an active Regulatory and Compliance group which interfaces with the appropriate State workers' compensation Boards and Departments of Insurance. Dane Street is a URAC-accredited review organization and the reviews are delivered according to all URAC, jurisdictional and client requirements. They understand the importance of state - specific medical treatment guidelines, turnaround times, match requirements —and track any changes across these categories in their rules -based PeerAccess platform. Paee l ! 6 1) Methodology for tracking lost days (include your company's definition of lost days); measures the savings in comparison to ODG guidelines Third party guidelines and standards of care benchmarks are referred to validate the need for treatment or to confirm the disability status, The physician is contacted to verify discrepancies between the care being delivered and the established third party guidelines. The Official Disability Guidelines are referenced for disability management and Pressley Reed's Medical Disability Advisor is referenced for standard medical treatment including but not limited to diagnostics and therapies. McKesson's InterQual is utilized under the URAC guidelines for the pre -certification of invasive/surgical procedures. As stated earlier, the use of these guidelines allows the nurse case -manager to plan and benchmark the claim for appropriate treatment and anticipated return -to -work and MMI. Once the timeframes are set per the evidence -based criteria and variances occur in either treatment or disability, the nurse case -manager can then question the treating physician as to the medical necessity of either. If this does not resolve the discrepancy, the medical director or physician advisors will be consulted to opine and intervene. When the NCM identifies treatment that appears outside of guidelines or there is a delay in release to RTW, AmeriSys can and does utilize our Medical Director to provide a peer to peer telephone conference to discuss any issues of concern. Very often this is able to resolve any questions. If questions remain, we may choose to use IME's or formal Peer Review to address the issue. The following screen shot shows the NCM current Return -to -Work benchmark tracking. Dotla} on the mZer Repasts .— C.'c_•,M .'•dos , Duea iist4.. ,, -r = :, Occupanon i Released to -an& wail?•tt&yon _ 1 C1amrDats 4 il. Atb Educatton Release toFuA:sn :1:.t.iCci 8t}r Day of Drsalvltn t70 00 6JGG ;_ .;veraee tV'sek2s Wage li Return to 'work \,addled Duty Sun 3.-9 •` Prom,sad 4!tsosr-to-R'n:t flat; y =e • ur Soce.. t =; A Compensator, CompensRsC te. `a I Actual PeetSa»to-Wodc Date . Prepottd` u-ober of Lost Das's. 6_ Rattam.t9-195'cri:33.14ge :; Fu1Wage s. Protected Releaaedte Modified Retu n To -Woof Lost :sere xmk nth. Buts is Return :e s&"oda Modified Duty Released co Dc.:- Dare Dora Bars ^nd Dar.:' Flestnenons Una's adahle Beta End Das s Fug Dun E2 136 .343 GLw4 a CG Oa 90•e • 4 c 1 ;. nib J ,u C..v'lo r 1= 1200 '•j 15 J- ild - t 4- 15 :916 ••l l la'S'G1s .:.� set =( 79 2=.Tns6 I4, Coarszents::-:r,e..A,{sy- ?col. tan LT Days. 3 " Lost Tate Calmar Days' 1; Arad Duty n Lnarad Mod Duty Calendar Day, .. 10 Lou Tine Wont Darr (t)51l4). 11 Mod_ Duty Work Days l,OSP-As. —is _ Cuaent &otutst-Ty-'A'elk Sassnq_ 3 PatentialAddntanal indemrnty_ Saymzs Prat. note LT Calendar Comp* Current P.M Restnctsd?ime Coartr • LT Days Dan Pare Sasarru as enasadaNe Rate G . y-.a rn 147 `�-15 .. _ ! "43.33 - 43711w The default Camp Fare =as coca to calculate the Cu meet RTW{Sashay Page 117 k) Describe and provide an example of documentation of medical management within your company's notes system; Documentation of medical management is inclusive of all pertinent aspect of an injured employee's care, inclusive of functional limitations. The DWC-25 is reviewect as well as any physician notes. Treatments and procedures are reviewed for medical necessity and causality. Once a determination is rendered, then the care is coordinated. All actions are documented in Corrus as well as the guidelines referenced. Office Visit - TCM Case Assessment Note Received by: 09/05/15 Dr. Orthopedist LOV: 08/09/2015 NOV: after MRI DX: M54.41 Lumbago M96.1 Post-laminectomy syndrome, Lumbar Region Acute or chronic lumbar syndrome in previously operated spine with previous history of 1- ThIP L4-5 and stenosis L3-4 Work Status: OOW Anticipated MMI per ODG guidelines: 10/05/2013 Drs. Evai: INSPECTION: No swelling or bruising. No gross deformity. There is a healed lumbar incision. PALPATION: No midline tenderness. Diffuse bilateral paraspinal lumbar tenderness. There is no paraspinal spasm. There is no sciatic notch tenderness. There is no sacroil inc joint tenderness. RANGE OF MOTION: Marked restriction of forward flexion, extension, lateral bending and rotation to each side. There is more lower back pain with extension. There is no pain with hip range of motion. STRAIGHT LEG RAISING: Negative on the right. Negative on the left. She has lower back pain with bilateral straight leg raising and pulling into her thighs. MOTOR STRENGTH: 5/5 bilaterally in hip flexion (TI,2,3), hip extension (L5,I), hip abduction (L.5), hip adduction (1.2,3,4), knee extension (L2,3,4), knee flexion (L5,1), ankle dorsiflexion (L4), EHL (L5), plantarflexion (SI). The patient is able to stand on their toes and heels without difficulty. SENSATION: Intact to pin prick and light touch bilaterally. RELLEXES: Patellar (LA) 2+ bilaterally, Achilles (S1) absent bilaterally. There is no clonus or Babinski, GAIT: The patient walks with a slowed gait Imaging Orders: Three views with AP, Lateral and L5-SI spot of the lumbosacral spine were ordered, obtained and interpreted from an orthopedic standpoint Lumbosacral Spine X-rays: Lumbar x-ray shows a transitional L5-SI level, There is disc space narrowing throughout the lumbar spine. Drs. Treatment Plan: I had a long discussion and reviewed treatment options in detail, after reviewing the clinical findings and diagnostic studies with the patient. Due to the severe pain T would recommend an updated lumbar MRT scan with and without contrast. She has an appointment scheduled today with Dr. Epstein for medication management and will keep that appointment. No pain medications were prescribed from this office today. After the MRI scan I will be able to heifer determine whether not require surgery for lumbar spine and whether or not this is related to the pre-existing condition or this new accident on 7/3112013. MRI of the lumbar spine with and without contrast was ordered. The patient is to return when the result of MRI is available. A copy of the patient's note was sent to the adjuster. A copy of the patient's note was sent to the nurse case manager. Improvement noted: no Medications: Wellbutrin, Nabumetone 750mg Tab Oral Are there any medications concerns: no Average monthly medication cost: $63.25 per My Matrixx Treatment in compliance with MD Guidelines: yes Lumbar HNP Page 118 Based on clinical suspicion of a disc herniation, conservative treatment, which may range from simple rest to elaborate traction devices is recommended initially, except when signs of severe or progressive nerve compression (radiculopathy) are present. The individual is instructed to avoid aggravating activities such as heavy lifting, bending, twisting, or prolonged sitting. A corset may be worn during the day to provide support. For relief of pain and inflammation, treatment may include nonsteroidal anti-inflammatory drugs (NSAIDs) and, if pain is severe, a narcotic or an anticonvulsant for its analgesic effects. Muscle relaxants are frequently prescribed for their sedative effects. Other treatments such as ice, heat, massage, and ultrasound therapy may help relieve pain and muscle spasm. As symptoms subside, an increase in activity is recommended, including physical therapy and/or a home exercise program to strengthen the lower back and abdominal muscles and improve aerobic capacity (walking). The individual may attend "back school" to learn correct posture and body mechanics. Many individuals recover completely; however, recurrences of back pain and sciatica are common. Therefore, preventive and maintenance measures such as exercise and proper body mechanics may be continued indefinitely. If little or no improvement is seen after 4 to 6 weeks of treatment, and if the pain is severe and debilitating, further evaluation is appropriate. If imaging studies have not yet been performed, MRI or CT/myelogram are indicated. Individuals who have leg pain (radicular pain) as the predominant symptom may gain relief through the administration of epidural corticosteroid injections. If non -operative measures are unsuccessful in relieving the individual's symptoms, surgery consisting of a laminectomy and disc excision or a minimally invasive disc excision, may be considered. Proper patient selection is the key to favorable surgical results, and good outcomes are more highly associated with correlation between clinical findings of radiculopathy and imaging studies. Central disc herniations generally present with low back pain and without radicular complaints; they, rarely benefit from a lumbar laminectomy and discectomy. Individuals who have persistent back pain as the predominant symptom usually do not benefit from surgery intended for disc herniation (discectomy). Individuals with chronic low back pain may benefit from a rehabilitation program, and/or pain management. Emergent disc excision (discectomy) is indicated in the patient with cauda equine syndrome, which presents with bilateral severe leg pain, saddle anesthesia, and bowel and/or bladder incontinence. Surgery is also indicated in the individual with progressive muscle weakness; severe unilateral leg pain with objective signs of nerve root compression (nerve tension signs and/or loss of neurological function) that has not improved during an adequate trial of conservative treatment, with an imaging study that correlates with the clinical findings for nerve root compression; or recurrent episodes of severe leg pain with objective signs of nerve root compression and a matching defect on imaging studies. Microdiscectomy or minimally invasive discectomy are alternative procedures that may be done on an outpatient basis and may have shorter recovery periods. However, the indications for these procedures are the same as the indications for open laminectomy. Adjuster conference: per corrus notes Are there any red flags: pre-existing lumbar surgeries, complicating this claim Nurse Care Plan: coordinate MRI accordingly, results to provider, determination of exacerbation or new injury by Dr XXX. Monitor medicals. Field Case Manager update/report: Possible FCM request after. if surgery is indicated. RN BS Page 119 PCP A PCP B PCP C Ability to profile provider practice patterns and report on both clerical and financial outcomes on a case by case basis, as well as in aggregate; and AmeriSys has the ability to report on a providers practice patterns, both from a compliance with submitting of the correct documents as well as their billing practices. Comparison of Physician Outcomes for Claim Year 2015 at 12 months 20 Claim PT Days I 11 V$217.61 Avg Bill Cost $149.54 $90.28 187 Bill Count r_ 25 Avg Claim Cost $205.i9 36 Claim Count f 15 11 $518.42 $1,130.36 0 200 400 600 800 1000 1 00 PCPC ■ PCP B ■PCP Claim Count Avg Claim Cost ! B l Count Avg Bdl Cost Clain PT Days 11 $ 205.19! 25 $ 90.28 0 15 $ 518.421 52 $ 149.54 11 r 36 $ 1,130.36f 187 $ 217.61 20 Page 120 m) Examples of medical cost containment reports (either ad hoc or standard) that have been generated from your company's system using a real blind client. USISiAmeriSys has 7 on staff and on -site programmers who are able to build ad hoc reports and!or data extracts at your request for no additional charge. Please reference Attachment t 1- ArneriSys Sample Reports. ,lmertiSys (LS1S Database) RT«' Savings Report Return To Work Date: 07/01R015 - O913O/2O1s • indemnity • TCMM Both Opened and Closed (by date) Claimant Name DOA Claim Status P ujlxted RTW Pro; Num LT Calculi: Day Comp Mooed Ciirni ID Clam Number pasatt Lost Time TCN1 Status LT Days Dats Saved Rate Salm!s Full Duty Chas Cress- 10 911•3115 C144•4 1023:017 ilae.oy C14s.d 23$ I3 t.r.s.# 111�4 23:5 tairy Op® :nap.. r. r•.•N 9#4yb!!S Op.6 saat::5botomer Ors 29 IC:737 C104.56 i1..rm• C'.rn 0►:::417 CYaa.a II 21.`.P17 fees 1allr CA+.A 41 SS` a1 SAO. 31 • • 5/.1,3 r 1 :1 a111 1 31 sa9'31•• u,9'9 11 5.. a. 1 554 SW 13 •' 111,M:1 1111:b1". Are tly saw 21 '6 s:" ;1 U. 111 3iCd.1?' A! itt¢ka1) BdIS - �' '"'a.,•' CaM Ascent :cve Tacece AnscoSys (A ICYLSYs Dala8srr1 Medical Bill Review Activity Report Al Payers Pate F4u ce: won. ;2F113 Ttu0(4105..° 31, 2013 M,1 4351.55441 J+,45e1 /e.tae 44p • 4....st y.{, 6410.45.001401 t;titl'. +ate 1aP.antt 5e.3.5:45:.. N.247 1:4.4• 41.3`7 IOC .. _!a 13a114.02+.41 200.0% 1+.111,11119 ♦:.y'.5 1` • f :- ,. , 1;;'./c6.J4 33 % 12. tt✓+.1`0A7 t3,392.49+•f9 • . eaLa In -•• `a I'M% ._ 41t34QA Y 1Laba4•.513411.d# $LUJ7.*25 5 69.1.E 1 #J'? 4.Tt 4.6' 1471:013. S 041.19427 etrA455,04,t 1ka oak," 231 100n 6.324 1%0 }1,S4}.4T1.23 ifl0.$'1S 1515349.44 52.1 1. 155: ,-4..: 1' .5: -4 7-4'4 StL F53:Ar i-T k I461 4 1.39J:.0I736 4,94.160:rr 3.5FG*'r 109 100.0. 310 IOU # $412.79454 06:4 % 110L,'43.579 96.4 % $3 t: :. - 'S 23 • I;!" 559.5+ 0.7 ♦ L73+ ':: ": 6291.613.57 nr.sc4JTh.e.lo. 1.121 t09A% 10.4411004% 1454. 3'2.771145054 1175.71531 29.0'' 143115,:. f•311.29 az% s )6.177.21 J4.1\ I . $32".4CG.J3 q..7✓Jlcs 241100.04 124300,451 15.1' 11.134104% 5.5451125.90 51155 6.."A.:::.:• - JS\ 111.15.5? *400 3 ••: - 014.1}:!G =N '•M.x 14 1354% 441144.9W 115445.1.540.0• 14.++3.22 42.114 161r24+-'- .- 0.0• 14:.0 0i 1 7.21d: C,14 :5% :c4. .4 1541044 • 195":25-i73'i5154M 6499O50 1:1% 64C,05,... 1: 43:.5$ 5''. 63,461 .3 91.4K 5'-'_: c, 1.161 109.-» • 1351„ 344.94 100:9'. 54. I5561 t.J r. 6144,4c S :: 744461.$ •4 }• 1r4.'+ 12.4' :tlo +. .:+ 4 40 'I?.4 - •t 1Y:6.43a.:2 1OG.3 % 1145473,37 11.5 \ 1241.5+: #:7.31.4 T.5 ♦ 61.094A4 1_7 1 J:.n.+•-• Taut .. .. 441:11'-5:355 1753414,451-221413% 12.194,745.79 453A #a.#04.?9: ;. L454.514.43 4.5% 5455,4544.5$ 42 .. 1..; .8-' Page 121 Cost Containment Report Amount Charged Fee 5c hedute Reductions Fee fhmunder Type CescnpL' n Amnuunee AIL Ambulatory Surgical Center Geri Regis. Nurse:Advance-a Nurse Pracr,honer Doctor Durable htedical Equipment Hospital lndependam Lair Pharmacy Physics! Therapy 2-34 30.00 Fee s Redus 33-59 3,015 15 3.640.88 171.421325 453 80 217.99E94 4.13926 513 7.921 74 Ceti Regts. Nurse,Advanced Nurse Practitioner 340 84 Dentist 1 t4- 17 ector Oural,4 Mc1F01 Hcspital Independent Lab Pharmacy Physical Therapy IM,14•A Po.rnf Doctor Amount Charged 1,134,576.71 31.696 85 5.178.08 5.911_36 565 39 8.359.58 15.9:2 09 30.00 Amount Paid 659.954.08 85.788.29 850.954 08 Fee Schedule Reductions 4.955 )♦ 0.rMuderce +o-n4sulatory Simpcol :moire - Cw1 Rag% - H!us.'Advancad. MN Da4or 2,'50 Durable Mudrral imu4vner�L Haspeei hldepor.10nL Leo P1,nrla0y i Physcal Therapy Network Reductions —Can Rt. Nursa:ruria'cal. 0en!nl NB Doctor — Ouraloo 510011 :r� 0glll nit=r, Hospital 1M I,drq ndent L41, Pluemaeq Physcal'haroc• Other Reductions L S Doom Total Savings 474,622,63 I',LIiC 122 2. Detailed outline of medical management and medical cost containment fees for services proposed to the City to include the following: a) List all of the medical cost containment services included in your company's claim service fee. All medical cost containment services are priced separately from the claim service fee. Please reference Attachment 82 Managed Care Price Proposal. b) List all of the medical cost containment services provided by your company or your company's vendor partners, that are not included in the claim service fee with the itemized charges. NA - Refers to Part I Please reference Attachment B2 Managed Care Price Proposal. c) Outline all medical cost containment services provided to your company by an outside vendor, including PPO, Nurse Triage, Dedicated Nurse Case Manager and any other proposed services. Note: Proposers are requested to address the issue of physician dispensing and the high cost of repackaged drugs. AmeriSys is proposing DimensionComp for hospital and provider access, Coventry PPO as the secondary or "wrap" network, the AmeriSys Preferred Provider network for ancillary providers, and myMatrixx as the Pharmacy Benefit Manager. DimensionCornp is an affiliate of Dimension Health, Inc. DimensionCornp provides clients access to the one of the largest Workers' Compensation networks in South Florida. By maintaining strong relationships with the provider community, DirnensionComp is able to offer clients superior network savings and greater access. Under the 2003 -201 1 managed care agreement, AmeriSys provided the City with a certified carve out version of Dimensions Health Care. The carve -out was modified to meet the specific needs of the City while meeting the requirements of the Agency for Healthcare Administration. The AmeriSys Network Manager established a strong rapport with Dimensions Healthcare; thus ensuring the prompt attention to specific provider needs of the City of Miami. including the recruitment of specialty physicians that are qualified to care for those individuals covered under the Heart and Lung Bill. The AmeriSys Preferred Provider Network is made up of a select group of vendors to perform the services referenced below. Every three (3) years AmeriSys undergoes a very detailed RFP process for Ancillary Medical providers that include transportation, translation/languages, physical therapy, diagnostics, home health and durable medical equipment. These organizations undergo due diligence and are then contracted. Contracting includes indemnification for customers, insurance coverage verification as well significant discounting far services. We believe this provides our customers with the best protection at the best price, creating best value. Matrix Healthcare Services, Inc., d/b/a myMatrixx, is a full -service pharmacy benefit management (PBM) and ancillary ser-vices company focused on workers' compensation. The AmeriSys/myMatrixx partnership has existed 10+ years since the inception of myMatrixx. Together we have provided quality medical management and pharmacy services to customers in the entire south-east region. AmeriSys and myMatrixx through their relationship have joined forces to face multiple challenges in the Workers' Compensation arena such as the escalation of the need for cardiac medications (BADGE Program), and currently we are working together on the AmeriSys Pain Management initiative called SECURE. The Vice President of AmeriSys is currently a member of the myMatrixx pharmacy and therapeutics committee which establishes the general protocols and formularies for this PBM. Physician Dispensing USIS" procedures adhere to Florida Statute and Rule requirements that the dispensing of medicinal drugs is limited to a pharmacist or a licensed dispensing practitioner and must billed under the original NDC (National Drug Code) number. The Florida Fee Schedule reimbursement for the dispensing of prescription medications is: Average Wholesale Price (AWP) + $4.18 — $ Reimbursement [Note: In order to properly reimburse repackaged medications, USIS requires both Original and Repackaged NDC #] Through our PBM, myMatrixx, we are able to offer an extended network discount on repackaged physician -dispensed medications. For physicians who are willing to participate. the pricing is as follows: Average Wholesale Price (AWP) + $5 + $4.18 = $ Reimbursement which is a discount from the Florida Fee Schedule allowance. This is a savings over the Florida Fee Schedule pricing for repackaged physician -dispensed medications which is: Average Wholesale Price (AWP) x112.5% of the original + $8 = $ Reimbursement Example: For non -repackaged drugs, whether from a pharmacy or a physician, payment is based on Fee Schedule, unless a PBM contract is in place. If the physician has repackaged the drug, but there is no PBM in place, payment would be based on 112.5%, and both the repackaged code and the original code have to show. Dane Street, LLC - Physician Advisor Services for UR Dane Street provides Workers' Compensation Peer Reviews to Managed Care Organizations, Third Party Administrators, Utilization Review Organizations and Employers, Licensed in all rnandatoiy UR states, with an active Regulatory and Compliance group which interfaces with the appropriate State workers' compensation Boards and Departments of Insurance. Dane Street is a URAC-accredited review organization and the reviews are delivered according to all URAC, jurisdictional and client requirements. They understand the importance of state - specific medical treatment guidelines, turnaround times, match requirements —and track any changes across these categories in their rules -based PeerAccess platform. J'ig124 3. Provide the name, address and contact of the vendor and please also: 15IME SIO Dimension Health, Inc. 5881 N.W. 151 Street Suite 201 Miami Lakes, Florida 33014 Contact: Creta Diehs (305) 823-7664 Provider Hospital Network ' COVLNTRY Coventry Health Care Workers' Compensation, Inc. 4141 North Scottsdale Road Scottsdale, AZ 85251 Contact: Jennifer Cummings 615.854.0359 (Wrap) Provider Hospital Network r "1 Matrixx 5706 Benjamin Rd. Tampa, Florida 33634 Contact: Artemis Emslie 877.804.4900 Pharmacy Benefit Manager Dane Street, LLC Debbie Hill, MSN, RN, CCM, Director of Account Management 891 Centre Street • Boston, MA • 02130 951.543.1627 561.206.0659 (fax) dhill fSdanestreet.com www.daneStreet.eom Peer Review Provider Page 125 AmeriSys Preferred Provider Network ADDRESS PHONE NUMBER FAX 126 DIAGNOSTICS One Ca1I Care Management 841 Prudential Dr., Suite 900 Jacksonville, FL 32207 800.872.2875 866.632.2 16 I Orchid Medical P.O. Box 560370 Orlando. FL 32856 866.888.6724 407.893.7363 Spreemo 88 Pine Street, i I'�' Floor New York, NY 10005 800.595.7173 201.289.5765 TRANSPORTATION/TRANSLATION IU Group Languages & Transportation Services 10650 Treena Street. Suite 308 San Diego. CA 92131 800.726.9891 888.497.191 I JNJ Services 170 Camden Hill Road, Suite G Lawrenceville. GA 30045 800.588.9679 877.308.3805 Speak Easy 141 1 N. westshore Blvd., Suite 320 Tampa. FL 33607 888.939.7767 866.507.8362 ProCare l .isenhower Technology Park 4710 Eisenhower Blvd. Suite C-4 Tampa, FL 33634 866.941.7878 813.769.3883 DME One Call Care Management 841 Prudential Dr., Suite 900 Jacksonville, FL 32207 800.848.1989 866.672.6807 Orchid Medical P.O. Box 560370 Orlando, FL 32856 866.888.6724 407.893.7363 Priority Care Solutions 3802 Corporex Park Drive, Suite 100 Tampa, FL 33619 866.932.5779 877.212.9137 Page 127 HOME HEALTH One Call Care Management 841 Prudential Dr., Suite 900 Jacksonville, FL 32207 800 848 1989 866.672.6807 Orchid Medical f .C). Box 560370 Orlando, FL 32856 866.888.6724 407.893.7363 Priority Care Solutions 3802 Corporex Park Drive, Suite 100 Tampa,. FL 33619 866.932.5779 877.212.9137 PHYSICAL THERAPY Therapy Direct PO Box 915 Ooltewah, TN 37 363 888.904.6776 678 298.6271 AlignNetworks 7785 Baymeadows Way, Suite 305 Jacksonville, FL 32256 866.389.0211 904.998.0299 SPNet Clinical Solutions 2.2 Inverness Center Parkway, Suite SOU Birmingham, AL 35242 888.654.0049 205.995.189-1 HOME MODIFICATION Horne Modification Solutions P.O. Box 10541 Brooksville, FL 34603 866.939.6637 Home Safe 5914 Jet Part Industrial Blvd. Tampa, FL, 33634 877.854.8897 877.854.8898 Orchid Medical P.O. Box 560370 Orlando, FL 32856 866.888.6724 407.893.7363 One Call Care Management 841 Prudential Dr., Suitt 900 Jacksonville, FL 32207 800.848.1989 866.672.6807 Dental/Doctor/Hearing/Eye Programs Express Doctors 2(}U4 N. Flaming Road Pembroke Pines, FL 33028 888-569-0577 888-539-0579 Dental Works USA 1408 N. Westshore Blvd. Suite 704 Tampa, FL 33607 855.443.9872 813.251.3850 Page a) Confirm your company's willingness to allow the City to select and utilize a separate managed care vendor the City would like to utilize on the City's files; N/A. Refers to Part I b) Outline your company's philosophy on field medical case management versus telephonic case management; The Telephonic Nurse Case -Manager should provide Quality Care in a Cost Effective Manner focusing on early return -to -work. The purpose of Field Medical Case Management is to provide services that allow for more specific and detailed information regarding care, home situations, family dynamics and employee job site. This manner of -delivery is important for establishing rapport with the injured worker and/or family, particularly with high risk or severe injury situations Telephonic Nurse Case Management will be utilized based on criteria set by the City of Miami and ArneriSys. AmeriSys recommends Field Case Management assignments if the triggers listed below occur. Page 124 Recommendation for Assignments of Field Case Management I . All catastrophic injuries, such as, but not limited to: • Spinal cord injuries • Head injuries 2. Neck injuries (except for minor strains) • Burns of face, hands or greater than 9% of the body • Amputations • Loss of hearing • Electrical shock • Multiple fractures 3. Any potential serious back injury: • Failed back syndrome • Multiple fractures in the back • Herniated disc with radiculopathy • Positive neurological findings • Any back injury with any degree of paralysis 4. Chronic Pain Cases 5. Claims with high potential for PT rating including, but not limited to: • Fractures in or near major joints or weight -bearing body parts • Crush injuries • Hand injuries, particularly of the dominant hand 6. Injured employees with a previous history of workers' compensation injury or injuries. 7. Difficult pre-existing medical or social problems • Diabetes • Heart disease • Psychiatric problems • illiteracy • Mental retardation • Alcoholism and/or chemical dependency • Morbid obesity 8. Cases not fitting an expected recovery time frame: • Not responding to provided care • Time delays in getting appointments • In-egular appointment attendance • Disagreement with the course of treatment • Questionable or experimental treatment recommendations 9. Injured employees who are approaching 60 days without returning to work. The need for Re-employment Assessments is decided on .a case -by -case basis. 10. Need for extended home care. 11. Hospital discharging requiring planning for home health and/or durable medical equipment. 12. Location or communications barriers. (Injured employees in small rural areas with limited local facilities, or with language barriers who know limited or no English) 13. All new claims with an initial reserve established of $50,000 or greater. Page 129 Recommendations for Assignments of Telephonic Nurse Case Management Upon receipt of the First Report of Injury, the claims adjuster reviews the nature and cause of the injury to determine the necessity for further intervention. At the direction of the claims adjuster (per client protocols), a referral for case management is initiated. Serious injuries will be assigned for telephonic case management immediately. The goal of early intervention is to provide aggressive case management with a focus on early return to work. The medical case -manager within the first 24 hours will make contact with the injured worker and complete an assessment of the initial medical treatment; evaluation of the treatment. plan and assess the need for continued medical case management. If specific tasks need to be completed to assist the claims adjuster with the handlini of the file, these can also be assigned. Telephonic case management is the systematic evaluation of medical services, procedures, facilities for medical necessity, appropriateness and efficiency. This promotes optimal patient outcomes, reduce period of disability and assure high quality of care while controlling costs. A nurse facilitates the medical activity on a file with the ability to individualize the plan of care and coordinate early return -to -work strategy with the employer and medical provider. The functions included • Coordination and referral to network medical providers • Coordination of the treatment plan with the provider • Working with the provider to establish functional abilities and conditional release to return to work • Discussion with the injured worker to clarify the worker's understanding of the diagnosis and treatment plan • Monitor the treatment compliance of the injured employee • Identify and assist in the resolution of problems with compliance to the treatment plan • Provide regular reports to the claims handler to assist them in the management of the claim • Recommend on -site case management and vocational services when needed • Work with the employer to identify a medically appropriate job Coordination and referral to network medical providers allows for the best network penetration. The channeling of the network providers will allow for the best network discounts. Page 130 The Telephonic Case -Manager acts as the center point of contact ensuring delivery and communication to all approved providers of PBM and appropriate parties, forwarding appropriate issues to the utilization review department as necessary and reporting outcomes to the AmeriSys Quality Assurance Committee. Adjuster Diagnostics Physics Therapy Home Health Case Management Employer Injured Employee Medical Case -Manager Case Management Plan Assess Needs - Develop Plan - Implement Plan Items Monitor Progress - Evaluate Outcomes - Re -Evaluate Plan DME Pharmacy Transportation 6 Languages ATP (Attending Treating Physroarn Vocational and Field Case Management CAT Suppler DtJ¢ation Review Prospective lPreCertl Concurrent Relrospeohve We understand that it is imperative for both employee and customer satisfaction; we communicate promptly, which includes facilitating care and appointments properly. Prompt, accurate and complete communications are performance standards and measurements for our case management team. Page 131 c) Provide a sample of quarterly reports detailing savings realized as a result of your company's cost containment/medical management programs; pie Performance Report Report Outcomes for. Fiscal 4' Quarter Apnl —June 2015 Fiscal Year End July 2014 — June 2015 .-4r!ri.11'S * Si%As I S1a.14.4 area M+'4 era ear 'massy, L'et ma wrera ta. apakasr,'ee tapask-'a /sax ro Aaa/149499r4 aenrn[ wooer .ma leer. "drawl* ssaxatee re. rw,.n.,... YW :laww'ers. ...ekrl "w 4A.ch.:anaalk.a7 ea `ea:Cal ni n5. 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Amte!yln pv.<4"4»arsaaetAt<sun ; dtntnet. rdY.<sn vet .ax os;r luvsr+ ,?°'0wse de, I. , airs 7 EQ fides yr !N Fes04 Y e1Uertse a^g ita nun 7 A tar a, y.ra�a t:e fiscalrag For. cva tta rraw0 of ehota •nwsi u» a.ret -.. re s3+r3ad msa Physician Dispensed vs. Pharmacy Dispensed Claims that Received Medications Y"Rrwwl .'y.�+a V wn•nnd Page I33 Mirrww,v- TOTAL SAVINGS BREAKDOWN Fiscal 4' Quartet-7 April — June 2015 SOWS SAVINGS rere, [Puget le9.044 14.1103434 310 = 3 3 es s TOTAL SAVINGS BREAKDOWN Fiscal Year End: July 2014 —June 2015 !terin..011 KKK'S SAVINGS 94.5.10,5116 ULM% Saved *Sloe fee lettereere fre,oemeet egotte0 54,1331.44% rera Otero, a -own. ,ree ore.. AinertSys (ArnenSys Datneetsta) Medical Bill Review ActivitIT Report PaYer: Oatv Rave: 97/0112014 ThrouQn 01,139/20 IS Allecbca QI -1d‘dad.r.eikKtori Othr Casale Nees. Count Perrot er 34.330c600 & 3123. IGO 1003 -1-3 Km-00 IT, IMO% 376 1./;00 • t 14.0--n(g cri., -1 4 .4 1,Z41 itv . , 444944, 125 1101I11 11I11G1111 1414,441 4.515 1033 30 13,101 z .4 Neortersors 2E1 MO% 'en Ctse,:ceet,.110;WO>, IZert DYE 30, 10C ete- "62 t=t) /4111 100.11.11 4.113 1303 : 5.1 30 3.5 1,3 Te426 000.33. s sea &eau% 24301110211. ; t'-955 s ' `t, f.-97 463.09 naut 37033-34Y3-37 13S 1 Todals 143443 ILO 003 43.437 100 3 .1, 33 949.343 63 3.0C 034 33,393 40241 133.030 -113...351.6.%.333 1700.114 0 3 3. Rot40333.40431 1'atel 301134300 333.3333333.33 9.034 32.2313.315.41 3333.3.0333.33 411 110 11.53066 303 4.3 33 1113_344. :: 333 "33 .3.3 11.1 11 , 4 33 3.12333.0.76 33-5,3.55 13 7 - 5 99 35,63::40 130 3303.433. /0 .13,33.3 10 3 ,s "-"011."--.1.4-•15 35.3.1s033 033 311.4 .33 ; 31, 0- 2)01 5397,037.13 4 40 91i 3 .4 .5 eti 25 :7—..t.sae4 1113.13'13 331143 3 3 s s 01.3331.51 19-40,74.5.14 • e),C51.6-3 11S5.18i 30 343.24 5er10er4eSt21 54.1 Page 34 d) Outline any association your company may have with a managed care organization or PPO including the network your company utilize; AmeriSys is the Medical Management division of USIS and is contracted with DimensionComp for utilization of the Hospital and Physician components of medical services. We are direct -contracted with providers for Ancillary (DME, Physical Therapy, Diagnostics, Transportation, Translations and Home Health) for preferred service, as well as better pricing. Providers from Dimensions as well as our direct -contracted providers are readily accessible in your area. e) Provide references of clients using these associated medical management services indicating detail of services purchased; Client Bay County Board of County Commissioners Type of Entity Public Client contact person Eve Tooley Phone number 850.248.8231 Email address etooley@bayeountyll.gov Description of work WC Claims TPA Medical Bill Review Total dollar value $ I5,000+ annually Dates covering the term of the contract Established 1993 and remains active Prime contractor or subcontractor Prime Contractor Indicate whether Proposer assisted in disability, safety program, light duty / return - to -work program, etc. RTW Client _ Broward County BOCC Type of Entity Public Client contact person Jeff O'Connor Phone number 954.357.7230 Email address JCOC©NNOR(ct;broward.org Description of work Network Access/Bill Review/Intake Total dollar value S50,000+ annually Dates covering the term of the contract Established 2007 and remains active Prime contractor or subcontractor Prime Contractor Indicate whether Proposer assisted in disability, safety program, light duty / return - to -work program, etc. rage 135 Client City of Cocoa Type of Entity Public Client contact person John Titkanich Phone number 321.433.8686 Email address jtitkanichcocoafl.org Description of work WC Claims TPA, Medical Bill Review Total dollar value $50,000+annually Dates covering the term of the contract Established 2009 and remains active Prime contractor or subcontractor Prime Contractor Indicate whether Proposer assisted in disability, safety program, light duty / return - to -work program, etc. RTW Client City of Jacksonville Type of Entity Public Client contact person Twane Duckworth Phone number 904.630.2777 Email address twanedr4koj.net Description of work Network Access, Medical Bill Review and Medical Only Claims Handling on an as needed basis Total dollar value $275,000+ annually Dates covering the term of the contract Established 2013 and remains active Prime contractor or subcontractor Prime Contractor Indicate whether Proposer assisted in disability, safety program, light duty / return - to -work program, etc. Client Orange County Public Schools Type of Entity Public Client contact person Regina Cochrane Phone number 407.3 l 7.3918 Email address regina.cochrane,a,ocps.net _ Description of work WC Claims TPA. Bill Review and Medical Manement Total dollar value $400,000+ annually Dates covering the term of the contract Established 1996 and remains active Prime contractor or subcontractor Prime Contractor Indicate whether Proposer assisted in disability, safety program, light duty 1 return - to -work program, etc. RTW, Light Duty, Loss Control Page 136 Client Palm Beach County Sheriff's Office Type of Entity Public Client contact person Hilda Gonzalez Phone number 561.688.3550 Email address gonzalezH@pbso.org Description of work WC Claims TPA, Bill Review, Medical Management Total dollar value $750,000+ annually Dates covering the term of the contract Established 2000 and remains active Prime contractor or subcontractor Prime Contractor Indicate whether Proposer assisted in disability, safety program, light duty / return - to -work program, etc. RTW, Light Duty Client State of Florida (DRM) Type of Entity Public Client contact person Candy Janes Phone number 850.413.4827 Email address Candy.Janes@ mylloridacio.com Description of work Intake/Triage Medical Management Total dollar value $9,000,000+ Annually Dates covering the term of the contract Established 2014 and remains active Prime contractor or subcontractor Prime Contractor Indicate whether Proposer assisted in disability, safety program, light duty / return - to -work program, etc. Client Volusia County Public Schools Type of Entity Public Client contact person Sandra Higginbotham Phone number 386.734.7190 Email address skhiggin(a'volusia.k 12.11.us Description of work WC Claims TPA, Bill Review, Medical Management Total dollar value $250,000+ Annually Dates covering the term of the contract Established 2007 and remains active Prime contractor or subcontractor Prime Contractor Indicate whether Proposer assisted in disability, safety program, light duty / return - to -work program, etc. RTW, Light Duty Page 137 Client Preferred Governnnental Insurance Trust Type of Entity Public Client contact person Ann Hansen Phone number 321.832.1510 Email address ahansen publicrisk.cotn Description of work Medical Bill Review, Medical Management (USES /AmeriSys) Liability and Work Comp TPA (PGCS) Total dollar value Confidential Dates covering the term of the contract Established 1999 and remains active Prime contractor or subcontractor Subcontractor for Medical Bill Review, Medical Management Prime Contractor for Liability and Work Comp TPA Indicate whether Proposer assisted in disability, safety program, [ight duty / return -to -work program. etc. Client Brevard County BOCC Type of Entity Public Client contact person Julie Jones Phone number 321.637.5446 Entail address Julie.JonesCa brevardcounty.us Description of work Medical Bill Review, Medical Management (USIS /AmeriSys) Liability and Work Comp TPA (PGCS) Total dollar value $250,000+ annually Dates covering the term of the contract Established 2003 and remains active Prime contractor or subcontractor Subcontractor for Medical Bill Review, Medical Management Prime Contractor for Liability and Work Comp TPA Indicate whether Proposer assisted in disability, safety program. light duty .' return -to -work program. etc. Client Charlotte County _ Type of Entity Public Client contact person Raymond Carter Phone number 941.743.1334 Email address Raymond.Carter(gcharlottecountyfl.gov Description of work Medical Bill Review, Medical Management (USIS /AmeriSys) Liability and Work Comp TPA (PGCS) Total dollar value $40,000+ annually Dates covering the term of the contract Established 2010 and remains active Prime contractor or subcontractor Subcontractor for Medical Bill Review, Medical Management Prime Contractor for Liability and Work Comp Indicate whether Proposer assisted in disability. safety program, light duty / return -to -work program, etc. Page 139 Client City of Delay Beach Type of Entity Public Client contact person Eddie DeMicco Phone number 561.243.7150 Email address derniccomvdelraybeach.corn Description of work Medical Bill Review, Medical Managernent (USIS /AmeriSys) Liability and Work Comp TPA (PGCS) Total dollar value S50,000+ annually Dates covering the term of the contract Established 2013 and remains active Prime contractor- or subcontractor Subcontractor for Medical Bill Review, Medical Management Prime Contractor for Liability and Work Comp Indicate whether Proposer assisted in disability, safety program, light duty / return- to-work_pro ;rain, etc. Client Leon County BOCC Type of Entity Public Client contact person Karen Melton Phone number 850.606.5120 Email address Meltonk@leoncountyfl.gov Description of work Medical Bill Review, Medical Management (USIS /AmeriSys) Liability and Work Comp TPA (PGCS) Total dollar value S50,000+ annually Dates covering the term of the contract Established 2011 and remains active Prime contractor or subcontractor Subcontractor for Medical Bill Review, Medical Management Prime Contractor for Liability and Work Comp Indicate whether Proposer assisted in disability, safety program, light duty / return - to -work program, etc. Client Preferred Governmental Claims Services Type of Entity Private Client contact person Ken Picton Phone number 800.237.6617 Email address kpicton(ct)pgcs-tpa.com Description of work Medical Management, Bill Review Total dollar value Confidential Dates covering the term of the contract Established 2005 and remains active Prime contractor or subcontractor Prime Contractor for Medical Bill Review and Medical Management Indicate whether Proposer assisted in disability, safety program, light duty / return - to -work program, etc. Client Ferman Motor Car Company Type of Entity Private Client contact person Webb Bond Phone number 831.251.2765 Email address webb.bondla fennan.com Description of work WC Claims TPA, Bill Review Total dollar value $20,000+ Annually Dates covering the tern of the contract Established 2011 and remains active Prime contractor or subcontractor Prime Contractor Indicate whether Proposer assisted in disability, safety program, light duty / return - to -work program, etc. RTW, Light Duty Client Halifax Health Type of Entity Private Client contact person Teary Martin Phone number 386.254.4048 Email address Tery.martin(iihalifax.org Description of work WC Claims TPA, Bill Review Total dollar value $75,000+ Annually Dates covering the term of the contract Established 2012 and remains active Prime contractor or subcontractor Prime Contractor Indicate whether Proposer assisted in disability, safety program, light duty / return - to -work program, etc. RTW, Light Duty Client Health First, Inc. Type of Entity Private Client contact person Nancy Johnson Phone number 321.868.7248 Email address Nancy.johnsonchealth-first.org Description of work WC Claims TPA, Bill Review Total dollar value $125,000+ Annually Dates covering the term of the contract Established mid 1980's and remains active Prime contractor or subcontractor Prime Contractor Indicate whether Proposer assisted in disability, safety program, light duty / return - to -work program, etc. RTW, Light Duty Page 140 Page 141 Client Orlando Regional Health Systems Type of Entity Private Client contact person Christy Pearson Phone number 321.841.6104 Email address christy.pearson(:orhs.org Description of work WC Claims TPA, Bill Review Total dollar value $175,000+ Annually Dates covering the term of the contract Established 1996 and remains active Prime contractor or subcontractor Prime Contractor Indicate whether Proposer assisted in disability, safety program, light duty / return - to -work program, etc. RTW, Light Duty Client Parrish Medical Center Type of Entity Private Client contact person Roberta Chaildin Phone number 321.268.6333 Email address roberta.chaildin:aparrishmed.com Description of work WC Claims TPA. Bill Review Total dollar value $20,000+ Annually Dates covering the term of the contract Established 201 1 and remains active Prime contractor or subcontractor Prime Contractor Indicate whether Proposer assisted in disability, safety program, light duty / return - to -work program, etc. RTW, Light Duty Client Ring Power Corporation Type of Entity Private Client contact person Cindy Acosta Phone number 904.737.7730 Email address Cindv.Acosta@ ringpower.com Description of work WC Claims TPA, Bill Review Total dollar value $40.000+ Annually Dates covering the term of the contract Established 201 1 and remains active Prime contractor or subcontractor Prime Contractor Indicate whether Proposer assisted in disability. safety program, light duty / return - to -work program, etc. RTW, Light Duty Client FHM Insurance Company Type of Entity Private Client contact person Jack Lemine Phone number 800.329.4340 Ernail address jlemine(a:`tlirnic.corn Description of work WC Claims TPA, Bill Review, Medical Management Total dollar value Confidential Dates covering the term of the contract Established 2003 and remains active Prime contractor or subcontractor Prime Contractor Indicate whether Proposer assisted in disability, safety program, light duty / return - to -work program, etc. Client Florida Citrus, Business Industries Fund Type of Entity Private Client contact person Jim Emerson Phone number 863.660.5943 Email address jim.etnerson48(i mail.com Description of work WC Claims TPA, Bill Review, Medical Management Total dollar value Confidential Dates covering the term of the contract Established 2002 and remains open Prime contractor or subcontractor Prime Contractor Indicate whether Proposer assisted in disability, safety program, light duty / return - to -work program, ete. Client Florida Rural Electric Self Insurers Fund Type of Entity Private Client contact person William Willingham Phone number 850.877.6166 Email address Bill(aTECA.Com Description of work WC Claims TPA, Bill Review, Medical Management Total dollar value Confidential Dates covering the term of the contract Established 2002 and remains active Prime contractor or subcontractor Prime Contractor Indicate whether Proposer assisted in disability, safety program, light duty / return - to -work program, etc. Page l42 the an to Page E43 Client Florida Workers' Compensation Insurance Guaranty Association Type of Entity Private Client contact person Sandra Robinson Phone number 850.386.9200 Email address srobinson(ii?agfgroup.org Description ofwork _ WC Claims TPA, Bill Review Total dollar value Confidential Dates covering the terra of the contract Established 1998 and remains active Prime contractor or subcontractor Prime Contractor Indicate whether Proposer assisted in disability, safety program, light duty / return - to -work program, etc. Run off claims Client Sugar Cane Growers Cooperative of Florida Type of Entity Private Client contact person Carmen Abercrombi Phone number 561.996.4751 Email address cabercrombi0 scgc.org Description of work WC Claims TPA, Bill Review Total dollar value Confidential Dates covering the term of the contract Established 201 0 and remains active Prime contractor or subcontractor Prime Contractor Indicate whether Proposer assisted in disability, safety prograrn, light duty / return - to -work program, etc. f) Outline the process for nominating physician/facilities to your company's provider networks; USIS/AmeriSys employs a Director of Provider Services who coordinates provider nominations with DimensionComp. She will work closely with Risk Management, DimensionComp, the adjuster and the Telephonic Case -Manager to meet the needs of City of Miami. DimensionComp has a formal nomination process in place and encourages/welcomes client provider nominations for inclusion into the network. DimensionComp may receive nominations via on-line website, e-mail and/or fax. When its client services team receives eligible provider nomination, the provider is logged and forwarded to the network development team to begin the contracting process. DimensionComp will make every effort to obtain a contract with the nominated provider. Dimension Health providers understand and respond to patients' concerns about being able receive excellent medical care promptly and efficiently. At Dimension Health quality and access are emphasized. Dimension's local presence means that questions from insurers, employers and covered employees can often be answered on the spot. g) Describe your company's attributes for physicians within your Outcome Based Network, if applicable; While we measure outcomes of our physicians, we do not have a network based solely on outcomes. The attributes we look for in the physicians that treat our injured employees are as follows. First that they are familiar with the Florida Worker's Comp requirements for physicians treating injured employees within the state. We ensure through our network that they are credentialed and contracted below fee schedule to allow our customers savings. AmeriSys Director of Provider Services monitors the level of quality service and care being provided through multiple quality initiatives, including but not limited to satisfactions surveys. We also provide direct education to providers when there are industry changes to ensure the providers are current with standards of care. h) Provide medical cost savings as a percentage for the State of Florida; Calendar year 2015: AmeriSys total Medical Cost Savings including Fee Schedule savings is 55%. AmeriSys total Medical Cost Savings below fee schedule is 13.1%. i) Indicate if savings accomplished by use of outside medical vendor. 4. Provide the following information regarding your company's medical bill review offerings: a) Provide benchmarking data pertaining to your company's book of business bill review average savings per bill, per claim and return on investment; AmeriSys customizes benchmarking for each client based on the specific network, geographic location and business rules the client sets. b) Outline how duplicate bills will be charged; and No charges for duplicates c) Identify any states in which your company use, a third party vendor for medical bill review services, and provide any unique pricing arrangements. AmeriSys does not use a third party vendor for medical bill review services with the exception of Dane Street for Peer Review services. Page 144 7. RISK MANAGEMENT INFORMATION SYSTEMS Google Chrome -compatible or Firefox-compatible claims management system platform providing real-time interactive communication and claims management between nurses, adjusters, the City, and its business units. The City will determine the number of accesses by level of use dependent on your company's system capabilities in coordination with your company during this RFP process. Please respond in detail to the following: 1. Confirm your company's ability to establish an interface with a RMIS vendor of the City's choice with no fee to implement. USIS has the ability of establishing an interface with a RMIS of the City's choice with no fee to implement. 2. Confirm that your company will provide a daily feed to a RMIS vendor of the City's choice at no cost. AmeriSys is ready to implement a daily feed with the City at no cost. 3. Identify the access your company provides to the database: Internet, 1-800 or local call access. An absence of any one of these could cause the City to incur unreasonable costs for long distance calls for access. Please describe alternatives to direct long distance charges if applicable. AmeriSys provides access to our AmeriSysiNet webportal which contains claims information. If access to our internal system is required, it would be a secured VPN connection with secure permissions into our Corrus system. ArneriSys has a 1-800 available at all times. 4. State your company's current internal requirements for claim files updates. Discuss how often claims files are updated for: a) Adjuster/nurse notes b) Financial information c) Resolution plans TCM notes/updates: Initial contact is completed with first contact with Injured Worker Notes are added every contact with Injured Worker, Provider, Employer and Adjuster Notes and updated Plan of Care is added including RTW plan after each provider appointment Staffing notes are completed after every staffing meeting including plan for RTW and MMI Monthly claim summaries are completed including plan for RTW and MMI 5. Confirm that your company's system has scanning capability for all mail/correspondence pertaining to the claim file, and if so, whether the images can be accessed real time by the client or if there is a delay. Detail any delay. All mail/con—espondence/bills are scanned, on the same day of receipt, to the claim file. The images are scanned into a .pdf format and are accessible to the client via the USISiNet web portal real time. 6. Outline your company's system abilities to report on each specific claim line as opposed to gross reporting on the incident. Case Management reports and Loss Run reports can be generated on a specific claim line, in addition to other reports. Additionally, ad -hoc and sql queries can also be generated for a specific need or request by the City. Page 145 7. State your company's policy on the ability of any outside entity to enter notes into your company's system and describe how this is managed. The ability for an outside entity to enter notes in the system is decided during the implementation process and very careful permissions would be applied to each user. A notification process is in place to allow the claim staff of a new note and for review purposes. 8. Outline how notes are categorized in your company's system (i.e. by type or subject] and your company's ability to select, or identify those notes pertaining to a particular category for review). Please explain the difference, if any, between Client access to notes vs. Adjuster access notes. Case Notes are categorized by a Case note type and also a subject. They can be grouped, and reported by any of the groupings available. The web portal grid allows to easy search of a particular set of notes via the advanced search feature. The clients have access via the web portal to the same notes the adjusters do. 9. Confirm that nurse's notes are included in the same system as the adjuster notes within your company's system. Confirm if client has access to all nurse notes, and if so, whether or not the notes are readable in real time, or if there is a delay. Detail any delay. Nurse notes are included in the same system as the adjuster's notes. Similar to the adjusters notes, they are made available to clients in real-time, however, sensitive notes containing confidential medical information will not be made available on the web portal. 10. Confirm that your company's system incorporates e-mail for easy communication between users, permitting an email to be launched from the claim pages. AmeriSysiNet allows the client to launch an email window from the claims page of the web portal. 11. Explain controls and requirements around version updates of software and any fees associated with them. Our Corrus system is designed and maintained by an experience team of developers in-house. A detailed testing process is in place and system releases are schedule for releases. Our AmeriSysiNet web portal is designed by an internal team of developers and also fully tested and documented by different developers prior to being released to production. Neither system have fees associated with them to the client. 12. Confirm your company's agreement for providing tapes or EDI transfer of data, loss runs, weekly transaction registers, claims updates, and 1099 reports on a timely basis and detail any additional charge. AmeriSys confirms and agrees to provide tapes or EDI transfer of data, loss runs, weekly transaction registers, claims updates, and 1099 reports on a timely basis and detail any additional charge. 13. Confirm that your company's system allows for entry, tracking and reporting of: a. Claims data by Client specific coding (locations, departments, divisions, Employee Numbers, etc.); Yes, our Corrus system does allow for claims data by Client specific Coding. b. Policy Information and whether that information can be attached to the claim; and Yes, and yes, the policy information can be attached to the claim. c. Exposures. Yes Page 146i 14. Confirm your company's ability for the City to manage location changes within the system (Le. closing of facilities and/or adding new locations). At the current time, the ability to manage location changes is an internal process, however, we have the ability of automating the process via a data interface as we do with many of our clients. 15. Describe systems standard reporting capabilities. Please describe ad -hoc and custom reporting as well as the Clients ability to create, modify, and run reports in your company's system. Please provide examples of ad -hoc reports and describe the ability to run the following: a. Run triangles by policy years; b. Loss stratification; c. Ability to create graphs within a report; d. Client's ability to create scorecard and dashboards; e. Automated import into Excel, Access, Microsoft Word etc.; f. Litigation reports including mediation and trial dates; g. SOL reports. Reports that are run 90 calendar days prior to the SOL's running for SOX compliance purposes; h. Samples of standard available reports, a listing of all available fields within the system, and your company's ability to customize fields for the City and its locations; and i. Ability to track and run loss time reports. N/A Refers to Part 1. 16. Describe Bank Reconciliation, Cash Disbursement System, Audit Trails, and overall financial controls. AineriSys assumes that this question refers to Part 1 TPA Services. However, the following is USIS/AmeriSys Internal Controls. Checks are issued via the computer system on blank stock, printed with client bank account information on a daily basis. The computer room is locked and access is limited to authorized personnel. • Checks are printed in the computer room and taken to the Accounting Coordinator(s) for processing. Check numbers are verified to ensure they are sequential and continuous from prior day. Checks to be mailed are kept in Accounting Manager's office until processed for out -going mail. All Accounting Dept. offices are kept locked when unoccupied. • Checks are not returned to adjusters unless necessary for settlement or special handling by adjuster. Those have back-up sheets signed by management, and checks are given to adjusters with signed acknowledgement. • Company policy dictates that no employee may put checks in the Outgoing Mail bins to sit throughout the day — they must be returned to the Accounting Coordinator(s) for secure handling. W-9 Procedures Handled by Accounting Coordinator, who has no system access to issue checks or make changes in the claims system. For a change of address/name for a provider to be made in the system, a properly completed W-9 form must be received from the provider. Supplemental addresses or billing entities (such as a dba) will be accommodated when verifiable and requested in writing. This is verified for accuracy, where applicable. against available IRS and/or Division of Corporations information. Page 147 Checks are only paid to providers when the 'Billing Inforrnation' area of the medical bill form matches the W-9 (or Substitute) information on file which becomes the Payee on the check. Additional addresses: only Claim Managers and Supervisors have access to create addresses that are not the claimants' or verified providers, eg. settlement checks payable to attorney and claimant. Check Signing Protocol: Two signatures are required on all checks; hand -signed original signatures are required on checks S2500 and over, and for any amount on settlements, etc. This allows us to personally verify that no large checks go through the system without being scrutinized. Checks are issued every day and the check signing processing is a detailed, time consuming process as a lot of different data is checked before the check is signed. Internal controls are very stringent. Signers are selected based on authority, tenure and always ensuring complete diversification of duties for security purposes. No employee from the Accounting Dept or Claims Dept is permitted or has access to sign checks since they have claims system access and can issue checks; under Brown & Brown corporate guidelines it is forbidden. Anyone who can enter claims to the system, pay bills or has system access to anything related to claims is not allowed to sign checks. This ensures there is an absolute separation of duties. Our company cheek signing procedures are set by USIS per corporate guidelines, audited by Brown & Brown corporate audit team (including a SSAE 16), reviewed by Quality Control as part of its audit, governed by Sarbanes Oxley guidelines, audited by clients, the State and reinsurers. The people who are chosen must have nothing whatsoever to do with claims so that there is no crossover of duties. They are long term employees and/or those in whom management has confidence and who take the responsibility very seriously. There are great lengths taken to ensure security on the checks, particularly because it is clients' money -- any check in the amount of $2500 and over is pulled and verified with back-up paperwork and hand signed. The facsimile signature is computer -generated - printed to a check via the system check print onto blank check stock; the MICR coding, check number and client information is printed on the check in the computer room, which is a secured area. There is always back-up to any check. A check is not signed without a hill. EOB or a back-up form signed by the adjuster and the supervisor. As well as signing, the check -signer is verifying that the check was entered/paid correctly with the correct FEIN, claimant name, dates of service, amount, etc. Any item in question is verified with the claims manager and if anything is incorrect, the check is voided. Positive Pay We work with our clients and their preference of bank to set in place a "Positive Pay" process for all checks that are written within our system. Your bank is electronically notified the same day your checks are processed, Your bank will then only accept checks that were verified by our data feed to them. Payee, Check number, and Amount are key elements on all transactions. Bank Reconciliation Bank reconciliations are completed on a monthly basis. A copy of the reconciliation, bank statement and detailed check register will be emailed to a designated representative at the City of Miami. Page l48 17. Confirm the system has been reviewed by impartial outside experts and rated or written about in any publication. If so, please include copies of the publications/articles. The internal quality control system at USIS/AmeriSys is built in a working environment that is maintained by checks and balances for all activities. Control activities begin with a code of conduct and behavioral standards that must be signed by each USIS/AmeriSys employee at hire confirming his, her responsibility to follow company policies and procedures. USIS/AmeriSys implements separation of duties to avoid any acts with detrimental consequences. Separation of duties and all other internal controls are reviewed yearly by a SSAE16 Audit. The City of Miami would have access to the USIS/AmeriSys SSAE16 results each year. Upper management is extremely involved in day-to-day processes and procedures making for an even more secure control environment. Please reference Attachment 13 — SSAE 16 excerpt. 18. Please outline in detail access fees for your company's Claims/RMIS system and alternatives fee arrangements. AmeriSys does not charge access fees. 19. List the technical/system requirements necessary to access your company's Claims/RMIS. The client has access to our web portal. The only requirement is a web -browser. 20. Please detail available system training for the City and member employees including the typical time periods that should be dedicated to that training. System training would be conducted by AmeriSys in person at the City's facility if chosen by the City. After implementation, future trainings would be available and web training is always an option during the course of the contract. 21. Please detail that ongoing technical service assistance would be provided to the City and included in your company's fees. Please outline costs for additional services and what those additional services might include. Ongoing technical service assistance for would be provided by AmeriSys to the City and it is included in the company's fees. 22. Please provide the name and phone number of the technical resource(s) that will be responsible for data transfers, upload and system changes. Viviane Ruiz, Vice President Business Integration 407-949-3100/Viviane.ruizgusis-tpa.com 23. If the City does not renew its contract, outline and itemize in detail, all charges to maintain indefinite access to the system for all prior users. AmeriSys would charge $5,000.00 annually to maintain indefinite access to the system for all prior users. 24. Outline your company's system OSHA Recordkeeping and reporting ability: a. Outline/describe how the OSHA recordkeeping is integrated with the claims management system and your company's ability to provide annual logs in PDF format by plant/location. b. Confirm if your company have an OSHA consultant that is able to make a determination regarding recordability [reportability] under OSHA. NA Refers to Part I. Page 149 25. Please describe in detail your company's implementation process and provide bio for implementation team. Ron Warble, Executive Vice President, Ext. 6503 ron.warbleOusis-tpa.com Mr. Warble serves as Executive Vice President of USIS and is responsible for oversight of claims, medical management and overall operations within USIS. He has 33 years of experience in the Workers' Compensation arena. He previously owned and managed his own company which was acquired by USIS in April of 2000. That experience has allowed him to develop skills and expertise in many areas and is now being utilized to assist USIS' customers in providing quality and relevant programs on behalf of their injured employees. Additionally, Mr. Warble has had the honor and privilege to serve on the Georgia Chairman's Advisory Council for Workers' Compensation since 2008 and currently serves as the Chairman of the Medical Committee in that group. Cheryl Gulasa, RN, CPIIM, CCM,_ VP/AmeriSys, 800.444.9098 Ext. 6219 chervl.gulasa cr usis- tpa.cont Cheryl is currently the Vice President for AmeriSys. Her primary responsibilities include overseeing the professional operations of AmeriSys — Telephonic Case Management, Field Case Management, Provider Relations and Utilization Management, including Bill Review. Cheryl has 30 years' experience in nursing, the last 14 years in workers' compensation case management and utilization management. She has successfully implemented large public entity programs. Cheryl's experience coupled with her energy and leadership skills brings valuable assets to our organization. Jen White, RN, CCM, Program Manager/Supervisor, 800.444.9098 Ext. 6567 ien.white(ir usis- tpa.com Jen is currently Program Manager for AmeriSys in Florida. Jen is a Registered Nurse and Certified Case Manager. She has extensive workers' compensation experience including supervisor roles in large public entity programs. Jen joined AmeriSys in 2012 and has successfully enhanced program efficiencies and productivity while preserving customer service and satisfaction. Prior to joining AmeriSys, Jen worked for an international all lines insurance company as a telephonic case -manager for workers' comp claims in the states of Florida, North Carolina, Tennessee, New York, Rhode Island, New Hampshire, Massachusetts and South Carolina handling large national corporate accounts. Jen has clinical experience in Rehabilitation, Orthopedics, Neurology, and Emergency Room; with over 10 years in Quality Assurance and leadership positions. Eunice Romich, RN, Director of Provider Services, Ext 3118 eunice.romich'u amerisys- info.com Eunice is currently the Director of Provider Services at AmeriSys. Primary responsibilities include managing and coordinating issues involving provider networks utilized by AmeriSys, and educating and training case managers and staff regarding utilization, access, and grievances for network providers. Prior to this role, she was the telephonic case manager supervisor at AmeriSys. Eunice is also the Quality Assurance Coordinator and she ensures all medical management services are in compliance with statutory regulations, and the deliverance of quality care to all injured employees. She has 13 years of nursing experience, with the last 6 working in the workers' compensation field. Background nursing experience consists of cardiology, orthopedics, and surgery while working in both hospital setting and outpatient surgical setting institutions. Prior to joining AmeriSys in 2014, Eunice worked for an international all lines insurance company. in Alpharetta, Georgia, as a telephonic case -manager for workers' comp claims in the states of Georgia and Alabama. Page I50 Amv Krietemever, RN, CCM, Field Case Management Supervisor amv.kriietemeyerliianaerisys-info.com Amy is the Supervisor over Field Case Management. As Supervisor she is responsible for overall technical and quality oversight of field case management services. Primary duties include planning and directing field case -management services, assisting in development of long range plans for the department, promoting staff education and development, meeting with current and prospective customers and clients as required, overseeing compliance with all governmental agencies as it relates to field case management services and day to day management of the field case -management departments. Amy also serves as a resource to all departments, assisting in the development of service proposals for prospective clients and certifying cases as catastrophic as indicated by state law and in-house procedures. Amy has over 24 years of nursing experience, 20 of which has been devoted to the Worker's Compensation industry. AmeriSys has created a proposed implementation plan which includes the activities and tasks, along with the date and resource assigned for each activity. The implementation plan may be modified upon successful award of the contract based on initial meeting discussions between AmeriSys and the City. The implementation plan also demonstrates the information that will be needed from the City in order to begin the implementation. Please reference Attachment 10 — Transition Plan, 26. Detail system support set-up. USIS will provided the Helpdesk email address and 1800 number. Additionally, an email address could be implemented as a distribution group that would reach key personnel at USIS in event of an urgent matter. 27. Is there an 800# provided for technical support. Yes, our help desk has an 1-800 number. 28. Confirm your company's agreement to provide a designated support/contact and backup for the City. Yes, AmeriSys will have a designated support/contact and backup for the City. 29. Please detail any ongoing technical service assistance that would be provided to the City that is included in your company's fees as well as outlining costs for additional services. USIS would be prepared to provide technical services with our USISiNet web portal, additional training. reports, data interfaces, and with any additional technology used and offered by USIS as part of the contract. 30. Confirm your company's agreement to provide loss information to Beecher Carlson as requested. Please provide the name of the individual who would be responsible for providing this information and working with Beecher Carlson on that information. USIS agrees to provide loss information to Beecher Carlson. Viviane Ruiz is the responsible at USIS for ensuring this data is provided. Page 151 8. ACCOUNT MANAGEMENT The City believes coordination of service would best be accomplished with an empowered Account Executive. This individual should have excellent service management skills; analytical skills with strong spreadsheet, graphics, and database experience; a background in claims and risk management; and tenure within your organization. The Account Executive would need to have clear authority and lines to operating authority within your company's organization, so that required changes in service could be readily accomplished. We envision the Account Executive would have responsibilities to include: a) Working cooperatively with the City and its partners and/or vendors; b) Monitoring and reporting on compliance to agreed Quality standards; c) Using your company's Claims/RMIS to analyze and report on performance, with a view towards discovering and communicating potential for continuous improvement; d) Educating Successful Proposer's team members regarding their performance and the City expectations; e) Developing satisfaction surveys, and survey reports on the City satisfaction with various services; f) Providing the City with ongoing assistance in using your RMIS/claims management system and analyzing data in a pro -active manner; g) Troubleshooting all problems related to service delivery/claims management, in coordination with the Successful Proposer's claims office(s), the City, business units and locations; h) Studying the potential benefits of new or revised services, and making recommendations for such; and i) Assisting the City and Beecher Carlson with special project requests. AmeriSys agrees to the above Account Executive responsibilities. Please respond to the following: 1. Confirm your company's agreement to ensure that the assigned Account Executive will be available to the City 24/7. AmeriSys agrees that the assigned Account Executive will be available to the City 24/7. 2. Provide a backup for the Account Executive. Provide credentials of the Account Executive who will be primarily responsible for the management and supervision of this account, and a listing of other clients this Account Executive handles. USIS will provide a backup to the Account Executive. The credentials of the Account Executive are below. Cheryl Gulasa, RN, CPHM, CCM, Vice President/AmeriSys, Ext. 6219 cheryl. gulasa(t Jamerisys-info.com Cheryl is currently the Vice President for AmeriSys. Her primary responsibilities include overseeing the professional operations of AmeriSys — Telephonic Case Management, Field Case Management, Provider Relations and Utilization Management, including Bill Review. Cheryl has 30 years' experience in nursing, the last 14 years in workers` compensation case management and utilization management. She has successfully implemented large public entity programs. Cheryl's experience coupled with her energy and leadership skills brings valuable assets to our organization. Cheryl is responsible for the following accounts: State of Florida, State of Georgia, Broward County Government and the City of Jacksonville among others. Page 152 Describe the manner in which the Account Executive will monitor the level and Quality of service provided to the account. The Account Manager will monitor to ensure all agreed upon schedules and costs are being followed. Each unit leader is responsible for monitoring work product to ensure the staff is adhering to the agreed upon schedules, costs, account -specific protocols, work policy and procedure, including that all providers are within the network and on the USIS ancillary preferred provider listing to ensure cost savings for the City. 4. Explain the account manager's limits of authority. Provide an example of a client mandated change that would require authority beyond that of the Account Executive. The Account Executive limit of authority Limited at contract changes at which time the Executive Vice President would become involved. 5. Provide an organizational chart of your company with special emphasis on operations, safes & marketing and account management. ..ma leeMpraYon AAARpfth Mnysre Eup,ma1 :MEWL GVI&SA.. ON Yaaa PEPEIpm1 Arya RON WARBLE EXECUTIVE VICE PRESIDENT 4.000.13. AM etMF*i. Ibl YPEREiC ]yTE4 RM ENNEEPepea Kt WE ,iNMO 0/.444 NM NaNgPr IIN Son*** VE %ytt lab.. 1KNS f f},Erletd a„an CEO COELEE :realaK 6.41.0.61 a1e1ln44 Na IEVEEEEffet VOA Am+;RY tmemalam EYMEI SEM :ql PEEInet $A Fteecaywmam UpePeNP elw .el8vnpa.f hElvElErEkEWEEEE CEmedEtabEr MOIE11E GQTmQ wraNp ligEoloolos Lama teed. CEEsoltEats 3Ebn' xi:,.y CUIm Yaaiyr CMma UM cL&_a C.eea.1 AetEE.1 loam LEa6 ClowE, S %%pavan ,N9AN as TRAMP 9CdP IWF4M Briar Degoeimerrist CIMwa Ilaeayar G'swe Vow 6. Provide where the Account Executive will be located geographically. The Account Executive will be located in the Greater Orlando, FL area. WeEl#:S YMe rnanaua EWE Page 153 7. Outline the process that would be followed by the Account Executive should an adjuster, supervisor, or other team member fail to meet agreed the City expectations, based on an appropriate and acceptable performance evaluation. If failing, areas of education needed are identified and retraining is initiated. Employees are measured on quarterly scorecards and annual performance reviews. Once all education efforts have been exhausted, progressive disciple will occur which may include termination. AmeriSys Policies and Procedures include routine audits of the medical/clinical services and TCM activity of at least 10% of the files quarterly. Results are presented to the QA committee for review, and areas of education are identified. Audit results are communicated to all appropriate parties along with AmeriSys Quality Assurance Committee. Please reference the sample of our medical case management audit on the following page. This audit includes the monitoring that all practices are within approved guidelines and protocols are within the parameters of the Florida Statute and rules. This audit also contains all the necessary components of successfully managing a file to MMI. Each account supervisor provides a summation of the audit scores for the months included in the quarter to the AmeriSys Quality Assurance Committee for round table discussion, tracking and trending. Proactive performance -enhancing coaching is constant and on -going. A quarterly scorecard evaluating key performance indicators for each position is utilized for employee education and commendation, along with a more comprehensive evaluation on an annual basis. Quarterly scorecards are completed on each staff member by his/her direct supervisor. The scorecards allow the employee and the supervisor to discuss current issues, allow the employee a brief evaluation of how he/she is performing in comparison to the Key Performance Indicators assigned to that position, recognize the areas that the employee has gone above and beyond in helping his/her team succeed, and set goals for the next quarter. An annual performance review is completed in a more detailed and cumulative account of the employees performance for the year. In comparison to the short term goals addressed in the scorecards, the annual review addresses more long term goals regarding the employee's position. Page 154 TCM Thirty Day Audit Account: Auditor Total Points: Date completed: Total Possible: Audit Score: Note Date/Case Note? PCP/Physician listed in :hone icon? Medical treatment scheduled within last (30) days or as ter MD instruction? Last o ce visit identified? Next office visit identified? (This may include indication of time frame, i.e.: followin* MRI, PT, etc.) Current Work Status Addressed and documented? MMI addressed in note or care plan (anticipated date? NCP for next (30) da s? IW seen b MCC eve 30 da s? Has it been documented if there were red flags noted and addressed? Notification _iven to Ad'uster Documented? Current Medications Appropriate to WC Diagnosis and Treatment Plan? Has it been documented if there were medication concerns noted and addressed? Average monthly medication cost addressed? Practice Parameter compliance per MD Guidelines and documented? FRIIERAMPIMTPILTSVIM Diaries Pertinent and Timel •? Initial Assessment Documented? Cost Savings Documented (internal Audit Return to Work screen Areas of Concern/Conclusion: Areas of improvement: Solution/Plan to Address: Signature: Pape I55 8. Please confirm the availability of the Account Executive to travel and participate in meetings and training throughout the year. The Account Executive will be available to travel and participate in meetings and training throughout the year. 9. Should it become necessary, describe the process for the replacement of the Account Executive and/or claims adjusters. The AmeriSys Executive Vice President will inform the City of Miami if the Account Executive needs to be replaced. if a Nurse Case Manager needs to be replaced, the Account Executive will notify the City of Miami. The Account Executive, Nurse Case Manager and support staff are employees of AmeriSys. All of our staff is properly licensed as required and attend continuing educational classes on a regular basis. It is our intent to positively ensure that our equal employment opportunity philosophy, in accordance with federal, state, and local law, applies to all aspects of employment with AmeriSys including recruiting, hiring, training, transfer/promotions, compensation and benefits, and termination. At AmeriSys, handled through our Human Resources Dept., we ensure that our employment practices are free of discriminatory practices and that employment decisions are made on the basis of job -related qualifications, experience, including personal competence and potential for advancement. We would be willing to share the resumes of the employee(s) hired or transfen-ed internally to handle the City of Miami account. Once into the contract, should there be any staffing changes necessary, AmeriSys would communicate with the City as soon as known. AmeriSys will ensure that the staff handling the City's account is a good fit with the City's personnel and has the necessary experience for properly managing the claims, along with excellent customer service, communication and rapport -building skills. It should be noted that at AmeriSys we are committed to ensuring equal employment opportunity for all employees and applicants for employment. It is our goal to recruit, hire and develop the best employees using only job -related qualifications. We know that our people are the heart and soul of our enterprise and we recognize that our continued success depends on the full and effective recruitment, hiring and development of the very best employees, taking into consideration only job -related qualifications, regardless of race, color, religion, sex, age, national origin, marital status, disability, veteran status, genetic information and any other category protected by state or federal laws. AmeriSys strives to recognize the talents and job performance of all employees, and values the contributions that come from people with different backgrounds and perspectives. It is AmeriSys' desire to promote an environment that maximizes the potential of all of our employees, and to promote diversity throughout the Company because we believe that diversity is important to our ability to continue to excel in an increasingly diverse and dynamic marketplace. The Company does not permit discrimination or retaliation against qualified individuals with disabilities in regard to application procedures, hiring, advancement, discharge, compensation, training, or other terms, conditions. and privileges of employment. The Company will reasonably accommodate qualified individuals with a temporary or long -terra disability so that they can perform the essential functions of a job. A job applicant who can be reasonably accommodated for a job, without undue hardship, is given the same consideration for that position as any other applicant. Page 156 10. Provide the City with the name, contact person and number for (two) 2 current clients and (two) 2 former clients serviced by the proposed Account Executive so we may conduct reference checks. Current Clients Client Palm Beach County Sheriffs Office Client contact person Hilda Gonzalez Phone number 561.688.3550 Email address gonzalezH )pbso.org Client Broward County BOCC Client contact person Jeff O'Connor Phone number 954.357.7230 Email address JCOCONNOR;browvard.org Client City of Jacksonville Client contact person Twane Duckworth Phone number 904.630.2777 Email address twaned c coj.net Former Clients Client Marion County Client contact person Sheri Wiley Phone number 352.629.8359 Email address sheri.wiley@mationcountyfl.org 9. PRICING The City is requesting pricing for: PART l: Third Party Claims Administration (Please also refer to Section 2.18, Compensation Proposal of the solicitation): 1. Please provide your company's pricing options for claim handling such as; annual flat fee/annual retainer, per claim, per hour, etc. All pricing should be based on a life of claim basis within the authority and reporting levels outlined. Please also provide an alternative quote for a dedicated unit for handling claims for the City. Please be specific and detailed in all explanations of claim pricing. 2. Provide a complete listing of all charges that will appear as an allocated expense in addition to the flat rate/dedicated unit pricing. If the actual fee is known for that allocated expense, please include that fee. 3. Provide a complete listing of all services that are included in the flat rate claim handling charge. Identify any services that your company consider outside the flat rate claim handling charge. 4. Identify any outside vendors with which your company's contracts, stating their names, locations, and expertise, and identifying under what circumstances they are retained. 6. Confirm your company's agreement to keep any necessary time and expense charges to a minimum. 6. Describe, from an accounting standpoint, how your company treats duplicate files and files set- up in error once the error is caught. Describe procedures in place to identify duplicate claims. 7. Confirm your company's agreement to participate in a Performance Guarantee. 8. Confirm your company's agreement to assume any contractual responsibility for reporting to excess or re -insurance carriers. 9. Please outline your company's options for banking and loss funding arrangements. N/A - RcferstoPartI. PART II: Managed Care/Medical Bill Review Services. Provide quotes for all possible pricing alternatives, including a flat fee inclusive of PPO, and specialty network savings for the following: a) Fee Schedule (Bill Review); b) Medical provider System Networks; Preferred Provider Network (PPO); c) Out of Network (OON), Specialty Networks/Physical Therapy (PT); d) Medical bill review; e) Incident triage; f) Pharmacy Benefits Manager; g) Telephonic Nurse Case Management; h) Field Nurse Case Management; i) Utilization Review; j) Physician Review/Peer Review. Please Reference .Attachment B2 — Managed Care Price Proposal. Page 158 ATTACHMENT 1 Brown & Brown, Inc. Annual Report Brown ck Brown. Inc. • ' • "i ,1111 A 11 -• 0 , •..-1,. , .R. ff.4.•. Z. . I, {,-.7,... ..0.). ... .....11171"....la ‘: "4.4 'e °II' - . Will.laP. 41.111114Mrli-i°, _ -,-_,,, .r.fr-' .' ' ''''—:•::- ' 2'.—.016 aieto-.1.111.41.1110.M0.4100.0............- • - A. 'tr.-dill*. - - ..a. _ ....v.diesm... ...NO . .... Aim- ...- ..... -..,rar. ,........... .. .... ....- ............ ...,"....4.0.• Z.-.... -, - ,--...—•010.M" '''' '."........"4.111111-. +0,0...- - - - - • .....c . . ---..--A_dessio....romr7.11100.0.-dmillail&Z.....11.112;.. "4-...... .-eViEiLLOAIIV.-Ar,-- 7.iiirimt,......,__ ._,...... — --.0....ammit ... - - -- 4•1`"''''' — '-""`" ."--7 - , _. _ Lpa-1, f7.110141.11.0Mr"..- 7 R 1 NSW NNW I IMO WMIP M▪ EP Ar E� tiOT ar IMI n pi 11a111 _ .+ _ _a 111 r nfil � _• : ..MUD �'1 I:l nii�i • 1� •. II M NM .,_ ems.. # 1140.110.1, 1 r II IIIH-i1 R4` -"-" 1 xi 1t i11I�.fS W. • ��■1111R? �11 41 gllnl�'■_ • ■ !! IIA. 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This singular has been central to our for more than 75 years. 7 LETTER TO SHAREHOLDERS To our shareholders: 2015 was another year of growth and investment for Brown & Brown, even with a slowly improving economy and continued rate pressure, most notice- ably in coastal property. We grew our business to $1.66 billion in revenue, which is an increase of 5.4% and 2.6% organically over 2014. Our earnings per share were $1.70, which represents a 2 5% increase. Our growth would not be possible with- out the continued progress and development of each team member in our group of just more than 7,800 teammates. Through all the hard work of those teammates, we generated just over $400 million of cash flow, which was redeployed Into our Company and back to our shareholders. Last year, we allocated our capital through a mix of hiring new teammates. acquisitions and returns to shareholders through dividends and share repurchases. We constantly review this strategy with an eye towards the long term and how we can deliver shareholder returns. Last year, we made investments in people, acquired $56 million of annualized revenue. bought back $175 million of our stock and paid dividends of $64 million. Our dividend increase last year rep- resents our 22nd consecutive year of dividend J. Powell Brown. CPCU Presicentarc Chief Executive Officer increases. As we approach our $2 billion intermedi- ate goal. analytics are essential to forecasting and achieving long-term results. It is essential that we tap the deep pool of information that is dispersed in our 241 locations and use this information to the benefit of our customers. Thus. we will be making incremental investments in technology over the next two to three years with a total estimated cost of $30-$40 million. This is part of our evolution to the next level and beyond. This will give us the ability to leverage our revenues and gain additional insight into our business. We are an organization that grows organically and through acquisitions. When it comes to the acqui- sition process. cultural fit is the most important dynamic. and then the acquisition must make sense financially. If there is not a cultural fit. we do not move forward. In 2012.2013 and 2014, we purchased about $150 million annualized revenues. In 2015, we acquired companies with $56 million of annualized revenue. Our goal is to acquire firms of all sizes in each of our four segments that fit culturally and make sense financially. 2015 was a year in which we looked at a number of acquisitions that fit culturally, but the economics did not make sense. We are comfortable that this approach will enhance shareholder value for the long run. For the past 12 to 18 months. we have been dis- cussing rate pressure, especially in coastal property areas and the middle market. This is positive for our customers. but puts pressure on several of our pro- grams' businesses and certain segments of our retail and wholesale businesses. As you may know. it has been 11 years since the last hurricane struck Florida. So long as the sun keeps shining and fair winds keep blowing, property rates in coastal areas will continue to be under pressure. One of the changes we experienced in 2015 was the retirement of Linda Downs. Linda was one of our most valued leaders and closest friends. When she started with Brown Si. Brown 35 years ago, we were $2 million in revenue. Linda has been instrumental in the Company's growth and success, and she helped Browr & Brawl'., inc. 8 shape who we are today. The recognition we bestow annually to leaders who are integral to the development of rising team- mates will be named the Linda S. Downs Mentor of the Year Award from now moving forward. Brown & Brown's culture statement is very straightforward — "We are a lean. decentralized. highly competitive. profit oriented sales and service organization comprised of people of the highest integrity and quality, bound together by clearly defined goals and prideful relationships. This is what drives us each and every day as a team to perform at a higher level and links us with our strategic plan. We strive to: • Exceed customer expectations every time • Increase long-term shareholder value • Recruit. develop and reward our teammates • Grow our business organically and make quality acquisitions that fit culturally • Cultivate and enhance relationships with our carrier partners Thank you for your support of Brown & Brown. Our greatest assets are our teammates. our reputation and our capital. We make investments with this in mind for the long term. We are now approaching our $2 billion intermediate goal that we will attain through profitable organic growth and acquired revenue. There is no timeframe, but when we get there, we will set a new intermediate "stretch" goal. In closing. we are a "three yards and a cloud of dust" company that believes the only constant is change. All of us here at Brown & Brown are excited about 2016 and beyond. Regards. J. Powell Brown, CPCU President and Chief Executive Officer 1r:sletter .rducesselec:e: e•e,e^ces:3ce*a;nron-C,MP,t^arc+ alreast.res:^a. are made to provide adds ora. rreanirgfut rnethodsofevaluar,rgcertain aspects of our operatirg perforrrarce frarr per od :o period or a bas-.s :hat may rot be otherv:se apparer: or a GAAP bass. Far recorc - a: or and other rformatior corcerr'rg :hese roc -GAM f narcial measures •efer:c Gage 88 of :re Carroary s 2015 Arrual Report. 2,114 2,150 Total Revenues dollars in millions 1,363 1,200 1,014 11 12 13 1,576 14 1,661 i Net Income Per Share Diluted in dollars 1.70 L48 1.41 1 1.12 .26 11 12 13 14 15 Shareholders' Equity dollars in millions zoo 11 12 13 14 15 9 RETAIL Expertise and education support growth of The Joint Corp.'s business. When Brown & Brown first wrote coverage for The Joint Corp.. a busi- ness specializing in chiropractic care, it was a startup with 12 locations.. Now it's a publicly traded company with 335 Locations nationwide with ever-increasing business and risk complexity. Asa result of Brown & Brown's expertise and educational approach, and ability to manage The Joint's national expansion and breadth, The Joint named the Com- pany as the required Property and Casualty insurance provider for all franchises. Brown & Brown accom- plished this by holding monthly seminars for new franchise owners to explain why it's so important to manage risk and why it is imper- Brown & Brower. ative to buy proper coverage. This approach empowered the franchisees to feel informed and knowledgeable about how to man- age their risks and how what they're buying will respond in the event of a claim. Brown & Brown originally provided only the Property and Casualty lines of insurance for both the corporate -owned and franchise locations of The Joint. As a result of delivering value-added solutions, Brown & Brown began providing their employee benefits, as well. It is through Brown & Brown's flexibility, expertise. depth and attention to customer service that the Company is able to tailor solutions for The Joint and our many other customers. 10 John Richards Chief Executive Officer The Joint Corp. Scottsdale, Arizona Wayne Hubbard, CIC Senior Vice President Property and Casualty Brown & Brown Insurance of Arizona, Inc. Phoenix, Arizona oQ� r QY, f'.r• Chris P. Scherzer Senior Vice President Employee Benefits Team Leader Brown & Brown Insurance of Arizona, Inc. Phoenix, Arizona 11 Execut ve Ice "r" dent Brown & Brown Insurance of Arizona, Inc. Phoenix, Arizona REVIEW OF OPERATIONS The Retail Segment Success under all conditions. The Retail Segment is the largest of Brown & Brown's four segments and generated approxi- mately 52% of the Company's total revenues in 2015. In September, the Retail Segment was realigned into several regionalized segments. We believe this realignment will enable the Retail Segment to better focus on the specific needs of each particular region and serve our local customers by being able to adapt to changing market conditions even more quickly. One of the most striking testaments to the strength of our unique culture at Brown & Brown is our ability to succeed in both in good times as well as when circumstances are less than ideal. In 2015, the Retail Segment grew in spite of rate reductions and a slowly improving middle market economy. The success of the Retail Segment is solely the result of the efforts of our teammates. While no one enjoys challenging times, they do show what people are made of. and our teammates perform well under pressure by collaborating and innovating. In the Retail Segment. we continued to deliver great solutions for our customers by leveraging the capabilities of our carrier and wholesale brokerage partners that drove new business to a record high in 2015. Again, this is attributable to the culture of cooperation and self-discipline at Brown & Brown. Our offices did a tremendous job of sharing information and working together to find or create the best solutions for our customers. We believe we are well positioned for 2016. Looking to 2016. the Retail Segment MI con- tinue to focus not just on hiring the best people. but also on the training and development of our teammates. Additional priorities include enrich- ing our partnerships with carriers and continuing to develop innovative new products that reduce risk for our customers. B-o+v^ S Brow^, Inc. 12. Segment Total Revenues dollars in millions 737.3 11652.1 11 12 13 14 870.3 Our Retail Office Locations 15 Segment Adjusted Operating Profitl'I dollars in millions 211.3 197.5 11 12 memidatTr . Fr- -0 Contribution to Total Revenues 52.4% 257.8 271.2 Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Illinois Indiana Kansas Kentucky Louisiana Contribution to Total Adjusted Operating Profits') 50.0% Segment Adjusted Operating Profit Marginl'I as a percentage 32.2 32.4 32.5 1111312 Massachusetts Michigan Minnesota Mississippi Missouri Nevada New Hampshire NewJersey New Mexico New York Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina Tennessee Texas Vermont Virginia Washington Wisconsin Outside the U.S. Bermuda Cayman Islands (1) Please see non-GAAP reconciliation on page 88. 13 Crystal Million tlii��, and Operations, F' roperty Division Arrowhead General Insurance Agency. Inc. Carlsbad. California Brown & Brown. Inc. La Thum Vice =' "sident - Marketin: Per Property Divisio Arrs; dGeneral Ins Age; C• " allfornia Mark Corey President. Personal Property Division Arrowhead General Insurance Agency, Inc. Carlsbad, California 14 NATIONAL PROGRAMS Responding to challenges with innovation and determination. The National Programs Segment has always been diversified and innova- tive, and in spite of the challenges the entire industry faced in 2015, the National Programs Segment continued to innovate and expand our program offerings that delivered growth in 2015 and will have a pos- itive impact in 2016 and beyond To exemplify this innovation, our Arrow- head business in San Diego realized there was an opportunity for our cus- tomers to better manage their coastal property risks. This was specifically in response to a need for broader earthquake coverage in California, hurricane coverage in coastal areas, and coverage for tornadoes in the Midwest. By finding niche markets, 15 following the need and offering innovative solutions, we've helped thousands of people manage their risks and provided growth oppor- tunities for our carrier partners. In addition, last year our teammates saw an opportunity to work with our carrier partners and expand coverage for certain commercial customers. In addition to providing coverage for earthquake damage, with our new "all-risk" insurance program, we now have additional capacity to insure customers for a combination of wind damage, fire damage and more. This new "all- risk" program further broadens our capabilities and creates additional solutions for our customers. REVIEW OF OPERATIONS The National Programs Segment Viewing challenges through a lens of finding opportunities. Brown & Brown's National Programs Segment generated approximately 26% of the Company's total revenue in 2015. The goal of the National Programs Segment is to be the most efficient and innovative program manager in the specialty insurance market, while providing our teammates. carrier partners and distribution partners with opportunities for growth and enrichment. The importance of Brown & Brown's unique culture was never more evident than in 2015. Through collaboration, the National Programs Segment was able to grow in spite of a competitive and dynamic market. The challenging market conditions in 2015 sharpened the focus of the National Programs Segment and served as a launching pad for some tru ly exciting achievements, including the creation of our new "all-risk" insurance program. The new incubation team we created in 2015 is a team designed to collaborate and vet new ideas, products and programs. Again. without the culture of cooperation that exemplifies Brown & Brown. an effort such as this wouldn°t be possible. At Brown & Brown we work together to create innovative, viable solutions for our carrier and distribution partners, The focus has always been, and will continue to be, on our partners and how we can create solutions for our customers. The diversification and specialization of Brown & Brown's National Programs Segment is aimed at allowing it to achieve good results in the industry. For example. while competition in commercial property insurance was fierce last year, our personal Lines grew strongly, bolstered by dose relationships with our partners and the introduction of new products. This balanced portfolio of businesses enabled the National Programs Segment to grow in 2015 in spite of rate pressures and economic challenges. Innovation was not only focused on revenue growth. but the National Programs Segment worked tirelessly to further increase the scale of our technology platform and enable continued increasing profitable growth by taking advantage of our leadership position in the marketplace. As a result. the National Programs Segment oper- ates more efficiently than ever and will continue to seek opportunities to capitalize on our scale and standardization. This is critical because while no one can anticipate the direction market con- ditions will go, we believe the National Programs Segment is well prepared to face any challenge. In 2016, the the National Programs Segment's top priority is to achieve a solid rate of organic growth, capitalize on our new initiatives, and add more talented, hard-working insurance professionals to our team that will enable us to achieve our goals. Brown & Brown, lnc. 16 Segment Total Revenues dollars in millions 428.7 404.2 301.4 260.4 169.7 111 11 12 13 14 National Programs AFC Insurance Allied Protector Plan American Specialty Arrowhead General Insurance Agency Bellingham Underwriters CalSurance Associates Clear Risk Solutions CPA Protector Plan° Downey Public Risk Underwriters Florida Intracoastal Underwriters Ideal Insurance Agency Contribution to Total Revenues 25.9% Segment Adjusted Operating Profit{'l dollars in millions 153.4 104.9 . 97.6 74.1 11 12 13 Segment Adjusted Operating Profit Marginw 1593 as a percentage 43.7 37.S 373 37.1 34 8 14 15 11 12 13 14 15 Irving Weber Associates Lawyer's Protector Plan° onPoint Underwriting Optometric Protector Plan'' Parcel insurance Plan Proctor Financial Professional Protector Plan for Dentists Professional Risk Specialty Group Professional Services Plans Public Risk Advisors of New Jersey Contribution to Total Adjusted Operating Profit 28.8% Public Risk Underwriters Sigma Underwriting Managers Texas Monarch Management Corporation TitlePac° Wright Flood Wright Public Entity Wright Specialty For additional information on National Programs please visit www.natpragrams.com (1) Please see non-GAAP reconciliation on page 88. 17 2015 Ann,_. ?. WHOLESALE BROKERAGE One especially exciting accom- plishment for Brown & Brown's Wholesale Brokerage Segment in 2015 was a new opportunity in professional practice coverage for a large Iaw firm. One of our retail agents approached us about this prospect and indicated they didn't have access to carriers that focus on this type of coverage. We quickly selected one of our top teammates to work on designing a solution for both the agent and the customer. Brown & Brown. Inc. We analyzed the expiring policy. risk profile, and the customer's risk retention appetite, then worked with our vast group of carrier partners to secure coverage that would manage the risks and provide the customer with a cost-effective solution. It was only through our innovation and deep carrier rela- tions that we were able to win the business. Through this creativity. it has opened up other potential leads for more large Iaw firms. 18 19 REVIEW OF OPERATIONS The Wholesale Brokerage Segment The loyalty of our teammates is a testament to our culture. The Wholesale Brokerage Segment of Brown & Brown generated approximately 13% of the Company's revenue in 2015. In spite of enormous rate pressure on coastal properties. the entire team rallied in 2015 and made it possible for the Wholesale Brokerage Segment to deliver 5.9% organic growth. The Wholesale Brokerage Segment, like other areas of the Company, is a highly diverse business, which we believe enables us to be successful even when we face challenges on a number of fronts. In 2015, our property brokerage business was challenged by declining property rates, but our team looked for opportunities and worked tremendously hard to make progress in other areas. Because of our expertise and strong carrier relationships, the Wholesale Brokerage Segment created new opportunities in the area of professional practice liability coverage. It's this type of collaboration and tireless determination thatexempllfies both theWhoiesale Brokerage Segment and the entire Company. A huge testament to the importance of the culture at Brown & Brown is the loyalty and determination of our teammates. When times are tough, our team doesn't give up. They keep pushing forward to find new opportunities and solve risk management challenges for our customers every day. That leads to our top priority in 2016: hiring. training and mentoring even more new team- mates. It's important to remember that the effort doesn't stop with hiring, Brown & Brown has an excellent training program and is also fortunate we have numerous teammates throughout the Company who make it a point to seek out and mentor new talent. Many of our seasoned brokers have newer brokers with them every day in order to help develop their skills and become highly successful. It is this type of one-on-one attention and education that makes a real differ- ence in developingtomorrow's leaders. Another top priority for 2016 is expanding our capabilities geographically and serving some of the markets that we do not fully support today. This effort will be led by a number of our top lead- ers, and we are excited about our potential for growth as we expand our geographic footprint. Regardless of what 2016 brings. we believe the Wholesale Brokerage Segment will continue to innovate, endure and thrive. Thanks to the loyalty. creativity and determination of our teammates and our willingness to present our customers with effective solutions, we believe we are positioned for continued growth and success. Brown & Brown, Inc. 20 Segment Total Revenues Segment Adjusted Operating dollars in millions 168.2 Wholesale Brokerage Segment APEX Insurance Services Big Sky Underwriters Braishfield Associates Combined Group Insurance Services Decus Insurance Brokers ECC Insurance Brokers Graham Rogers Contribution to Total Revenues 13.1% Profit"I Segment Adjusted Operating Profit Margin" dollars in millions 78 3 as a percentage 33.7 34.3 361 72.7 321 32.5 65a 5L9 S4 6 11 11111 11 12 13 14 15 11 12 13 14 15 Halcyon Underwriters Hull& Company MacDuff Underwriters Mile High Markets National Risk Solutions Peachtree Special Risk Brokers Procor Solutions + Consulting Public Risk Underwriters of Texas Summit Risk Services Texas Security General Insurance Agency Contribution to Total Adjusted Operating Profit 14.2% WW1 Gip„\!Y+ (1) Please see non-GAAP reconciliation an page 88. 21 Ron Warble Executive Vice President USIS/AmeriSys Orlando. Florida Brown & Brown, Inc. Michael White Director of Brokerage Apex Insurance Services Norcross. Georgia 22 SERVICES Results come from perseverance and cooperation. The Services Segment is particularly proud of the difference it made for Columbus Consolidated Govern- ment in Georgia. Brown & Brown first approached Columbus several years ago, and reconnected with the new risk manager in late 2012 to discuss their Columbus Consolidated Government Contract for Workers' Compensation and Medical Care Organization TPA services. Colum- bus had been in a risk pool for several years and was looking for a more customized solution. Our teammates listened to the issues presented by the risk manager and then began the process to create a better alternative. Brown & Brown's USIS business assembled'a team of subject matter experts from across Brown & Brown, including USIS, AmeriSys and Apex as well as external partners in order to provide a new solution using a Med- ical Care Organization model as the key differentiator for managing risks and costs. With the risk manager's leadership, the council decided that the USIS/AmeriSys option was the best choice for Columbus. It was only through our capabilities and inno- vation that we were able to create a new and creative solution for this customer that has saved Columbus over half a million dollars annually. 23 REVIEW OF OPERATIONS The Services Segment Planting seeds and nurturing them to growth. In 2015. the Services Segment of Brown & Brown was responsible for generating approx- imately 9% of the Company's revenue and delivering 7% organic growth. The Services Segment generates its revenues differently than the Company's other segments. Much of its revenue is derived from fees paid for services, so the Segment generally doesn't feel the direct impact of rate pressures to the same degree as our other segments. In the Services Segment. our customers are municipalities, self -insured companies and insurance carriers. with the latter impacted mostly by premium rates. The Services Segment had an exciting year. For this Segment, 2015 was a year of planting seeds and generating new ideas. It's been tremen- dously exciting to see which of those seeds germinated and grew. In spite of challenges pre- sented by the economy, we were able to write new business and develop new solutions. Mary of our offices rose to the challenges presented and had a really good year. Our success in Columbus County, Georgia, is just one example of what can be accomplished by working together, being resourceful and focus- ing on customers' success. It can't be stressed enough that at Brown & Brown, the culture is everything. Our Company is infused with a "get it done" attitude that drives success and allows us to overcome almost any obstacle. Further, our decentralized sales and service model enables our offices to respond and make decisions on a local level and is a critical component of our success. Looking ahead to 2016, the adjective "exciting" continues to be an appropriate descriptor for the Services Segment. To be successful in 2016. first the Services Segment will continue making changes and implementing strategies quickly and nimbly as conditions evolve. Given the ingenuity. perseverance and resource- fulness the Services Segment demonstrated in 2015. there's every reason to believe we can achieve this in 2016. Success breeds success. With our unique culture. Brown & Brown attracts and retains individuals who are driven by results and are focused on delivering solutions for our customers. Regardless of what the market does. the Services Segment will maintain its unwavering focus on providing excellent service and solutions for our customers. Brown & Brown. Inc. 24 Segment Total Revenues dollars in millions 145.4 131.5 136.6 117.5 Segment Adjusted Operating Segment Adjusted Operating Profit"' Profit Margin" dollars in milions as a percentage 41.2 3I.2 65.8 20.0 11 12 11 12 13 14 15 Services Segment 13 14 15 11 12 13 30.4 30.7 31.7 26.5 31.3 II22.5 21.8 14 15 The Advocator Group NuQuest Protocols American Claims Management Preferred Government United Self Insured Insurance Claims Adjusters Claims Services Services Contribution to Total Revenues 8.8% Contribution to Total Adjusted Operating Proflto) 5.7% {1) Please see non-GAAP reconciliation on page 88. 25 _?a; LEADERSHIP OVERVIEW ih` FigiA 1` J. Powell Brown, CPCU R. Andrew Watts President & Chief Executive Executive Vice President, Officer Treasurer & Chief Financial Officer Charles H. Lydecker, CPCU, CIC, AIM Executive Vice President: Regional President - Retail Segment J. Neal Abernathy Senior Vice President Kathy H. Colangelo CIC, ASLI Senior Vice President Richard A. Knudson, CIC Senior Vice President; Regional President - Retail Segment ch.. J. Scott Penny, CIC Chief Acquisitions Officer Sam R. Boone, Jr. Senior Vice President Steve Denton Senior Vice President: Regional President - Retail Segment Richard A. Freebourn, Sr., CPCU, CIC Executive Vice President - Internal Operations & People Officer Anthony T. Strianese President - Wholesale Brokerage Segment Steve M. Boyd Senior Vice President Anthony M. Grippa Senior Vice President; Regional President - Retail Segment Robert W. Lloyd, Esq., CIC Executive Vice President, Secretary & General Counsel Chris L. Walker President - National Programs Segment P. Barrett Brown Senior Vice President; Regional President - Retail Segment Thomas K. Huval, CIC Senior Vice President; Regional President - Retail Segment 26 BOARD OF DIRECTORS Left to right: Samuel P. Bell, III, Esq. Of Counsel to the law firm of Buchanan Ingersoll & Rooney PC Acquisition Committee: Compensation Committee James S. Hunt Former Executive Vice President and Chief Financial Officer, Walt Disney Parks and Resorts Worldwide Acquisition Committee: Audit Committee, Chair: Compensation Committee Theodore J. Hoepner Former Vice Chairman, SunTrust Bank Holding Company Audit Committee: Compensation Committee Bradley Currey, Jr. Former Chairman & Chief Executive Officer, Rock Tenn Company Nominating/Corporate Governance Committee Chilton D. Varner, Esq. Partner, King & Spalding LLP Nominating/Corporate Governance Committee Wendell S. Reilly Managing Partner, Grapevine Partners, LLC Lead Director; Nominating/Corporate Governance Committee, Chair J. Hyatt Brown, CPCU, CLU Chairman, Brown & Brown, Inc. J. Powell Brown, CPCU President & Chief Executive Officer, Brown & Brown, Inc. Toni Jennings Chairman, Jack Jennings & Sons: Former Lieutenant Governor, State of Florida Audit Committee: Compensation Committee, Chair H. Palmer Proctor, Jr. President/Director, Fidelity Bank Acquisition Committee. Chair: Compensation Committee Hugh M. Brown Founder and former President & Chief Executive Officer, BAMSI, Inc. Acquisition Committee: Audit Committee: Nominating/Corporate Governance Committee Timothy R. M. Main Managing Director, Evercore Group LLC Acquisition Committee 27 COMMUNITY INVOLVEMENT The honor to serve our communities We value the communities we serve and find every opportunity to give back. Each year we contribute millions of dollars to non-profit organizations in our communities. Below is a sample of some of the organizations we supported in 2015: AccessCNY Achieve Allie's Friends American Cancer Society American Diabetes Association American Heart Association American Lebanese Syrian Associated Charities American Red Cross Aspire - Massachusetts General Hospital Barbara Bush Foundation - Annual Celebration of Reading Basis Schools Better Housing Coalition Bighorn Golf Club Charities Bivona Child Advocacy Center BJ's Wholesale Club Charitable Foundation The Bottom Line Boys & Girls Club Boy Scouts of America Broward County Outreach Center Cal State Fullerton Philanthropic Foundation Camp Boggy Creek Catskill Area Hospice and Palliative Care Central City Concern Center for Family Services Children's Cancer Association Christel House Crouse Health Foundation Cumberland County Guidance Center Development at Schechter Westchester Doug Flu tie, Jr. Foundation for Autism Education Foundation of Lake County Elwyn Foundation Embassy of Hope Embry Riddle Father Lopez Catholic High School FCCA First Call For Help of Broward - 2-1-1 Broward The First Tee Florida Hospital Foundation Florida Lions Conklin Centers Florida Southwest State College Florida Southwestern University Footlocker Foundation Florida State University Gamma Iota Sigma Glens Falls Hospital Greater New York Councils Halifax Health Foundation Holy Redeemer Health System Hospice by the Bay Horizon House Humane Society I Have A Dream Foundation International Rhett Syndrome The Jason Ritchie Hockey Foundation Jesuit High School Foundation Joliet Catholic Academy Junior Achievement Juvenile Diabetes Research Foundation Larc's Acadian Village Lee Memorial Health Foundation Lifepath Foundation Lighthouse Louisiana Make -A -Wish Mary McLeod Bethune MEHTA Milagros para Ninos Miss Tampa Crown Scholarship Mount Sinai Medical Center Museum of Arts and Sciences The NASCAR Foundation Nathan Adelson Hospice National Black McDonald's Franchisee Foundation National Multiple Sclerosis Society New York Police and Fire Widows' and Children's Benefit Fund Niagara Falls Memorial Medical NY Schools Insurance Foundation Oakland Zoo PBA Piscataway Township Education Foundation Pooch & Poodle Rescue Portland State University R'Club Child Care RFK Children's Action Corps Rochester General Hospital Foundation Rome Memorial Hospital Foundation Ronald McDonald House Rotary Club Saint Francis Hospice and Cancer Research Schweiger Memorial Scholarship Fund Southeastern Guide Dog Association Special Olympics St. Maris Academy St. Matthews House Step Up For Students Temple University University of Central Florida University of Florida University of Georgia Union for Reform Judaism United Way UR Medicine Valley Health Services Vincent DePaui Foundation Voices For Children Foundation Volunteer New York Walker Home and School WeSN I P Whirlpool Collective Impact WSCFF Benevolent Fund YCS Foundation YMCA Youth About Business Brown & Brown, Inc. 28 2015 Financial Review 30 Management's Discussion and Analysis of Financial Condition and Results of Operations 51 Consolidated Statements of Income 52 Consolidated Balance Sheets 53 Consolidated Statements of Shareholders' Equity 54 Consolidated Statements of Cash Flows 55 Notes To Consolidated Financial Statements 88 GAAP Reconciliation —Income Before Income Taxes to Operating Profit and Adjusted Operating Profit 89 Reports of Independent Registered Public Accounting Firm 91 Management's Report on Internal Control Over Financial Reporting 92 Performance Graph 29 2015 Annual Report MANAGEMENT'S DISCUSSION AND ANALYSIS OF FINANCIAL CONDIT/ON AND RESULTS OF OPERATIONS General The following discussion should be read in conjunction with our Consolidated Financial Statements and the related Notes to those Financial Statements and "Information Regarding Non-GAPP Measures" with regard to important information on non -GAWP financial measures, all contained in our discussion and analysis included elsewhere in this Annual Report. We are a diversified insurance agency, wholesale brokerage, insurance programs and services organization headquar- tered in Daytona Beach, Florida. As an insurance intermediary, our principal sources of revenue are commissions paid by insurance companies and, to a lesser extent, fees paid directly by customers. Commission revenues generally represent a percentage of the premium paid by an insured and are affected by fluctuations in both premium rate levels charged by insurance companies and the insureds' underlying"insurable exposure units,' which are units that insurance companies use to measure or express insurance exposed to risk (such as property values, or sales and payroll levels) to determine what premium to charge the insured. Insurance companies establish these premium rates based upon many factors, including loss experience, risk profile, and reinsurance rates paid by such insurance companies, none of which we control. We have increased revenues every year from 1993 to 2015, with the exception of 2009, when our revenues dropped 1.0%. Our revenues grew from $95.6 million in 1993 to $1.7 billion in 2015, reflecting a compound annual growth rate of 13.9%. In the same 22-year period, we increased net income from $8.1 million to $243.3 million in 2015, a compound annual growth rate of 16.7%. The volume of business from new and existing customers, fluctuations in insurable exposure units, changes in premium rate levels, and changes in general economic and competitive conditions all affect our revenues. For example, level rates of inflation or a general decline in economic activity could limit increases in the values of insurable exposure units. Conversely, the increasing costs of litigation settlements and awards have caused some customers to seek higher levels of insurance coverage. Historically, our revenues have typically grown as a result of our focus on net new business growth and acquisi- tions. We foster a strong, decentralized sales and service culture with the goal of consistent, sustained growth over the long term. The term "core commissions and fees" excludes profit-sharing contingent commissions and guaranteed supplemental commissions, and therefore represents the revenues earned directly from specific insurance policies sold, and specific fee -based services rendered. The term "core organic commissions and fees" is our core commissions and fees less (i) the core commissions and fees earned for the first twelve months by newly -acquired operations and (ii) divested business (core commissions and fees generated from offices, books of business or niches sold or terminated during the comparable period), "Core organic commissions and fees"; a non-GAAP measure, are reported in this manner in order to express the current year's core commissions and fees on a comparable basis with the prior year's core commissions and fees. The resulting net change reflects the aggregate changes attributable to (i) net new and lost accounts, (ii) net changes in our clients' exposure units, and (iii) net changes in insurance premium rates or the commission rate paid to us by our carrier partners. We also earn "profit-sharing contingent commissions," which are profit-sharing commissions based primarily on underwriting results, but which may also reflect considerations for volume, growth and/or retention. These commissions are primarily received in the first and second quarters of each year, based on the aforementioned considerations for the prioryear(s). Over the last three years, profit-sharing contingent commissions have averaged approximately 4.0% of the previous year's total commissions and fees revenue. Profit-sharing contingent commissions are included in our total commissions and fees in the Consolidated Statement of Income in the year received. Certain insurance companies offer guaranteed fixed -base agreements, referred to as "Guaranteed Supplemental Commissions" ("GSCs") in lieu of profit-sharing contingent commissions. Since GSCs are not subject to the uncertainty of loss ratios, they are accrued throughout the year based on actual premiums written. For the twelve-month period ending December 31, 2015, we had earned $10,0 million of GSCs, of which $7.6 million remained accrued at December 31, 2015 as most of this will be collected in the first quarter of 2016. For the twelve-month periods ended December 31, 2015, 2014, and 2013, we earned $10.0 million, $9.9 million and $8.3 million, respectively, from GSCs. Brown & Bru vr, -c. 30 Fee revenues relate to fees negotiated in lieu of commissions, which are recognized as services are rendered. Fee revenues have historically been generated primarily by: (1) our Services Segment, which provides insurance -related services, including third -party claims administration and comprehensive medical utilization management services in both the workers' compensation and all -lines liability arenas, as well as Medicare Set -aside services, Social Security disability and Medicare benefits advocacy services, and claims adjusting services, (2) our National Programs and Wholesale Brokerage Segments, which earn fees primarily for the issuance of insurance policies on behalf of insurance companies, and to a lesser extent (3) our Retail Segment in our large -account customer base. These services are provided over a period of time, typically one year. Fee revenues, on a consolidated basis, as a percentage of our total commissions and fees, represented 30.6% in 2015, 30.6% in 2014 and 26.6% in 2013. Additionally, our profit-sharing contingent commissions and GSCs for the year ended December 31, 2015 decreased by $5.8 million over 2014 primarily as a result of increased Toss ratios in our National Programs and Wholesale Brokerage Segment. Other income decreased by $5.0 million primarily as a result of a reduction in the gains on the sale of books of business when compared to 2014 and the change in where this activity is presented in the financial statements as described in the results of operations section as described later in this document. For the years ended December 31, 2015 and 2014, our consolidated internal revenue growth rate was 2.6% and 2.0% respectively. Additionally, each of our four segments recorded positive internal revenue growth for the year ended December 31, 2015. In the event that the gradual increases in insurable exposure units that occurred in the past few years continues through 2016 and premium rate changes are similar with 2015, we believe we will continue to see positive quarterly internal revenue growth rates in 2016. Historically, investment income has consisted primarily of interest earnings on premiums and advance premiums collected and held in a fiduciary capacity before being remitted to insurance companies. Our policy is to invest available funds in high -quality, short-term fixed income investment securities. Investment income also includes gains and losses realized from the sale of investments. Other income primarily reflects legal settlements and other miscellaneous income. Income before income taxes for the year ended December 31, 2015 increased over 2014 by $62.8 million, primarily as a result of acquisitions completed in the past twelve months and net new business, partially offset by the incremental interest expense associated with our inaugural public debt offering completed in 2014 along with incremental investments in revenue producing teammates. Information Regarding Non-GAAP Measures In the discussion and analysis of our results of operations, in addition to reporting financial results in accordance with GAAP, we provide information regarding core commissions and fees, core organic commissions and fees, and our internal growth rate, which is the growth rate of our core organic commissions and fees, and adjusted calculations of core commissions and fees, core organic commissions and fees and our internal growth rate after adjusting for the significant revenue recorded at our Colonial Claims operation in the first half of 2013 attributable to Superstorm Sandy. These measures are not in accor- dance with, or an alternative to (including any adjusted internal growth rate) the GAAP information provided in this Annual Report on Form 10-K. Tabular reconciliations of this supplemental non-GAAP financial information to our most comparable GAAP information are contained in this Annual Report on Form 10-K. We present such non-GAAP supplemental financial information, as we believe such information provides additional meaningful methods of evaluating certain aspects of our operating performance from period to period on a basis that may not be otherwise apparent on a GAAP basis. This supple- mental financial information should be considered in addition to, not in lieu of, our Consolidated Financial Statements. Acquisitions Part of our continuing business strategy is to attract high -quality insurance intermediaries to join our operations. From 1993 through the fourth quarter of 2015, we acquired 472 insurance intermediary operations, excluding acquired books of business (customer accounts). 31 2015 Ann,;ai Report MANAGEMENT'S DISCUSSION AND ANALYSIS OF FINANCIAL CONDITION AND RESULTS OF OPERAT]ONS Critical Accounting Policies Our Consolidated Financial Statements are prepared in accordance with U.S. GAAP. The preparation of these financial statements requires us to make estimates and judgments that affect the reported amounts of assets, liabilities, revenues and expenses. We continually evaluate our estimates, which are based on historical experience and on assumptions that we believe to be reasonable under the circumstances. These estimates form the basis for our judgments about the carrying values of our assets and liabilities, of which values are not readily apparent from other sources. Actual results may differ from these estimates. We believe that of our significant accounting and reporting policies, the more critical policies include our accounting for revenue recognition, business combinations and purchase price allocations, intangible asset impairments and reserves for litigation. In particular, the accounting for these areas requires significant use of judgment to be made by management. Different assumptions in the application of these policies could result in material changes in our consolidated financial position or consolidated results of operations. Refer to Note 1 in the "Notes to Consolidated Financial Statements". Revenue Recognition Commission revenues are recognized as of the effective date of the insurance policy or the date on which the policy premium is processed into our systems, whichever is later. Commission revenues related to installment billings are recog- nized on the later of the date effective or invoiced, with the exception of our Arrowhead business which follows a policy of recognizing on the later of the date effective or processed into our systems regardless of the billing arrangement. Management determines the policy cancellation reserve based upon historical cancellation experience adjusted in accor- dance with known circumstances. Subsequent commission adjustments are recognized upon our receipt of notification from insurance companies concerning matters necessitating such adjustments. Profit-sharing contingent commissions are recognized when determinable, which is generally when such commissions are received from insurance companies, or periodically when we receive formal notification of the amount of such payments. Fee revenues, and commissions for employee benefits coverages and workers' compensation programs, are recognized as services are rendered. Business Combinations and Purchase Price Allocations We have acquired significant intangible assets through business acquisitions. These assets consist of purchased customer accounts, non -compete agreements, and the excess of purchase prices over the fair value of identifiable net assets acquired (goodwill). The determination of estimated useful lives and the allocation of purchase price to intangible assets requires significant judgment and affects the amount of future amortization and possible impairment charges. All of our business combinations initiated after June 30, 2001 have been accounted for using the purchase method. In connection with these acquisitions. we record the estimated value of the net tangible assets purchased and the value of the identifiable intangible assets purchased, which typically consist of purchased customer accounts and non -compete agree- ments. Purchased customer accounts include the physical records and files obtained from acquired businesses that contain information about insurance policies. customers and other matters essential to policy renewals. However, they primarily represent the present value of the underlying cash flows expected to be received over the estimated future renewal periods of the insurance policies comprising those purchased customer accounts. The valuation of purchased customer accounts involves significant estimates and assumptions concerning matters such as cancellation frequency, expenses and discount rates. Any change in these assumptions could affect the carrying value of purchased customer accounts. Non -compete agreements are valued based on their duration and any unique features of the particular agreements. Purchased customer accounts and non -compete agreements are amortized on a straight-line basis over the related estimated lives and contract periods, which range from 5 to 15 years. The excess of the purchase price of an acquisition over the fair value of the identifiable tangible and intangible assets is assigned to goodwill and is not amortized. Acquisition purchase prices are typically based on a multiple of average annual operating profit earned over a one- to three-year period within a minimum and maximum price range. The recorded purchase prices for all acquisitions consum- mated after January 1, 2009 include an estimation of the fair value of liabilities associated with any potential earn -out provisions. Subsequent changes in the fair value of earn -out obligations are recorded in the Consolidated Statement of Income when incurred, Brown & Brown. Inc. 32 The fair value of earn -out obligations is based on the present value of the expected future payments to be made to the sellers of the acquired businesses in accordance with the provisions contained in the respective purchase agreements, In determining fair value, the acquired businesses future performance is estimated using financial projections developed by management for the acquired business and this estimate reflects market participant assumptions regarding revenue growth and/or profitability. The expected future payments are estimated on the basis of the earn -out formula and performance targets specified in each purchase agreement compared to the associated financial projections. These estimates are then discounted to a present value using a risk -adjusted rate that takes into consideration the likelihood that the forecasted earn -out payments will be made. Intangible Assets Impairment Goodwill is subject to at least an annual assessment for impairment measured by a fair -value -based test. Amortizable intangible assets are amortized over their useful lives and are subject to an impairment review based on an estimate of the undiscounted future cash flows resulting from the use of the assets. To determine if there is potential impairment of goodwill, we compare the fair value of each reporting unit with its carrying value. If the fair value of the reporting unit is less than its carrying value, an impairment loss would be recorded to the extent that the fair value of the goodwill within the reporting unit is less than its carrying value. Fair value is estimated based on multiples of earnings before interest, income taxes, depreciation, amortization and change in estimated acquisition earn -out payables ("EBITDAC"), or on a discounted cash flow basis. Management assesses the recoverability of our goodwill and our amortizable intangibles and other long-lived assets annually and whenever events or changes in circumstances indicate that the carrying value of such assets may not be recoverable. Any of the following factors, if present, may trigger an impairment review: (i) a significant underperformance relative to historical or projected future operating results; (ii) a significant negative industry or economic trends; and (iii) a significant decline in our market capitalization. If the recoverability of these assets is unlikely because of the existence of one or more of the above -referenced factors, an impairment analysis is performed. Management must make assumptions regarding estimated future cash flows and other factors to determine the fair value of these assets. If these estimates or related assumptions change in the future, we may be required to revise the assessment and, if appropriate, record an impairment charge. We completed our most recent evaluation of impairment for goodwill as of November 30, 2015 and determined that the fair value of goodwill exceeded the carrying value of such assets. Additionally, there have been no impairments recorded for amortizable intangible assets for the years ended December 31, 2015, 2014 and 2013. Non -Cash Stock -Based Compensation We grant stock options and non -vested stock awards to our employees, and the related compensation expense is required to be recognized in the financial statements over the associated service period based upon the grant -date fair value of those awards. During the first quarter of 2016, the performance conditions for approximately 1.4 million shares of the Company's common stock granted under the Company's Stock Incentive Plan are expected to be determined by the Compensation Committee to have been satisfied relative to performance -based grants issued in 2011. These grants had a performance measurement period that concluded on December 31, 2015. The vesting condition for these grants requires continuous employment for a period of up to ten years from the January 2011 grant date in order for the awarded shares to become fully vested and non -forfeitable. The shares are expected to be awarded during the first quarter of 2016, pursuant to review and certification of the performance measurements against the stated grant targets by the Compensation Committee in accordance with the Stock Incentive Plan. As a result of the awarding of these shares, the grantees will be eligible to receive payments of dividends and exercise voting privileges after the awarding date, and the awarded shares will be included as issued and outstanding common stock shares and included in the calculation of basic and diluted EPS. 33 2015 Annt.si Report MANAGEMENT'S DISCUSSION AND ANALYSIS OF FINANCIAL CONDITION AND RESULTS OF OPERATIONS Litigation Claims We are subject to numerous litigation claims that arise in the ordinary course of business. If it is probable that a liability has been incurred at the date of the financial statements and the amount of the loss is estimable, an accrual for the costs to resolve these claims is recorded in accrued expenses in the accompanying Consolidated Balance Sheets. Professional fees related to these claims are included in other operating expenses in the accompanying Consolidated Statement of Income as incurred. Management, with the assistance of in-house and outside counsel, determines whether it is probable that a liability has been incurred and estimates the amount of loss based upon analysis of individual issues. New developments or changes in settlement strategy in dealing with these matters may significantly affect the required reserves and affect our net income. Results of Operations for the Years Ended December 31, 2015, 2014 and 2013 The following discussion and analysis regarding results of operations and liquidity and capital resources should be consid- ered in conjunction with the accompanying Consolidated Financial Statements and related Notes. Financial information relating to our Consolidated Financial Results is as follows: (in thousands, except percentages) Percent Percent 2015 Change 2014 change 2013 REVENUES Core commissions and fees $ 1,595,218 6.4 % $ 1.499,903 15.7% $ 1,295,977 Profit-sharing contingent commissions 51,707 (10.4)% 57,706 12,6% 51.251 Guaranteed supplemental commissions 10,026 1.8 % 9,851 19.0% 8,275 Investment income 1,004 34.4 % 747 17.1% 638 Other income, net 2,554 (66.3)% 7,589 6.3% 7,138 Total revenues 1,660,509 5.4 % 1,575,796 15,6% 1,363,279 EXPENSES Employee compensation and benefits 841,439 6.3 % 791,749 15.9% 683,000 Non -cash stock -based compensation 15,513 (19.9)% 19,363 (14.3)% 22,603 Other operating expenses 251,055 6,7 % 235,328 20.3% 195,677 Loss/(gain) on disposal (619) (101.3)% 47,425 -% - Amortization 87,421 5.5 % 82.941 22.1% 67,932 Depreciation 20,890 - % 20,895 19,5% 17,485 Interest 39,248 38.2 % 28,408 72.8% 16,440 Change in estimated acquisition earn -out payables 3,003 (69,8)% 9,938 NMF " 2,533 Total expenses 1,257,950 1.8 % 1,236,047 22.9% 1,005,670 Income before income taxes 402,559 18.5 % 339,749 (5.0)% 357,609 Income taxes 159,241 19.9 % 132,853 (5.4)% 140,497 NET INCOME $ 243,318 17.6 % $ 206,896 (4.7)% $ 217,112 Net internal growth rate -core organic commissions and fees Employee compensation and benefits ratio Other operating expenses ratio Capital expenditures Total assets at December 31 2.6 % 50.7 % 15,1 % $ 18,375 $ 5,012,739 2.0 % 50.2 % 14.9 % $ 24,923 $ 4,956,458 6.7% 50,1% 14.4% $ 16,366 $ 3,649,508 (1) NMF = Not a meaningful figure Brown & Brown, inc, 34 Commissions and Fees Commissions and fees, including profit-sharing contingent commissions and GSCs for 2015, increased $89.5 million to $1,657.0 million, or 5.7% over 2014. Core commissions and fees revenue for 2015 increased $95.3 million, of which approximately $76.6 million represented core commissions and fees from agencies acquired since 2014 that had no comparable revenues. After accounting for divested business of $19.3 million, the remaining net increase of $38.0 million represented net new business, which reflects a growth rate of 2.6% for core organic commissions and fees. Profit-sharing contingent commissions and GSCs for 2015 decreased by $5.8 million, or 8.6%, compared to the same period in 2014. The net decrease of $5.8 million was mainly driven by a decrease in profit-sharing contingent commissions in the National Programs Segment as a result of increased loss ratios. Commissions and fees, including profit-sharing contingent commissions and GSCs for 2014, increased $212.0 million to $1,567.5 million. or 15.6% over the same period in 2013. Core commissions and fees revenue in 2014 increased $203.9 million, of which approximately $186.8 million represented core commissions and fees from acquisitions that had no comparable revenues in 2013. After accounting for divested business of $8.5 million, the remaining net increase of $25.6 million represented net new business, which reflects an internal growth rate of 2.0% for core organic commissions and fees. Profit- sharing contingent commissions and GSCs for 2014 increased by $8.0 million, or 13.5%, compared to the same period in 2013. The net increase was due primarily to $4.9 million, $1.3 million, and $1.8 million increases in profit-sharing contingent commissions and GSCs in our Retail, National Programs and Wholesale Brokerage Segments, respectively. Investment Income Investment income increased to $1.0 million in 2015, compared with $0.7 million in 2014 due to additional interest income driven by cash management activities to earn a higher yield. Investment income increased to $0.7 million in 2014, compared with $0.6 million in 2013 mainly due to higher average daily invested balances in 2014 than in 2013. Other Income, Net Other income for 2015 reflected income of $2.6 million, compared with $7.6 million in 2014 and $7.1 million in 2013. Other income in 2015 consisted primarily of legal settlements and also gains and loss on the sale and disposition of fixed assets. In 2014 and 2013, other income included legal settlements and gains and loss on the sale and disposition of fixed assets as well as gains and losses from the sale on books of business (customer accounts). Prior to the adoption of ASU No. 2014-08, "Reporting Discontinued Operations and Disclosures of Disposals of Components of an Entity" ("ASU 2014-08") in the fourth quarter of 2014, net gains and losses on the sale of businesses or customer accounts were reflected in other income. Any such gains or losses are now reflected on a net basis in the expense section since the adoption of ASU 2014-08. The $5.0 million change in 2015 other income from the comparable period in 2014 was primarily due to prior year book of business sales and to a lesser extent, the change to the presentation of this activity in the financial statements. We recog- nized gains of $0.6 million, $5.3 million and $3.1 million from sales on books of business (customer accounts) in 2015, 2014 and 2013, respectively. Employee Compensation and Benefits Employee compensation and benefits expense increased 6.3%. or $49.7 million, in 2015 over 2014. This increase included $25.8 million of compensation costs related to stand-alone acquisitions that had no comparable costs in the same period of 2014. Therefore, employee compensation and benefits expense attributable to those offices that existed in the same time periods of 2015 and 2014 increased by $23.9 million or 3.2%. This underlying employee compensation and benefits expense increase was primarily related to (i) an increase in producer and staff salaries as we made targeted investments in our business; (ii) increased profit center bonuses and commissions due to increased revenue and operating profit; and (ii i) the increased cost of health insurance. Employee compensation and benefits expense as a percentage of total revenues was 50.7% for 2015 as compared to 50.2% for the year ended December 31, 2014. 35 2015 Annual Report MANAGEMENT'S DISCUSSION AND ANALYSIS OF FINANCIAL CONDITION AND RESULTS OF OPERATIONS Employee compensation and benefits expense increased, approximately 15.9% or $108.7 million in 2014 over 2013. However, that net increase included $81.0 million of compensation costs related to new acquisitions that were stand-alone offices. Therefore, employee compensation and benefits from those offices that existed in the same time periods of 2014 and 2013 increased by $27.7 million. The employee compensation and benefit increases from these offices were primarily related to increases in staff and management salaries of $13.8 million, new salaried producers of $4.8 million, profit center and other related bonuses of $6.7 million, compensation to our commissioned producers of $0.9 million and health insur- ance costs of $4.8 million, These increases were partially offset by net reductions in temporary employees, employer 401(k) plan matching contributions and accrued vacation expense. Employee compensation and benefits expense as a percentage of total revenues was 50.2% as compared to 50.1% for the year ended December 31, 2013. This slight increase was driven by continued investment in new teammates. Non -Cash Stock -Based Compensation The Company has an employee stock purchase plan, grants non -vested stock awards, and to a lesser extent grants stock options under other equity -based plans to its employees. Compensation expense for all share -based awards is recognized in the financial statements based upon the grant -date fair value of those awards. For 2015, 2014 and 2013, the non -cash stock -based compensation expense incorporated the costs related to each of the Company's four stock -based plans as explained in Note 11of the Notes to the Consolidated Financial Statements. Non -cash stock -based compensation expense decreased $3.9 million, or 19.9% in 2015 over 2014. The decrease was the result of: (i) older grants attaining the vesting requirements and therefore being fully expensed in prior periods: (i) some forfeitures driven by certain grants not achieving all vesting requirements; and (iii) underlying participation levels; all of which were partially offset by the additional expense attributable to the new grants issued in 2015. Non -cash stock -based compensation expense decreased $3.2 million, or 14.3% in 2014 over 2013, primarily as a result of forfeitures due to the non -achievement of certain performance criteria, partially offset by an increase associated with new, non -vested stock awards granted on July 1, 2013 under our Stock Incentive Plan ("SIP"). Other Operating Expenses As a percentage of total revenues, other operating expenses represented 15.1% in 2015,14.9% in 2014, and 14.4% in 2013. Other operating expenses in 2015 increased $15.7 million, or 6.7%, over 2014, of which $12.6 million was related to acquisitions that had no comparable costs in the same period of 2014. The other operating expenses for those offices that existed in the same periods in both 2015 and 2014, increased by $3.1 million or 1.3%, which was primarily attributable to increased sales meetings, legal and consulting expenses, partially offset by decreases in expenses associated with office rent, telecommunications and bank fees. Other operating expenses in 2014 increased $39.7 million, or 20.3%, over 2013, of which $39.0 million was related to acquisitions. Therefore, other operating expenses attributable to offices that existed in the same periods in both 2014 and 2013 (including the new acquisitions that "folded in" to those offices) increased by $0.7 million. The $0.7 million net increase includes increases of $2.0 million related to increased data processing and software licensing expense, $1.2 million related to increased inspection and consulting fees, $0.8 million related to office rent, and $0.9 million related to increased employee sales meeting costs, offset by decreases of $3.0 million for legal claims and litigation expenses, $1.0 million for insurance expenses, and $0.2 million in other various expense decreases. Gain or Loss on Disposal The Company recognized a gain on disposal of $0.6 million in 2015 and a loss on disposal of $47,4 million in 2014. The pretax loss for 2014 is the result of the disposal of the Axiom Re business as part of the Company's strategy to exit the reinsurance brokerage business. Prior to the adoption of ASU 2014-08 in the fourth quarter of 2014 as previously men- tioned, net gains and losses on the sale of businesses or customer accounts were reflected in other income. Although we are not in the business of selling customer accounts, we periodically sell an office or a book of business (one or more customer accounts) that we believe does not produce reasonable margins or demonstrate a potential for growth, or because doing so is in the Company's best interest. We recognized gains of $0.6 million, $5.3 million and $3.1 million from sales on books of business (customer accounts) in 2015, 2014 and 2013, respectively. Brown & Brown, inc. 36 Amortization Amortization expense increased $4.5 million, or 5.5%, in 2015, and increased $15.0 million, or 22.1%, in 2014. The increases were due primarily to the amortization of additional intangible assets as the result of acquisitions completed in those years. Depreciation Depreciation expense remained flat in 2015, and increased $3.4 million, or 19.5%, in 2014. The increase in 2014 was due primarily to the addition of fixed assets resulting from acquisitions completed since 2013, while the stable level of expense in 2015 versus 2014 reflected capital additions approximately equal to the value of prior additions that became fully depreciated. Interest Expense Interest expense increased $10.8 million, or 38.2%, in 2015, and $12.0 million, or 72.8% in 2014. These increases were primarily due to the increased debt borrowings and an increase in our effective rate of interest for the years ended 2015 and 2014. The increased debt borrowings from the prior year include: the Credit Facility term loan entered into in May 2014 in the initial amount of $550.0 million at LIBOR plus 137.5 basis points, and the $500.0 million Senior Notes due 2024 issued during September 2014 at a fixed rate of interest of 4.2%. The Credit Facility term loan proceeds replaced pre-exist- ing debt of $230.0 million with similar rates of interest. The proceeds from the Senior Notes due 2024 were used to settle the Credit Facility revolver debt of $375.0 million, which had a lower, but variable rate of interest based on an adjusted LIBOR. This transitioned the debt to a favorable long-term fixed rate of interest and extended the date of maturity of those funds. These changes were the result of an evolution and maturation of our previous debt structure and provide increased debt capacity and flexibility. Change in Estimated Acquisition Earn -Out Payables Accounting Standards Codification ("ASC") Topic 805 — Business Combinations is the authoritative guidance requiring an acquirer to recognize 100% of the fair value of acquired assets, including goodwill, and assumed liabilities (with only limited exceptions) upon initially obtaining control of an acquired entity. Additionally, the fair value of contingent consideration arrangements (such as earn -out purchase price arrangements) at the acquisition date must be included in the purchase price consideration. As a result, the recorded purchase prices for all acquisitions consummated after January 1, 2009 include an estimation of the fair value of liabilities associated with any potential earn -out provisions. Subsequent changes in these earn -out obligations are required to be recorded in the Consolidated Statement of Income when incurred or reasonably estimated. Estimations of potential earn -out obligations are typically based upon future earnings of the acquired operations or entities, usually for periods ranging from one to three years. The net charge or credit to the Consolidated Statement of Income for the period is the combination of the net change in the estimated acquisition earn -out payables balance, and the interest expense imputed on the outstanding balance of the estimated acquisition earn -out payables. As of December 31, 2015, the fair values of the estimated acquisition earn -out payables were re-evaluated and meas- ured at fair value on a recurring basis using unobservable inputs (Level 3) as defined in ASC 820 — Fair Value Measurement. The resulting net changes, as well as the interest expense accretion on the estimated acquisition earn -out payables, for the years ended December 31, 2015, 2014, and 2013 were as follows: (in thousands) 2015 2014 2013 Change in fair value of estimated acquisition earn -out payables $ 2.990 $ 7.375 $ 570 Interest expense accretion 13 2.563 1.963 Net change in earnings from estimated acquisition earn -out payables $ 3,003 $ 9,938 $ 2,533 37 2013 Ann=�o�- MANAGEMENT'S DISCUSSION AND ANALYSIS OF FINANCIAL CONDITION AND RESULTS OF OPERATIONS For the years ended December 31, 2015, 2014 and 2013. the fair value of estimated earn -out payables was re-evalu- ated and increased by $3.0 million, $7.4 million and $0.6 million, respectively, which resulted in charges to the Consolidated Statement of Income. As of December 31, 2015, the estimated acquisition earn -out payables equaled $78.4 million, of which $25.3 million was recorded as accounts payable and $53.1 million was recorded as other non -current liability. As of December 31, 2014, the estimated acquisition earn -out payables equaled $75.3 million, of which $26.0 million was recorded as accounts payable and $49.3 million was recorded as other non -current liability. Income Taxes The effective tax rate on income from operations was 39.6% in 2015, 39.1% in 2014, and 39.3% in 2013. The increased effective tax rate was largely the result of more income in states with a higher average effective state income tax rate, which was primarily New York State. Results of Operations — Segment Information As discussed in Note 15 of the Notes to Consolidated Financial Statements, we operate four reportable segments: Retail, National Programs, Wholesale Brokerage, and Services. On a segmented basis, increases in amortization, depreciation and interest expenses generally result from completed acquisitions within a given segment in a particular year. Likewise, other income in each segment reflects net gains primarily from legal settlements and miscellaneous income. As such, in evaluating the operational efficiency of a segment, management emphasizes the net internal growth rate of core commissions and fees revenue. the ratio of total employee compensation and benefits to total revenues, and the ratio of other operating expenses to total revenues. Segment results for prior periods have been recast to reflect the current year segmental structure. Certain reclassifica- tions have been made to the prior -year amounts reported in this Annual Report on Form 10-K in order to conform to the current year presentation. The internal growth rates for our core organic commissions and fees for the years ended December 31, 2015, 2014 and 2013 by Segment, are as follows: (in thousands, except percentages) For the Year Ended December 31, Less Internal Internal Total Net Total Net Acquisition Net Net 2015 2014 Change Growth % Revenues Growth $ Growth % Retail'' $ 836,123 $ 789,503 $ 46,620 5.9% $ 35.644 $ 10,976 1.4% National Programs 412,885 367,672 45,213 12,3 % 38,519 6.694 1.8 % Wholesale Brokerage 200,835 187,257 13.578 7.3% 2,469 11.109 5.9 % Services 145,375 136,135 9,240 6.8% — 9.240 6.8 % Total core commissions and fees $ 1,595,218 $ 1,480,567 $ 114,651 7.7% $ 76,632 $ 38,019 2.6% 38 The reconciliation of the above internal growth schedule to the total commissions and fees included in the Consolidated Statement of Income for the years ended December 31, 2015, and 2014, is as follows: (in thousands) For the Year Ended December 31, 2015 2014 Total core commissions and fees $ 1,595,218 $ 1,480,567 Profit-sharing contingent commissions 51,707 57,706 Guaranteed supplemental commissions 10,026 9,851 Divested business - 19,336 Total commissions and fees $ 1,656,951 $ 1,567,460 {in thousands, except percentages) For the Year Ended December 31, Less Internal Internal Total Net Total Net Acquisition Net Net 2014 2013 Change Growth % Revenues Growth $ Growth % Retail $ 792,794 $ 701,211 $ 91,583 13.1% $ 77,315 $ 14,268 2.0% National Programs 376,483 277,082 99,401 35.9% 93,803 5,598 2.0% Wholesale Brokerage 194,144 177,725 16,419 9.2% 68 16,351 9.2% Services 136,482 131,502 4,980 3.8% 15,599 {10,619) (8.1) % Total core commissions and fees $ 1,499,903 $ 1,287,520 $ 212,383 16.5% $ 186,785 $ 25,598 2.0 % Less Superstorm Sandy $ - $ (18,275) $ 18,275 100.0% $ - $ 18,275 100.0% Total core commissions and fees less Superstorm Sandy $ 1,499,903 $ 1,269,245 $ 230,658 18.2 % $ 186,785 $ 43,873 3.5 % There would be a 3.5% Internal Net Growth rate when excluding the $18.3 million of revenues recorded at our Colonial Claims operation in the first half of 2013 related to Superstorm Sandy. The reconciliation of the above internal growth schedule to the total commissions and fees included in the Consolidated Statement of Income for the years ended December 31, 2014 and 2013, is as follows: (in thousands) For the Year Ended December 31, 2014 2013 Total core commissions and fees $ 1,499,903 $ 1,287,520 Profit-sharing contingent commissions 57,706 51,251 Guaranteed supplemental commissions 9,851 8,275 Divested business - 8,457 Total commissions and fees $ 1,567,460 $ 1,355,503 39 2015 Annual Report MANAGEMENT'S DISCUSSION AND ANALYSIS OF FINANCIAL CONDITION AN❑ RESULTS OF OPERATIONS (In thousands, except percentages) For the Year Ended December 31, Less Internal Internal Total Net Total Net Acquisition Net Net 2013 2012 Change Growth % Revenues Growth $ Growth % Retail"' $ 706,525 $ 619,057 $ 87,468 14.1% $ 79,455 $ 8,013 1.3% National Programs 280,695 240,550 40,145 16.7% 7,099 33.046 13.7% Wholesale Brokerage 177,725 152,961 24,764 16.2% 4,332 20.432 13,4% Services 131,032 116,247 14,785 12.7% 657 14.128 12.2% Total core commissions and fees $1,295,977 $ 1,128,815 $ 167,162 14.8% $ 91,543 $ 75,619 6.7% The reconciliation of the above internal growth schedule to the total commissions and fees included in the Consolidated Statement of Income for the years ended December 31, 2013 and 2012, is as follows: (in thousands) For the Year Ended December 31, 2013 2012 Total core commissions and fees Profit-sharing contingent commissions Guaranteed supplemental commissions Divested business $ 1.295,977 51,251 8,275 $ 1,128,815 43,683 9,146 7,437 Total commissions and fees $ 1,355,503 $ 1,189,081 (1) The Retail Segment includes commissions and fees reported in the 'Other" column of the Segment Information in Note 15 of the Notes to the Consolidated Financial Statements, which includes corporate and consolidation items. Brown & Brown, Inc. 40 Retail Segment The Retail Segment provides a broad range of insurance products and services to commercial, public and quasi -public, professional and individual insured customers. Approximately 87.0% of the Retail Segment's commissions and fees revenue is commission -based. Because most of our other operating expenses are not correlated to changes in commissions on insurance premiums, a significant portion of any fluctuation in the commissions we receive, net of related producer compen- sation, will result in a similar fluctuation in our income before income taxes, unless we make incremental investments in the organization. Financial information relating to our Retail Segment is as follows: (in thousands, except percentages) Percent Percent 2015 Change 2014 Change 2013 Revenues Core commissions and fees $ 837,420 5.5 % $ 793,865 12.2% $ 707,721 Profit-sharing contingent commissions 22,051 2.0 % 21,616 23.2% 17,544 Guaranteed supplemental commissions 8,291 7.3 % 7,730 12.9% 6,849 Investment income 87 29.9 % 67 (18.3)% 82 Other income, net 2,497 NMF(') 408 (92.1)% 5,153 Total revenues 870,346 5.7 % 823,686 11.7% 737,349 Expenses Employee compensation and benefits 445,242 7.1 % 415,876 13.0% 368,164 Non -cash stock -based compensation 12,109 (25.7)% 16,293 58.5% 10,281 Other operating expenses 137,519 2.9 % 133,682 11.9% 119,489 Loss/(gain) on disposal (1,207) - % -% - Amortization 45,145 5.1 % 42,935 11.5% 38,523 Depreciation 6,558 1.7 % 6,449 9.8% 5,874 interest 41,036 (5.7)% 43,502 25.5% 34,658 Change in estimated acquisition earn -out payables 2,006 (73.1)% 7,458 NMF}') (1,427) Total expenses 688,408 3.3 % 666,195 15.7% 575,562 Income before income taxes $ 181,938 15.5 % $ 157,491 (2.7)% $ 161,787 Net internal growth rate -core organic commissions and fees Employee compensation and benefits ratio Other operating expenses ratio Capital expenditures Total assets at December 31 1.4 % 51.2 % 15.8 % $ 6,797 $ 3,507,476 2.0 % 50.5 % 16.2 % $ 6,873 $ 3,229,484 1.3 % 49.9 % 16.2 % $ 6,886 $ 3,012,688 (1) NMF = Not a meaningful figure 41 2015Arf.:3I eno MANAGEMENT'S DISCUSSION AND ANALYSIS OF FINANCIAL CONDITION AND RESULTS OF OPERATIONS The Retail Segment's total revenues in 2015 increased 5.7%, or $46.7 million, over the same period in 2014, to $870.3 million. The $43.6 million increase in core commissions and fees revenue was driven by the following: (i) approxi- mately $35.6 million related to the core commissions and fees revenue from acquisitions that had no comparable revenues in the same period of 2014; (ii) $11.0 million related to net new business; and (iii) an offsetting decrease of $3.0 million related to commissions and fees revenue from business divested in 2014 and 2015. Profit-sharing contingent commissions and GSCs in 2015 increased 3.4%, or $1.0 million, over 2014, to $30.3 million. The Retail Segment's internal growth rate for core organic commissions and fees revenue was 1.4% for 2015 and was driven by revenue from net new business written during the preceding twelve months along with modest increases in commercial auto rates, and partially offset by: (i) termi- nated association health plans in the State of Washington; (ii) continued pressure on the small employee benefits business as some accounts adopt alternative plan designs and move to a per employee/per month payment model due to the imple- mentation of the Affordable Care Act; and (iii) reductions in property insurance premium rates specifically in catastrophe -prone areas. Income before income taxes for 2015, increased 15.5%, or $24.4 million, over the same period in 2014, to $181.9 million. The primary factors affecting this increase were: (i) the net increase in revenue as described above; (ii) a 7.1%, or $29.4 million increase in employee compensation and benefits due primarily to the year -on -year impact of new teammates related to acquisitions completed in the past twelve months in addition to incremental investments in revenue producing teammates: (iii) operating expenses which increased by $3.8 million or 2.9%, due to increased travel and value added consulting services; offset by (iv) a reduction in the change in estimated acquisition earn -out payables of $5.5 million, or 73.1% to $2.0 million; and (v) a $4.2 million, or 25.7% reduction in non -cash stock -based compensation to $12.1 million due to the forfeiture of certain grants where performance conditions were not fully achieved, The Retail Segment's total revenues in 2014, increased 11.7%, or $86.3 million, over the same period in 2013, to $823.7 million. Profit-sharing contingent commissions and GSCs in 2014 increased 20.3%, or $5.0 million, over 2013, to $29.3 million, primarily due to improved loss ratios resulting in increased profitability for insurance companies in 2013. The $86.1 million increase in core commissions and fees revenue was driven by the following: (i) approximately $77.3 million related to the core commissions and fees revenue from acquisitions that had no comparable revenues in the same period of 2013; (ii) $14.3 million related to net new business; and (iii) an offsetting decrease of $5,5 million related to commissions and fees revenue recorded from business divested in the last year. The Retail Segment's internal growth rate for core organic commissions and fees revenue was 2.0% for 2014, and was driven by net new customers, increasing insurable exposure units in certain areas of the United States, and was partially offset by continued pressure on property and casualty rates, especially in coastal areas. Income before income taxes for 2014, decreased 2.7%, or $4.3 million, over the same period in 2013, to $157.5 million. This decrease was primarily due to a higher interest charge of $8.8 million corresponding to capital utilized for acquisitions in 2014 and $8.9 million related to the year -on -year changes in the estimated earn -out payable. The underlying increase was driven by net new business, acquired business and increased profit-sharing contingent commissions and GSCs. Non - cash stock -based compensation increased $6.0 million, or 58.5%, for 2014 over the same period in 2013, as the cost of grants to employees for the purpose of driving performance were realized. Brown & Brown. Inc. 42 National Programs Segment The National Programs Segment manages over S0 programs with approximately 40 well -capitalized carrier partners. In most cases, the insurance carriers that support the programs have delegated underwriting and, in many instances, claims - handling authority to our programs operations. These programs are generally distributed through a nationwide network of independent agents and Brown & Brown retail agents, and offer targeted products and services designed for specific industries, trade groups, professions, public entities and market niches. The National Programs Segment operations can be grouped into five broad categories: Professional Programs, Arrowhead Insurance Programs, Commercial Programs, Public Entity -Related Programs and the National Flood Program. The National Programs Segment's revenue is primarily commis- sion -based. Financial information relating to our National Programs Segment is as follows: (in thousands, except percentages) Percent 2015 Change Percent 2014 Change 2013 Revenues Core commissions and fees Profit-sharing contingent commissions Guaranteed supplemental commissions Investment income Other income, net $ 412,885 9.7 % $ 15,558 (25.3)% 30 42.9 % 210 28.0 % 51 (99.2)% Total revenues Expenses Employee compensation and benefits Non -cash stock -based compensation Other operating expenses Loss/{gain) on disposal Amortization Depreciation Interest Change in estimated acquisition earn -out payables 428,734 6.1 % 178,185 6.1 % 4,669 NMF u 86,157 9.4 % 458 - % 28,479 13.3 % 7,250 (7.1)% 55,705 12.2 % 158 {49.8)% Total expenses 361,061 9.1 % Income before income taxes 376,483 34.1% $ 20,822 6.3% 21 NMF" 164 NMF" 6,749 NMF{i1 404,239 34.1% 280,695 19,590 (23) 19 1,091 301,372 168,018 22.9% 136,748 1,387 (72.6)% 5,060 78,744 44.0% 54,690 -% 25,129 68.1% 14,953 7,805 42.1% 5,492 49,663 106.8% 24,014 315 (139.0)% (808) 331,061 37.9% 240,149 $ 67,673 (7.5)% $ 73,178 19.5% $ 61,223 Net internal growth rate ---core organic commissions and fees Employee compensation and benefits ratio Other operating expenses ratio Capital expenditures Total assets at December 31 1.8 % 41.6 % 20.1 % $ 6,001 $ 2,505,752 2.0 % 41.6 % 19.5 % 14,133 $ 2,455,749 13.7 % 45.4 %. 18.1 % $ 4,810 $ 1,377,404 (1) NMF = Not a meaningful figure 43 2015 Annual 4e,00rt MANAGEMENT'S DISCUSSION AND ANALYSIS OF FINANCIAL CONDITION AND RESULTS OF OPERATIONS National Programs total revenues in 2015, increased 6.1%, or $24.5 million, over 2014, to a total $428.7 million. The $36.4 million increase in core commissions and fees revenue was driven by the following: (i) an increase of approximately $38.5 million related to core commissions and fees revenue from acquisitions that had no comparable revenues in 2014; (ii) $6.7 million related to net new business offset by (iii) a decrease of $8.8 million related to commissions and fees revenue recorded in 2014 from businesses since divested. Profit-sharing contingent commissions and GSCs were $15.6 million in 2015 which was a decrease of $5,3 million over 2014, which was primarily driven by the loss experience of our carrier partners. The National Programs Segment's internal growth rate for core commissions and fees revenue was 1.8% for 2015. This internal growth rate was mainly due to the Arrowhead Personal Property program, which continued to produce more written premium, the Arrowhead Automotive Aftermarket program which received a commission rate increase from their carrier partner, growth in our Wright Specialty education program and the on -boarding of new clients by Proctor Financial. Growth in these businesses was partially offset by certain programs that have been affected by lower rates. Income before income taxes for 2015, decreased 7,5%, or $5.5 million, from the same period in 2014, to $67.7 million. The decrease is the result of the $6.0 million gain on the sale of Industry Consulting Group ("ICG"), along with the $3.7 million SIP grant forfeiture benefit associated with Arrowhead, which were both credits recorded in 2014. After adjusting for these one-time items in 2014, underlying income before income taxes increased and was driven by the net revenue growth noted above and expense management initiatives as we grow and scale our programs. The National Programs Segment's total revenues in 2014, increased 34.1%, or $102.9 million, over 2013, to a total of $404.2 million. The $95.8 million increase in core commissions and fees revenue was driven by the following: (i) approxi- mately $93.8 million related to the core commissions and fees revenue from the Wright and Beecher Carlson acquisitions that had no comparable revenues in 2013; (ii) $5.6 million related to net new business; and (iii) an offsetting decrease of $3.6 million in books of business that were disposed or transferred to other segments. Profit-sharing contingent commis- sions and GSCs were $20.8 million in 2014 which was an increase of $1.3 million from the same period of 2013. This increase was due primarily to a $0.5 million increase in profit-sharing contingent commissions received by Florida Intracoastal Underwriters, Limited Company, and a $0.8 million increase in profit-sharing contingent commissions received by Proctor Financial, Inc. Other income increased by approximately $5.7 million primarily due to the gain recognized on the sale of Industry Consulting Group, Inc. ("ICG") of $6.0 million. Income before income taxes for 2014, increased 19.5%, or $12.0 million, from the same period in 2013, to $73.2 million. The increase in income before taxes was clue to net new business growth noted above, revenues and operating profits derived from Wright, the gain on the sale of ICG, and a non -cash stock -based compensation decrease of $3.7 million primarily related to partial SIP grant forfeitures associated with Arrowhead. The $12.0 million increase was partially offset by an increase in the inter -company interest expense charge related to Wright. Brown , Brown. Inc. 44 Wholesale Brokerage Segment The Wholesale Brokerage Segment markets and sells excess and surplus commercial and personal lines insurance, primarily through independent agents and brokers. Like the Retail and National Programs Segments, the Wholesale Brokerage Segment's revenues are primarily commission -based. Financial information relating to our Wholesale Brokerage Segment is as follows: (in thousands, except percentages) Percent Percent 2015 Change 2014 Change 2013 Revenues Core commissions and fees $ 200,835 3.4 % $ 194,144 9.2% $ 177,725 Profit-sharing contingent commissions 14,098 (7.7)% 15,268 8.2% 14,117 Guaranteed supplemental commissions 1,705 (1.8.8)% 2,100 44.9% 1,449 Investment income 150 NMF'1' 26 18.2% 22 Other income, net 208 (44.2)% 373 (6.0)% 397 Total revenues 216,996 2.4 % 211,911 9.4% 193,710 Expenses Employee compensation and benefits 101,590 1.7 % 99,918 9.3% 91,449 Non -cash stock -based compensation 3,102 2.0 % 3,041 32.5 % 2,295 Other operating expenses 34,379 (5.1)% 36,234 4.2% 34,770 Loss/(gain) on disposal (385) NMF"I' 47,425 -% - Amortization 9,739 (9.0)% 10,703 (0.1)% 10,719 Depreciation 2,142 (13,3)% 2,470 (7.6)% 2,674 Interest 891 (31.1)% 1,294 (44.1)% 2,316 Change in estimated acquisition earn -out payables 830 (67.5)% 2,550 28.4% 1,986 Total expenses 152,288 (25.2)% 203,635 39.3% 146,209 Income before income taxes $ 64,708 NMFil' $ 8,276 (82.6)% $ 47,501 Net internal growth rate -core organic commissions and fees Employee compensation and benefits ratio Other operating expenses ratio Capital expenditures Total assets at December 31 5.9 % 46.8 % 15.8 % $ 3,084 $ 895,782 9.2 % 47.2 % 17.1 % $ 1,526 $ 857,804 13.4 % 47.2 % 17.9 % $ 1,825 $ 865,731 (1) NMF = Not a meaningful figure 45 2015 Annual Report MANAGEMENT'S DISCUSSION AND ANALYSIS OF FINANCIAL CONDITION AND RESULTS OF OPERATIONS The Wholesale Brokerage Segment's total revenues for 2015, increased 2.4%. or $5.1 million, over 2014, to $217.0 mil- lion. The $6.7 million net increase in core commissions and fees revenue was driven by the following; (i) $11.1 million related to net new business: (ii) $2.5 million related to the core commissions and fees revenue from acquisitions that had no compara- ble revenues in 2014: and (iii) an offsetting decrease of $6.9 million related to commissions and fees revenue recorded in 2014 from businesses divested in the past year. Contingent commissions and GSCs for 2015 decreased $1.6 million over 2014, to $15.8 million. This decrease was driven by an increase in Toss ratios, The Wholesale Brokerage Segment's internal growth rate for core organic commissions and fees revenue was 5.9% for 2015, and was driven by net new business and modest increases in exposure units, partially offset by significant contraction in insurance premium rates for catastrophe - prone properties. Income before income taxes for 2015 increased $56.4 million over 2014, to $64.7 million, primarily due to the follow- ing: (i) the $47.4 million net pretax lass on disposal of the Axiom Re business in 2014; (ii) the net increase in revenue as described above and (iii) the impact of the Axiom Re business divested in 2014 that reported lower margins than the Wholesale Brokerage Segment's average. The Wholesale Brokerage Segment's total revenues for 2014, increased 9.4%, or $18.2 million, over 2013, to $211.9 mil- lion. Profit-sharing contingent commissions and GSCs for 2014 increased $1.8 million over 2013, to $17.4 million. The $16.4 million net increase in core commissions and fees revenue was driven by the following: (i) $16.4 million related to net new business; (ii) $0.1 million related to the core commissions and fees revenue from acquisitions that had no comparable revenues in 2013; and (iii) an offsetting decrease of $0.1 million related to commissions and fees revenue recorded in 2013 from businesses divested in the past year. As such. the Wholesale Brokerage Segment's internal growth rate for core organic commissions and fees revenue was 9.2% for 2014. Income before income taxes for 2014, decreased 82.6%, or $39.2 million, over 2013, to $8.3 million. This decrease included a $47.4 million net loss on the disposal of the Axiom Re business. Effective December 31, 2014, the Company sold certain assets of the Axiom Re business as part of the strategic plan to exit the reinsurance brokerage market. Axiom Re had annual revenues of approximately $6.9 million in 2014. The underlying performance of this segment was driven by new business growth and to a lesser extent an increase in profit-sharing contingent commissions. Brown & Brown. Inc. 46 Services Segment The Services Segment provides insurance -related services, including third -party claims administration and comprehensive medical utilization management services in both the workers' compensation and all -lines liability arenas. The Services Segment also provides Medicare Set -aside account services, Social Security disability and Medicare benefits advocacy services, and claims adjusting services, Unlike the other segments, nearly all of the Services Segment's revenue is generated from fees, which are not signifi- cantly affected by fluctuations in general insurance premiums. Financial information relating to our Services Segment is as follows: in thausands, except percentage Percent Percent 2015 Change 2014 Change 2013 Revenues Core commissions and fees $ 145,375 6.5 % $ 136,482 4.2% $ 131,032 Profit-sharing contingent commissions - - % -% - Guaranteed supplemental commissions - - % - -% - Investment income 42 NMFm 3 200.0% 1 Other income, net (52) NMF.i. 73 (84.0)% 456 Total revenues 145,365 6.4 % 136,558 3.9% 131,489 Expenses Employee compensation and benefits 76,249 5.1 % 72,583 18.6% 61,193 Non -cash stock -based compensation 845 185.5 % 296 (71.2)% 1,027 Other operating expenses 36,057 12.1 % 32,168 14.7% 28,053 Loss/(gain) on disposal 515 - % -% - Amortization 4,019 (2.8)% 4,135 11.8% 3,698 Depreciation 1,988 (10.2)% 2,213 36.4% 1,623 Interest 5,970 (22.2)% 7,678 4.9% 7,322 Change in estimated acquisition earn -out payables 9 (102.3)% (385) (113.8)% 2,782 Total expenses 125,652 5.9 % 118,688 12.3% 105,698 Income before income taxes $ 19,713 10.3 % $ 17,870 {30.7)% $ 25,791 Net internal growth rate -core organic commissions and fees Employee compensation and benefits ratio Other operating expenses ratio Capital expenditures Total assets at December 31 6.8 % 52.5 % 24.8 % $ 1,088 $ 285,459 (8.1)% 53.2 % 23.6 % $ 1,210 $ 296,034 12.2 % 46.5 % 21.3 % $ 1,811 $ 277,652 (1) NMF = Not a meaningful figure The Services Segment's total revenues for 2015 increased 6.4%, or $8.8 million, over 2014, to $145.4 million. The $8.9 million increase in core commissions and fees revenue primarily resulted from growth in our advocacy businesses driven by new clients and growth in several of our claims processing units related to new client relationships. The Services Segment's internal growth rate for core commissions and fees revenue was 6.8% for 2015. 47 2015 Annual Report MANAGEMENT'S DISCUSSION AND ANALYSIS OF FINANCIAL CONDITION AND RESULTS OF OPERATIONS Income before income taxes for 2015 increased 10.3%, or $1.8 million, over 2014, to $19.7 million due to a combina- tion of: (i) internal revenue growth noted above; (ii) the continued efficient operation of our businesses: and (iii) a decrease in the intercompany interest expense charge. The impact from the sale of the Colonial Claims business on 2015 revenues and income before income taxes was immaterial. The Services Segment's total revenues for 2014 increased 3.9%, or $5.1 million, over 2013, to $136.6 million. The $5.5 million increase in core commissions and fees revenue consisted of the following: (i) an increase of approximately $15.6 million related to the core commissions and fees revenue from the acquisition of ICA, that had no comparable revenues in the same period of 2013; (ii) net new business of $7.7 million; (iii) offset by a reduction of $18.3 million due to the significant flood claims processed in 2013 resulting from Superstorm Sandy in 2012 with no comparable storm in 2013 and (iv) $0.4 million of net sold books of business, As such, the Services Segment's internal growth rate for core commis- sions and fees revenue was (8.1)% for 2014 and excluding the impact of Superstorm Sandy internal growth would have been 6.8% in 2014. Income before income taxes for 2014 decreased 30.7%, or $7.9 million, over the same period in 2013, to $17.9 million due to the reduction in Superstorm Sandy related revenues and corresponding operating profit partially offset by the increase associated with net new and acquired business. Other As discussed in Note 15 of the Notes to Consolidated Financial Statements, the "Other" column in the Segment Information table includes any income and expenses not allocated to reportable segments, and corporate -related items, including the inter -company interest expense charges to reporting segments. Liquidity and Capital Resources The Company strives to maintain a conservative balance sheet and liquidity profile. Our capital requirements to operate as an insurance intermediary are low and we have been able to grow and invest in our business principally through cash that has been generated from operations. We have the ability to access the use of our revolving credit facilities, which provide up to $825.0 million in available cash, and we believe that we have access to additional funds, if needed, through the capital markets to obtain further debt financing under the current market conditions. The Company believes that its existing cash, cash equivalents, short-term investment portfolio and funds generated from operations, together with the funds available under the credit facilities, will be sufficient to satisfy our normal liquidity needs, including principal payments on our long-term debt, for at least the next twelve months. Our cash and cash equivalents of $443.4 million at December 31, 2015 reflected a decrease of $26.6 million from the $470.0 million balance at December 31, 2014. During 2015, $411.8 million of cash was generated from operating activities. During this period, $136.0 million of cash was used for acquisitions, $25.4 million was used for acquisition earn -out payments, $18.4 million was used for additions to fixed assets, $64.1 million was used for payment of dividends, $175.0 million was used as part of accelerated share repurchase programs. and $45.6 million was used to pay outstanding principal balances owed on long-term debt. We hold approximately $17.2 million in cash outside of the U.S. for which we have no plans to repatriate in the near future. Our cash and cash equivalents of $470.0 million at December 31, 2014 reflected an increase of $267.1 million from the $203.0 million balance at December 31, 2013. During 2014, $385.0 million of cash was generated from operating activities. During this period, $696.5 million of cash was used for acquisitions, $9.5 million was used for acquisition earn -out payments, $24.9 million was used for additions to fixed assets, $59.3 million was used for payment of dividends, and $718.0 million was provided from proceeds received on net new long-term debt. • c. 48 On May 1, 2014, we completed the acquisition of Wright for a total cash purchase price of $609.2 million, subject to certain adjustments. We financed the acquisition through various modified and new credit facilities. Our cash and cash equivalents of $203.0 million at December 31, 2013 reflected a decrease of $16.9 million from the $219.8 million balance at December 31, 2012. During 2013, $389.4 million of cash was generated from operating activities. During this period, $367.7 million of cash was used for acquisitions, $15.5 million was used for acquisition earn -out payments, $16.4 million was used for additions to fixed assets, $53.5 million was used for payment of dividends, and $30.0 million was provided from proceeds received on new long-term debt. On July 1, 2013, we completed the acquisition of Beecher Carlson for a total cash purchase price of $364.2 million, subject to certain adjustments. We financed the acquisition through various modified and new credit facilities. Our ratio of current assets to current liabilities (the "current ratio") was 1.16 and 1.24 at December 31, 2015 and 2014, respectively. Contractual Cash Obligations As of December 31, 2015, our contractual cash obligations were as follows: (in thousands) Payments Due by Period Total Less Than 1 Year 1-3 Years 4.5 Years After 5 Years Long-term debt $ 1,154,375 $ 73,125 $ 210,000 Other liabilitiesS1, 60,516 20,065 15,794 Operating leases 195,272 40,900 68,721 Interest obligations 227,332 37,182 67,343 Unrecognized tax benefits 584 584 Maximum future acquisition contingency payments2 137,365 34,467 85,815 $ 371,250 1,098 47,245 44,932 17,083 $ 500,000 23,559 38,406 77,875 Total contractual cash obligations $1,775,444 $ 205,739 $ 448,257 $ 481,608 $ 639,840 (1)Includes the current portion of other tong -term liabilities. (2) lncludes S 78.4 million of current and non -current estimated earn -out payables resulting from acquisitions consummated after January 1.2009. Debt Total debt at December 31, 2015 was $1,153.0 million, which was a decrease of $45.5 million compared to December 31, 2014. This decrease was primarily due to the repayments of $45.6 million in principal payments, and the amortization of discounted debt related to our 4.20% Notes due 2024, of $0,1 million. On January 15, 2015, the Company retired the Series D senior notes of $25.0 million that matured and were issued under the original private placement note agreement from December 2006. As of December 31, 2015, the Company satisfied the third installment of scheduled quarterly principal payments on the Credit Facility term loan. Each installment equaled $6.9 million. The Company has satisfied $20.6 million in total principal payments through December 31, 2015. Scheduled quarterly principal payments are expected to be made until maturity. The balance of the Credit Facility term loan is $529.4 million as of December 31.2015.Of the total amount, $48.1 million is classified as short-term debt and current portion of Tong -term debt in the Consolidated Balance Sheet as the date of maturity is less than one year representing the quarterly debt payments due in 2016. During 2015, the $25.0 million of 5.66% Notes due December 2016 were classified as short-term debt and current portion of long-term debt in the Consolidated Balance Sheet as the date of maturity is less than one year. 49 2015Annual Report MANAGEMENT'S DISCUSSION AND ANALYSIS OF FINANCIAL CONDITION AND RESULTS OF OPERATIONS Off -Balance Sheet Arrangements Neither we nor our subsidiaries have ever incurred off -balance sheet obligations through the use of, or investment in, off -balance sheet derivative financial instruments or structured finance or special purpose entities organized as corpora- tions, partnerships or limited liability companies or trusts. For further discussion of our cash management and risk management policies, see "Quantitative and Qualitative Disclosures About Market Risk." Quantitative and Qualitative Disclosures About Market Risk Market risk is the potential loss arising from adverse changes in market rates and prices. such as interest rates, foreign exchange rates and equity prices. We are exposed to market risk through our investments, revolving credit line, term loan agreements and international operations. Our invested assets are held primarily as cash and cash equivalents, restricted cash, available -for -sale marketable debt securities, non -marketable debt securities, certificates of deposit. U.S. treasury securities, and professionally managed short duration fixed income funds. These investments are subject to interest rate risk. The fair values of our invested assets at December 31, 2015 and December 31,2014, approximated their respective carrying values due to their short-term duration and therefore, such market risk is not considered to be material. We do not actively invest or trade in equity securities. In addition, we generally dispose of any significant equity securities received in conjunction with an acquisition shortly after the acquisition date. As of December 31, 2015 we had $529.4 million of borrowings outstanding under our term loan which bears interest on a floating basis tied to the London Interbank Offered Rate (LIBOR) and therefore subject to changes in the associated interest expense. The effect of an immediate hypothetical 10% change in interest rates would not have a material effect on our Consolidated Financial Statements. We are subject to exchange rate risk primarily in our U.K based wholesale brokerage business that has a cost base principally denominated in British pounds and a revenue base in several other currencies, but principally in U.S. dollars. Based on our foreign currency rate exposure as of December 31, 2015, an immediate 10% hypothetical changes of foreign currency exchange rates would not have a material effect on our Consolidated Financial Statements. Brown & Brown, Inc. 50 CONSOLIDATED STATEMENTS OF INCOME (in thousands. except per share data) Year Ended December 31. 2015 2014 2013 Revenues Commissions and fees Investment income Other income, net $ 1,656,951 $ 1,567,460 $ 1,355,503 1,004 747 638 2,554 7,589 7,138 Total revenues 1,660,509 1,5 75,796 1,363,279 Expenses Employee compensation and benefits 841,439 791,749 683,000 Non -cash stock -based compensation 15,513 19,363 22,603 Other operating expenses 251,055 235,328 195,677 Lass/(gain) on disposal (619) 47,425 - Amortization 87,421 82,941 67,932 Depreciation 20,890 20,895 17,485 Interest 39,248 28,408 16,440 Change in estimated acquisition earn -out payables 3,003 9,938 2,533 Total expenses 1,257,950 1,236,047 1,005,670 Income before income taxes Income taxes 402,559 339,749 357,609 159,241 132,853 140,497 Net income $ 243,318 $ 206,896 $ 217,112 Net income per share: Basic $ 1.72 $ 1.43 $ 1.50 Diluted $ 1.70 $ 1.41 $ 1.48 Dividends declared per share $ 0.45 $ 0.41 $ 0.37 See accompanying notes to Consolidated Financial Statements. 51 2015 Annual Report CONSOLIDATED BALANCE SHEETS (in thousands, except per share data) December 31. De cember 31. 2015 2014 Assets Current Assets: Cash and cash equivalents Restricted cash and investments Short-term investments Premiums, commissions and fees receivable Reinsurance recoverable Prepaid reinsurance premiums Deferred income taxes Other current assets $ 443,420 229,753 13,734 433,885 31,968 309,643 24,635 50,351 $ 470,048 259,769 11.157 424,547 13,028 320,586 25,431 45,542 Total current assets Fixed assets, net Goodwill Amortizable intangible assets, net Investments Other assets 1,537,389 81,753 2,586,683 744,680 18,092 44,142 1,570,108 84,668 2,460,611 784,642 19,862 36,567 Total assets $ 5,012,739 $ 4,956,458 Liabilities And Shareholders' Equity Current Liabilities: Premiums payable to insurance companies Losses and loss adjustment reserve Unearned premiums Premium deposits and credits due customers Accounts payable Accrued expenses and other liabilities Current portion of long-term debt $ 574,736 31,968 309,643 83,098 63,910 192,067 73,125 $ 568.184 13,028 320.586 83,313 57,261 181,156 45,625 Total current liabilities Long-term debt Deferred income taxes, net Other liabilities Commitments and contingencies (Note 13) Shareholders' Equity: Common stock. par value $0.10 per share; authorized 280,000 shares; issued 146,415 shares and outstanding 138,985 shares at 2015, issued 145,871 shares and outstanding 143,486 shares at 2014 Additional paid -in capital Treasury stock, at cost 7,430 and 2,385 shares at 2015 and 2014, respectively Retained earnings 1,328,547 1,079,878 360,949 93,589 14,642 426,498 (238,775) 1,947,411 1,269,153 1,152,846 341.497 79.217 14,587 405,982 (75,025) 1,768,201 Total shareholders' equity 2,149,776 2,113,745 Total liabilities and shareholders' equity $ 5,012,739 $ 4,956,458 See accompanying notes to Consolidated Financial Statements. Brown & Brown, inc. 52 CONSOLIDATED STATEMENTS OF SHAREHOLDERS' EQUITY (in thousands, except per share data) Common Stock Shares Additional Par Paid -In Treasury Retained Value Capital Stock Earnings Total Balance at January 1, 2013 143,878 $ 14,388 $ 335,872 $ — $ 1,457,073 $ 1,807,333 Net income Common stock issued for employee stock benefit plans 1.541 154 33.730 Income tax benefit from exercise of stock benefit plans 2,358 Cash dividends paid ($0.37 per share) 217,112 217,112 33,884 2,358 (53,546) (53,546) Balance at December 31, 2013 145,419 14,542 371,960 — 1,620,639 2,007,141 Net income Common stock issued for employee stock benefit plans 442 44 30,405 30,449 Purchase of treasury stock (75,025) (75,025) Income tax benefit from exercise of stock benefit plans 3,298 3,298 Common stock issued to directors 10 1 319 320 Cash dividends paid ($0.41 per share) (59,334) (59,334) Balance at December 31, 2014 145,871 14,587 405,982 (75,025) 1,768,201 2,113,745 206,896 206,896 Net income 243,318 243,318 Common stock issued for employee stock benefit plans 528 53 27,992 28,045 Purchase of treasury stock (11,250) (163,750) (175,000) Income tax benefit from exercise of stock benefit plans 3,276 3,276 Common stock issued to directors 16 2 498 500 Cash dividends paid ($0.45 per share) (64,108) (64,108) Balance at December 31, 2015 146,415 $ 14,642 $ 426,498 $ (238,775) $ 1,947,411 $ 2,149,776 See accompanying notes to Consolidated Financial Statements. 53 CONSOLIDATED STATEMENTS OF CASH FLOWS (in thousands) Year Ended December 31. 2015 2014 2013 Cash flows from operating activities: Net income Adjustments to reconcile net income to net cash provided by operating activities: Amortization Depredation Non -cash stock -based compensation Change in estimated acquisition earn -out payables Deferred income taxes Amortization of debt discount Income tax benefit from exercise of shares from the stock benefit plans (Gain)/loss on sales of investments. fixed assets and customer accounts Payments on acquisition earn -outs in excess of original estimated payables Changes in operating assets and liabilities, net of effect from acquisitions and divestitures: Restricted cash and investments decrease (increase) Premiums, commissions and fees receivable (increase) Reinsurance recoverables (increase) decrease Prepaid reinsurance premiums decrease (increase) Other assets (increase) Premiums payable to insurance companies decrease Premium deposits and credits due customers (decrease) increase Losses and loss adjustment reserve increase (decrease) Unearned premiums (decrease) increase Accounts payable increase Accrued expenses and other liabilities increase Other liabilities (decrease) $ 243,318 5 206.896 87,421 82.941 20,890 20.895 15,513 19.363 3,003 9.938 22,696 7.369 157 46 13.276) (3,298) 1107) 42,465 (11.383) (2,539) 30,016 (7,163) (18,940) 10,943 (5,318) 542 (2,973) 18,940 (10.943) 34.206 8,204 (23,898) (9,760) (11,160) 12.210 (31.573) (12,564) B.164 2.323 (12,210) 31.573 36.949 11.718 (24,727) $ 217,112 67,932 17.485 22.603 2,533 32,247 (2,358) (2,806) (2,788) (85,445) (40,729) (2,583) 61,624 41,049 5,180 70,872 (12,554) Net cash provided by operating activities 411,848 385,019 389,374 Cash flows from investing activities: Additions to fixed assets Payments for businesses acquired. net of cash acquired Proceeds from sales of fixed assets and customer accounts Purchases of investments Proceeds from sales of investments (18,375) (136,000) 10.576 (22,766) 21,928 (24,923) (696.486) 13.631 (17.813) 18.278 (16,366) (367,712) 5,886 (18,102) 15,662 Net cash used in investing activities (144,637) (707,313) (380,632) Cash flows from financing activities: Payments on acquisition earn -outs Proceeds from long-term debt Payments on long-term debt Borrowings on revolving credit facilities Payments on revolving credit facilities Income tax benefit from exercise of shares from the stock benefit plans Issuances of common stock for employee stock benefit plans Repurchase of stock benefit plan shares for employees to fund tax withholdings Purchase of treasury stock Prepayment of accelerated share repurchase program Cash dividends paid (25,415) (45,625) 3,276 15,890 (2,857) (163,750) (11,250) (64,108) (9,530) 1,048,425 (330,000) 475.000 {475.000) 3,298 14.808 (3.252) (75,025) (59,334) (15,491) 30,000 (93) 31,863 (31.863) 2.358 12.445 (1.284) (53,546) Net cash (used in) provided by financing activities (293,839) 589,390 (25,611) Net (decrease) increase in cash and cash equivalents Cash and cash equivalents at beginning of period (26,628) 470,048 267,096 202.952 (16,869) 219.821 Cash and cash equivalents at end of period $ 443,420 $ 470,048 $ 202,952 See accompanying notes to Consolidated Financial Statements. Brawn & Brown, Inc. 54 NOTES TO CONSOLIDATED FINANCIAL STATEMENTS NOTE 1 Summary of Significant Accounting Policies Nature of Operations Brown & Brown, Inc., a Florida corporation, and its subsidiaries (collectively, "Brown & Brown" or the "Company") is a diversified insurance agency, wholesale brokerage, insurance programs and services organization that markets and sells to its customers, insurance products and services, primarily in the property and casualty area. Brown & Brown's business is divided into four reportable segments: the Retail Segment provides a broad range of insurance products and services to commercial. public entity, professional and individual customers; the National Programs Segment, acting as a managing general agent ("MGA"), provides professional liability and related package products for certain professionals, a range of insurance products for individuals, flood coverage, and targeted products and services designated for specific industries, trade groups, governmental entities and market niches, all of which are delivered through nationwide networks of indepen- dent agents, and Brown & Brown retail agents; the Wholesale Brokerage Segment markets and sells excess and surplus commercial insurance, primarily through independent agents and brokers, as well as Brown & Brown Retail offices; and the Services Segment provides insurance -related services, including third -party claims administration and comprehensive medical utilization management services in both the workers' compensation and all -lines liability arenas, as well as Medicare Set -aside services, Social Security disability and Medicare benefits advocacy services, and claims adjusting services. In addition, as the result of our acquisition of The Wright Insurance Group, LLC ("Wright") in May 2014, we own a Flood insurance carrier. Wright National Flood Insurance Company ("Wright Flood"), that is a Wright subsidiary. Wright Flood's business consists of policies written pursuant to the National Flood Insurance Program, the program administered by the Federal Emergency Management Agency ("FEMA°), and several excess flood insurance policies, all of which are fully reinsured. Recently Issued Accounting Pronouncements In February 2016, the Financial Accounting Standards Board ("FASB") issued Accounting Standards Update ("ASU") 2016-02, "Leases (Topic 842)" ("ASU 2016-02"), which provides guidance for accounting for leases. tinder ASU 2016-02, the Company will be required to recognize the assets and liabilities for the rights and obligations created by leased assets. ASU 2016-02 will take effect for public companies for fiscal years, and interim periods within those fiscal years, beginning after December 15, 2018. The Company is currently evaluating its leases against the requirements of this pronouncement. In November 2015, FASB issued ASU No. 2015-17, "Income Taxes (Topic 740)—Balance Sheet Classification of Deferred Taxes" ('ASU 2015-17"), which simplifies the presentation of deferred income taxes by requiring deferred tax assets and liabilities be classified as a single non -current item on the balance sheet. ASU 2015-17 is effective for fiscal years beginning after December 15, 2016 with early adoption permitted as of the beginning of any interim or annual reporting period. The Company plans to adopt ASU 2015-17 in the first quarter of 2017. This is not expected to have a material impact on our Consolidated Financial Statements other than reclassifying current deferred tax assets and liabilities to non -current in the balance sheet. In September 2015, FASB issued ASU No, 2015-16, "Business Combinations (Topic 805): Simplifying the Accounting for Measurement -Period Adjustments" ("ASU 2015-16"), which requires that an acquirer recognize adjustments to provi- sional amounts that are identified during the measurement period in the reporting period in which the adjustment amounts are determined.ASU 2015-16 is effective for fiscal years, and interim reporting periods within those fiscal years, beginning after December 15, 2015. The Company has determined that the impact of the adoption of this guidance on the Consolidated Financial Statements would not be material, In August 2015, FASB issued ASU No. 2015-15, "Interest -Imputation of Interest (Subtopic 835-30): Presentation and Subsequent Measurement of Debt Issuance Costs Associated with Line -of -Credit Arrangements". This standard is in addition to ASU No. 2015-03 and adds SEC paragraphs pursuant to an SEC Staff Announcement that the SEC staff would not object to an entity deferring and presenting debt issuance costs associated with a line -of -credit arrangement as an asset and subsequently amortizing the costs ratably over the term of the arrangement. The Company plans to adopt ASU 2015-03 in the first quarter of 2016. As the Company's debt issuance costs are not material, implementation of this update is not expected to have a material impact on the Company's Consolidated Financial Statements. 55 7_`,1= c': NOTES TO CONSOLIDATED FINANCIAL STATEMENTS In April 2015, FASB issued ASU No. 2015-05, "Intangibles -Goodwill and Other -Internal -Use Software (Subtopic 350-40): Customer's Accounting for Fees Paid in a Cloud Computing Arrangement" ("ASU 2015-05"), which issues guidance on determining whether a cloud computing arrangement contains a software license that should be accounted for as internal -use software. If a cloud computing arrangement does not contain a software license, it should be accounted for as a service contract. This guidance is effective for fiscal years beginning after December 15, 2015 and for interim periods within those fiscal years, with early adoption permitted. The Company has to this point not been a party to any material cloud computing arrangements and as such has determined the impact of the adoption of this guidance on the Consolidated Financial Statements to be immaterial. In April 2015, FASB issued ASU No. 2015-03, "Simplifying the Presentation of Debt Issuance Costs" ("ASU 2015-03"), which requires that debt issuance costs related to a recognized debt liability be presented in the balance sheet as a direct deduction from the carrying amount of that debt liability, consistent with debt discounts, and not recorded as separate assets. This update is effective for reporting periods beginning after December 15, 2015, and is to be applied on a retro- spective basis. The Company plans to adopt ASU 2015-03 in the first quarter of 2016. As the Company's debt issuance costs are not material, implementation of this update is not expected to have a material impact on the Company's Consolidated Financial Statements. In August 2014, FASB issued ASU No. 2014-15, "Disclosure of Uncertainties About an Entity's Ability to Continue as a Going Concern" ("ASU 2014-15"). which addresses management's responsibility in evaluating whether there is substantial doubt about a company's ability to continue as a going concern and to provide related footnote disclosures. ASU 2014-15 is effective for fiscal years beginning after December 15, 2016 and for interim periods within those fiscal years, with early adoption permitted. The Company does not expect to early adopt this guidance, and it believes the adoption of this guid- ance will not have an impact on the Consolidated Financial Statements. In May 2014, FASB issued ASU No. 2014-09, " Revenue from Contracts with Customers" ("ASU 2014-09"). which provides guidance for revenue recognition. ASU 2014-09 affects any entity that either enters into contracts with customers to transfer goods or services or enters into contracts for the transfer of non -financial assets, and supersedes the revenue recognition requirements in Topic 605, "Revenue Recognition," and most industry -specific guidance. The standard's core principle is that a company will recognize revenue when it transfers promised goods or services to customers in an amount that reflects the consideration to which a company expects to be entitled in exchange for those goods or services. In doing so, companies will need to use more judgment and make more estimates than under the current guidance. These may include identifying performance obligations in the contract, estimating the amount of variable consideration to include in the transaction price and allocating the transaction price to each separate performance obligation. ASU 2014-09 is effec- tive for the Company beginning January 1, 2018, after FASB voted to delay the effective date by one year. At that time, the Company may adopt the new standard under the full retrospective approach or the modified retrospective approach. The Company is currently evaluating its revenue streams against the requirements of this pronouncement. Principles of Consolidation The accompanying Consolidated Financial Statements include the accounts of Brown & Brown, Inc. and its subsidiaries. All significant inter -company account balances and transactions have been eliminated in the Consolidated Financial Statements. Segment results for prior periods have been recast to reflect the current year segmental structure. Certain reclassifica- tions have been made to the prior -year amounts reported in this Annual Report on Form 10-K in order to conform to the current year presentation. Revenue Recognition Commission revenues are recognized as of the effective date of the insurance policy or the date on which the policy premium is processed into our systems. whichever is later. Commission revenues related to installment billings are recog- nized on the latter of effective or invoiced date, with the exception of our Arrowhead business which follows a policy of Brown & Brc •. . -c. 56 recognizing on the latter of effective or processed date into our systems regardless of the billing arrangement. Management determines the policy cancellation reserve based upon historical cancellation experience adjusted for any known circum- stances. Subsequent commission adjustments are recognized upon our receipt of notification from insurance companies concerning matters necessitating such adjustments. Profit-sharing contingent commissions are recognized when determin- able, which is generally when such commissions are received from insurance companies, or when we receive formal notification of the amount of such payments. Fee revenues and commissions for workers' compensation programs are recognized as services are rendered. Use of Estimates The preparation of the Consolidated Financial Statements in conformity with accounting principles generally accepted in the United States of America ("U.S. GAAP") requires management to make estimates and assumptions that affect the reported amounts of assets and liabilities, as well as disclosures of contingent assets and liabilities, at the date of the Consolidated Financial Statements, and the reported amounts of revenues and expenses during the reporting period. Actual results may differ from those estimates. Cash and Cash Equivalents Cash and cash equivalents principally consist of demand deposits with financial institutions and highly liquid investments with quoted market prices having maturities of three months or less when purchased. Restricted Cash and I nvestments, and Premiums, Commissions and Fees Receivable In our capacity as an insurance agent or broker, the Company typically collects premiums from insureds and, after deducting its authorized commissions, remits the net premiums to the appropriate insurance company or companies. Accordingly, as reported in the Consolidated Balance Sheets, "premiums" are receivable from insureds. Unremitted net insurance premi- ums are held in a fiduciary capacity until Brown & Brown disburses them. Where allowed by law, Brown & Brown invests these unremitted funds only in cash, money market accounts, tax-free variable -rate demand bonds and commercial paper held for a short term. In certain states in which Brown & Brown operates, the use and investment alternatives for these funds are regulated and restricted by various state laws and agencies. These restricted funds are reported as restricted cash and investments on the Consolidated Balance Sheets. The interest income earned on these unremitted funds, where allowed by state law, is reported as investment income in the Consolidated Statement of Income. In other circumstances, the insurance companies collect the premiums directly from the insureds and remit the applicable commissions to Brown & Brown. Accordingly, as reported in the Consolidated Balance Sheets, "commissions" are receivables from insurance companies. "Fees" are primarily receivables due from customers. Investments Certificates of deposit, and other securities, having maturities of more than three months when purchased are reported at cost and are adjusted for other -than -temporary market value declines. As part of the acquisition of Wright in 2014, we acquired additional investments, which include U.S. Government, Municipal, domestic corporate and foreign corporate bonds as well as short -duration fixed income funds. Investments within the portfolio or funds are held as available for sale and are carried at their fair value. Any gain/loss applicable from the fair value change is recorded, net of tax, as other comprehensive income under the equity section of the Consolidated Balance Sheet. Realized gains and losses are reported on the Consolidated Statement of Income, with the cost of securities sold determined on a specific identification basis. Fixed Assets Fixed assets, including leasehold improvements, are carried at cost, less accumulated depreciation and amortization. Expenditures for improvements are capitalized, and expenditures for maintenance and repairs are expensed to operations as incurred, Upon sale or retirement, the cost and related accumulated depreciation and amortization are removed from the accounts and the resulting gain or Toss, if any, is reflected in other income. Depreciation has been determined using the straight-line method over the estimated useful lives of the related assets, which range from three to 15 years. Leasehold improvements are amortized on the straight-line method over the shorter of the useful life of the improvement or the term of the related lease. 57 2015 Annual Report NOTES TO CONSOLIDATED FINANCIAL STATEMENTS Goodwill and Amortizable Intangible Assets All of our business combinations initiated after June 30.2001 are accounted for using the purchase method. Acquisition purchase prices are typically based on a multiple of average annual operating profit earned over a one to three year period within a minimum and maximum price range. The recorded purchase prices for all acquisitions consummated after January 1, 2009 include an estimation of the fair value of liabilities associated with any potential earn -out provisions. Subsequent changes in the fair value of earn -out obligations are recorded in the Consolidated Statement of Income when incurred. The fair value of earn -out obligations is based on the present value of the expected future payments to be made to the sellers of the acquired businesses in accordance with the provisions contained in the respective purchase agreements. In determining fair value, the acquired business' future performance is estimated using financial projections developed by management for the acquired business and this estimate reflects market participant assumptions regarding revenue growth and/or profitability. The expected future payments are estimated on the basis of the earn -out formula and performance targets specified in each purchase agreement compared to the associated financial projections. These estimates are then discounted to present value using a risk -adjusted rate that takes into consideration the likelihood that the forecasted earn -out payments will be made. Amortizable intangible assets are stated at cost, less accumulated amortization, and consist of purchased customer accounts and non -compete agreements. Purchased customer accounts and non -compete agreements are amortized on a straight-line basis over the related estimated lives and contract periods, which range from five to 15 years. Purchased customer accounts primarily consist of records and files that contain information about insurance policies and the related insured parties that are essential to policy renewals. The excess of the purchase price of an acquisition over the fair value of the identifiable tangible and amortizable intangible assets is assigned to goodwill. While goodwill is not amortizable, it is subject to assessment at least annually, and more frequently in the presence of certain circumstances, for impairment by application of a fair value -based test. The Company compares the fair value of each reporting unit with its carrying amount to determine if there is potential impair- ment of goodwill. If the fair value of the reporting unit is less than its carrying value, an impairment loss is recorded to the extent that the fair value of the goodwill within the reporting unit is less than its carrying value, Fair value is estimated based on multiples of earnings before interest, income taxes, depreciation, amortization and change in estimated acquisi- tion earn -out payables ("EBITDAC" ), or on a discounted cash flow basis. Brown & Brown completed its most recent annual assessment as of November 30, 2015 and determined that the fair value of goodwill exceeded the carrying value of such assets. In addition, as of December 31, 2015, there are no accumulated impairment losses. The carrying value of amortizable intangible assets attributable to each business or asset group comprising Brown & Brown is periodically reviewed by management to determine if there are events or changes in circumstances that would indicate that its carrying amount may not be recoverable. Accordingly, if there are any such changes in circumstances during the year, Brown & Brown assesses the carrying value of its amortizable intangible assets by considering the estimated future undiscounted cash flows generated by the corresponding business or asset group. Any impairment identified through this assessment may require that the carrying value of related amortizable intangible assets be adjusted. There were no impairments recorded for the years ended December 31, 2015, 2014 and 2013. Income Taxes Brown & Brown records income tax expense using the asset -and -liability method of accounting for deferred income taxes. Under this method, deferred tax assets and liabilities are recognized for the expected future tax consequences of tempo- rary differences between the financial statement carrying values and the income tax bases of Brown & Brown's assets and liabilities. Brown & Brown files a consolidated federal income tax return and has elected to file consolidated returns in certain states, Deferred income taxes are provided for in the Consolidated Financial Statements and relate principally to expenses charged to income for financial reporting purposes in one period and deducted for income tax purposes in other periods. B-cw- , Brown, ~�c. 58 Net Income Per Share Basic EPS is computed based on the weighted average number of common shares (including participating securities) issued and outstanding during the period. Diluted EPS is computed based on the weighted average number of common shares issued and outstanding plus equivalent shares, assuming the exercise of stock options. The dilutive effect of stock options is computed by application of the treasury -stock method. The following is a reconciliation between basic and diluted weighted average shares outstanding for the years ended December 31: (in thousands, except per share data) 2015 2014 2013 Net income $ 243,318 $ 206,896 $ 217,112 Net income attributable to unvested awarded performance stock (5,695) (5,186) (5,446) Net income attributable to common shares $ 237,623 $ 201,710 $ 211,666 Weighted average number of common shares outstanding —basic Less unvested awarded performance stock included in weighted average number of common shares outstanding —basic Weighted average number of common shares outstanding for basic earnings per common share Dilutive effect of stock options Weighted average number of shares outstanding —diluted 141,113 144,568 144,662 {3,303) (3,624) {3,629) 137,810 140,944 141,033 2.302 1,947 1,591 140,112 142,891 142,624 Net income per share: Basic $ 1.72 $ 1.43 $ 1.50 Diluted 1.70 $ 1.41 $ 1.48 Fair Value of Financial Instruments The carrying amounts of Brown & Brown's financial assets and liabilities, including cash and cash equivalents; restricted cash and short-term investments; investments; premiums, commissions and fees receivable; reinsurance recoverable; prepaid reinsurance premiums; premiums payable to insurance companies; losses and loss adjustment reserve; unearned premium; premium deposits and credits due customers and accounts payable, at December 31, 2015 and 2014, approxi- mate fair value because of the short-term maturity of these instruments. The carrying amount of Brown & Brown's long-term debt approximates fair value at December 31, 2015 and 2014 as our fixed-rate borrowings of $623.6 million approximate their values using market quotes of notes with the similar terms as ours, which we deem a close approximation of current market rates. Of the $623.6 million, $25.0 million is related to short-term notes which approximates its carrying value due to its proximity to maturity. The estimated fair value of the $529.4 million remaining on the term loan under our J.P. Morgan Credit Facility approximates the carrying value due to the variable interest rate based on adjusted LIBOR. See Note 2 to our Consolidated Financial Statements for the fair values related to the establishment of intangible assets and the establishment and adjustment of earn -out payables. See Note 5 for information on the fair value of investments and Note 8 for information on the fair value of long-term debt. Stock -Based Compensation The Company granted stock options and grants non -vested stock awards to its employees, officers and directors. The Company uses the modified -prospective method to account for share -based payments. Under the modified -prospective method, compensation cost is recognized for all share -based payments granted on or after January 1, 2006 and for all awards granted to employees prior to January 1, 2006 that remained unvested on that date. The Company uses the alternative -transi- tion method to account for the income tax effects of payments made related to stock -based compensation. The Company uses the Black-Scholes valuation model for valuing all stock options and shares purchased under the Employee Stock Purchase Plan (the "ESPP"). Compensation for non -vested stock awards is measured at fair value on the grant date based upon the number of shares expected to vest. Compensation cost for all awards is recognized in earnings, net of estimated forfeitures, on a straight-line basis over the requisite service period. 59 2015 Annual Reoort NOTES TO CONSOLIDATED FINANCIAL STATEMENTS Reinsurance The Company protects itself from claims related losses by reinsuring all claims risk exposure. The only line of insurance the Company underwrites is flood insurance associated with Wright. However, all exposure is reinsured with FEMA for basic admitted policies conforming to the National Flood Insurance Program. For excess flood insurance policies, all exposure is reinsured with a reinsurance carrier with an AM Best Company rating of "A" or better. Reinsurance does not legally discharge the ceding insurer from the primary liability for the full amount due under the reinsured policies. Reinsurance premiums, commissions, expense reimbursement and related reserves related to ceded business are accounted for on a basis consistent with the accounting for the original policies issued and the terms of reinsurance contracts. Premiums earned and losses and loss adjustment expenses incurred are reported net of reinsurance amounts. Other underwriting expenses are shown net of earned ceding commission income. The liabilities for unpaid losses and loss adjustment expenses and unearned premiums are reported gross of ceded reinsurance recoverable. Balances due from reinsurers on unpaid losses and loss adjustment expenses, including an estimate of such recoverables related to reserves for incurred but not reported (" IBNR") losses, are reported as assets and are included in reinsurance recoverable even though amounts due on unpaid loss and loss adjustment expense are not recoverable from the reinsurer until such losses are paid. The Company does not believe it is exposed to any material credit risk through its reinsurance as the reinsurer is FEMA for basic admitted flood policies and a national reinsurance carrier for excess flood policies, which has an AM Best Company rating of "A' or better, Historically. no amounts due from reinsurance carriers have been written off as uncollectible. Unpaid Losses and Loss Adjustment Reserve Unpaid losses and loss adjustment reserve include amounts determined on individual claims and other estimates based on the past experience of WNFIC and the policyholders for IBNR claims, less anticipated salvage and subrogation recoverable. The methods of making such estimates and for establishing the resulting reserves are continually reviewed and updated, and any adjustments resulting therefrom are reflected in operations currently. WNFIC engages the services of outside actuarial consulting firms (the "Actuaries") to assist on an annual basis to render an opinion on the sufficiency of the Company's estimates for unpaid losses and related loss adjustment reserve. The Actuaries utilize both industry experience and the Company's own experience to develop estimates of those amounts as of year-end. These estimated liabilities are subject to the impact of future changes in claim severity, frequency and other factors. In spite of the variability inherent in such estimates, management believes that the liabilities for unpaid losses and related loss adjustment reserve is adequate. Premiums Premiums are recognized as income over the coverage period of the related policies. Unearned premiums represent the portion of premiums written that relate to the unexpired terms of the policies in force and are determined on a daily pro rata basis. The income is recorded to the commissions and fees line of the income statement. NOTE 2 Business Combinations During the year ended December 31, 2015, the Company acquired the assets and assumed certain liabilities of thirteen insurance intermediaries and four books of business (customer accounts). Additionally, miscellaneous adjustments were recorded to the purchase price allocation of certain prior acquisitions completed within the last twelve months as permitted by Accounting Standards Codification Topic 805 — Business Combinations ("ASC 805"). Such adjustments are presented in the "Other" category within the following two tables. All of these businesses were acquired primarily to expand Brown & Brown's core business and to attract and hire high -quality individuals. The recorded purchase price for all acquisitions consummated after January 1,2009 included an estimation of the fair value of liabilities associated with any potential earn -out provisions. Subsequent changes in the fair value of earn -out obligations will be recorded in the Consolidated Statement of Income when incurred. Brew- & Brown. 1.-c. 60 The fair value of earn -out obligations is based on the present value of the expected future payments to be made to the sellers of the acquired businesses in accordance with the provisions outlined in the respective purchase agreements. In determining fair value, the acquired business's future performance is estimated using financial projections developed by management for the acquired business and reflects market participant assumptions regarding revenue growth and/or profitability. The expected future payments are estimated on the basis of the earn -out formula and performance targets specified in each purchase agreement compared to the associated financial projections, These payments are then discounted to present value using a risk -adjusted rate that takes into consideration the likelihood that the forecasted earn -out pay- ments will be made. Based on the acquisition date and the complexity of the underlying valuation work, certain amounts included in the Company's Consolidated Financial Statements may be provisional and thus subject to further adjustments within the permitted measurement period, as defined in ASC 805, For the year ended December 31, 2015, several adjustments were made within the permitted measurement period that resulted in a decrease in the aggregate purchase price of the affected acquisitions of $503,442 relating to the assumption of certain liabilities. Cash paid for acquisitions was $136.0 million and $721.9 million in the twelve-month periods ended December 31, 2015 and 2014, respectively. We completed thirteen acquisitions (excluding book of business purchases) in the twelve- month period ended December 31, 2015. We completed ten acquisitions (excluding book of business purchases) in the twelve-month period ended December 31, 2014. The following table summarizes the purchase price allocation made as of the date of each acquisition for current year acquisitions and significant adjustments made during the measurement period for prior year acquisitions: (in thousands) Nome Maximum Effective Recorded Net Potential Business Date of Cash Other Earn -Out Assets Earn -out Segment Acquisition Paid Payable Payable Acquired Payable Liberty Insurance Brokers, Inc. and Affiliates (Liberty) Retail February 1, 2015 $ 12,000 $ - $ 2,981 $ 14,981 $ 3,750 Spain Agency, Inc. (Spain) Retail March 1,2015 20,706 - 2,617 23,323 9,162 Bellingham Underwriters, Inc. National (Bellingham) Programs May 1, 2015 9.007 500 3,322 12,829 4,400 Fitness Insurance, LLC (Fitness) Retail June 1, 2015 9,455 - 2,379 11,834 3,500 Strategic Benefit Advisors, Inc, (SBA) Retail June 1, 2015 49,600 400 13,587 63,587 26,000 Bentrust Financial, Inc. (Bentrust) Retail December 1,2015 10,142 391 319 10,852 2,200 MBA Insurance Agency of Arizona, Inc. (MBA) Retail December 1, 2015 68 8,442 6,063 14,573 9,500 Smith Insurance, Inc. (Smith) Retail December 1,2015 12,096 200 1,047 13,343 6,350 Other Various Various 12,926 95 4,584 17,605 8,212 Total $ 136,000 $ 10,028 $ 36,899 $ 182,927 $ 73,074 61 2015 Annual Report NOTES TO CONSOLIDATED FINANCIAL STATEMENTS The following table summarizes the estimated fair values of the aggregate assets and liabilities acquired as of the date of each acquisition. The data included in the 'Other' column shows a negative adjustment for purchased customer accounts. This is driven mainly by the final valuation adjustment for the acquisition of Wright. (in thousands) Liberty Spain ham Fitness SBA Bentrust MBA Smith Other Tata1 Other current assets $ 2.486 $ 324 5 - $ 9 $ 652 $ - $ - $ - $ 169 $ 3.640 Fixed assets 40 50 25 17 41 36 33 73 59 374 Goodwill 10.010 15.748 9,608 8,105 39,859 8,166 13,471 10,374 21,040 136.381 Purchased customer accounts 4.506 7,430 3,223 3,715 23.000 2,789 7,338 3,526 (2,135) 53,392 Non -compete agreements 24 21 21 - 21 43 11 31 156 328 Other assets - - - - 14 - - - - 14 Total assets acquired 17,066 23,573 12,877 11,846 63,587 11,034 20,853 14,004 19,289 194,129 Other current liabilities (42) (250) (48) (12) - (182) (6,280) (504) (4,895) (12,213) Deferred income tax, net - - - - - - - - 2,576 2,576 Other liabilities (2,043) - - - - - - (157) 635 (1,565) Total liabilities assumed (2,085) (250) (48) (12) - (182) (6,280) (661) (1,684) (11,202) Net assets acquired $ 14,981 $ 23,323 $ 12,829 $ 11,834 $ 63,587 $ 10,852 $ 14,573 $ 13,343 $ 17,605 $ 182,927 The weighted average useful lives for the acquired amortizable intangible assets are as follows: purchased customer accounts, 15 years; and non -compete agreements, 5 years. Goodwill of $136.4 million was allocated to the Retail, National Programs and Wholesale Brokerage Segments in the amounts of $113.8 million, $18.0 million and $4.6 million, respectively. Of the total goodwill of $136.4 million, $91.1 million is currently deductible for income tax purposes and $8.4 million is non-deductible.The remaining $36.9 million relates to the recorded earn -out payables and will not be deductible until it is earned and paid. For the acquisitions completed during 2015. the results of operations since the acquisition dates have been combined with those of the Company. The total revenues from the acquisitions completed through December 31, 2015, included in the Consolidated Statement of Income for the year ended December 31, 2015, were $28.2 million. The income before income taxes, including the inter -company cost of capital charge, from the acquisitions completed through December 31, 2015, included in the Consolidated Statement of Income for the year ended December 31, 2015, was $1.5 million. if the Brown & Brown. lnc. 62 acquisitions had occurred as of the beginning of the respective periods, the Company's results of operations would be as shown in the following table. These unaudited pro forma results are not necessarily indicative of the actual results of operations that would have occurred had the acquisitions actually been made at the beginning of the respective periods. (UNAUDITED) For the Year Ended December 31, (in thousands, except per share data) 2015 2014 Total revenues $ 1,688,297 $ 1,630,992 Income before income taxes $ 411,497 $ 356,426 Net income $ 248,720 $ 217,053 Net income per share: Basic $ 1.76 $ 1.50 Diluted $ 1,73 $ 1.48 Weighted average number of shares outstanding: Basic 137,810 140,944 Diluted 140,112 142,891 Acquisitions in 2014 During the year ended December 31, 2014, Brown & Brown acquired the assets and assumed certain liabilities of nine insurance intermediaries, all of the stock of one insurance intermediary that owns an insurance carrier and five books of business (customer accounts). The cash paid for these acquisitions was $721.9 million. Additionally, miscellaneous adjust- ments were recorded to the purchase price allocation of certain prior acquisitions completed within the last twelve months as permitted by Accounting Standards Codification Topic 805 — Business Combinations ("ASC 805"). Such adjustments are presented in the "Other" category within the following two tables. All of these acquisitions were acquired primarily to expand Brown & Brown's core business and to attract and hire high -quality individuals. For the year ended December 31, 2014, several adjustments were made within the permitted measurement period that resulted in a decrease in the aggregate purchase price of the affected acquisitions of $25,941 relating to the assump- tion of certain liabilities. The following table summarizes the purchase price allocation made as of the date of each acquisition for current year acquisitions and significant adjustment made during the measurement period for prior year acquisitions: (in thousands) Name Maximum Effective Recorded Net Potential Business Date of Cash Other Earn -Out Assets Earn -Out Segment Acquisition Paid Payable Payable Acquired Payable The Wright Insurance National Group, LLC Programs May 1, 2014 $ 609,183 $ 1,471 $ $ 610,654 $ Pacific Resources Benefits Advisors, LLC ("PacRes") Retail May 1, 2014 90,000 — 27,452 117,452 35,000 Axia Strategies. Inc Wholesale ("Axial Brokerage May 1, 2014 9,870 — 1,824 11,694 5,200 Other Various Various 12,798 433 3.953 17,184 9,262 Total $ 721,851 $ 1,904 $ 33,229 $ 756,984 $ 49,462 63 2015 Annual Report NOTES TO CONSOLIDATED FINANCIAL STATEMENTS The following table summarizes the estimated fair values of the aggregate assets and liabilities acquired as of the date of each acquisition. (in thousands) Wright FocRes Axia Other Total Cash $ 25,365 $ - $ - $ - $ 25,365 Other current assets 16,474 3,647 101 742 20,964 Fixed assets 7,172 53 24 1,724 8,973 Reinsurance recoverable 25,238 - - - 25,238 Prepaid reinsurance premiums 289,013 - - - 289,013 Goodwill 420,209 76,023 7,276 10,417 513,925 Purchased customer accounts 213,677 38,111 4,252 4,384 260.424 Non -compete agreements 966 21 41 166 1,194 Other assets 20,045 - - - 20,045 Total assets acquired 1,018,159 117,855 11,694 17,433 1,165,141 Other current liabilities (14,322) (403) - (249) (14,974) Losses and loss adjustment reserve (25,238) - - - (25,238) Unearned premiums (289,013) - - (289,013) Deferred income tax, net (46,566) - - - (46.566) Other liabilities (32,366) - - - (32,366) Total liabilities assumed (407,505) (403) - {249) (408,157) Net assets acquired $ 610,654 $ 117,452 $ 11,694 $ 17,184 $ 756,984 The weighted average useful lives for the acquired amortizable intangible assets are as follows: purchased customer accounts, 15 years; and non -compete agreements, 3.4 years. Goodwill of $513.9 million was allocated to the Retail, National Programs, Wholesale Brokerage and Services Segments in the amounts of $86.4 million, $420.0 million, $7.7 million and $(0.2) million, respectively. Of the total goodwill of $513.9 million, $141.9 million is currently deductible for income tax purposes and $338.8 million is non -deductible. The remaining $33.2 million relates to the recorded earn -out payables and will not be deductible until it is earned and paid. For the acquisitions completed during 2014, the results of operations since the acquisition dates have been combined with those of the Company. The total revenues and income before income taxes. including the inter -company cost of capital, from the acquisitions completed through December 31, 2014, included in the Consolidated Statement of Income for the year ended December 31, 2014, were $112.2 million and $(1.3) million, respectively. If the acquisitions had occurred as of the beginning of the respective periods, the Company's results of operations would be as shown in the following table. These unaudited pro forma results are not necessarily indicative of the actual results of operations that would have occurred had the acquisitions actually been made at the beginning of the respective periods. 64 (UNAUDITED) For the Year Ended December 31. (in thousands, except per share data) 2014 2013 Total revenues $ 1,630,162 $ 1,520,858 Income before income taxes $ 358,229 $ 409,522 Net income $ 218,150 $ 248,628 Net income per share: Basic $ 1.51 $ 1.72 Diluted $ 1.49 $ 1.70 Weighted average number of shares outstanding: Basic 140,944 141,033 Diluted 142,891 142,624 Acquisitions in 2013 During the year ended December 31, 2013, Brown & Brown acquired the assets and assumed certain liabilities of eight insurance intermediaries, all of the stock of one insurance intermediary and one book of business (customer accounts). The cash paid for these acquisitions was $408.1 million. Additionally, miscellaneous adjustments were recorded to the purchase price allocation of certain prior acquisitions completed within the last twelve months as permitted by Accounting Standards Codification Topic 805 — Business Combinations ("ASC 805"). Such adjustments are presented in the "Other" category within the following two tables. All of these acquisitions were acquired primarily to expand Brown & Brown's core business and to attract and hire high -quality individuals. For the year ended December 31, 2013, several adjustments were made within the permitted measurement period that resulted in a decrease in the aggregate purchase price of the affected acquisitions of $504,300 relating to the assump- tion of certain liabilities. The following table summarizes the aggregate purchase price allocation made as of the date of each acquisition for current year acquisitions and adjustment made during the measurement period for prior year acquisitions: (in thousands) Name Maximum Effective Recorded Net Potential Business Date of Cash Other Earn -Out Assets Earn -Out Segment Acquisition Paid Payable Payable Acquired Payable The Rollins Agency, Inc. Retail June 1, 2013 $ 13,792 $ 50 $ 2,321 $ 16,163 $ 4,300 Beecher Carlson Retail; Holdings, Inc. National Programs July 1, 2013 364,256 — — 364,256 — ICA, Inc. Services December 31, 2013 19.770 — 727 20,497 5,000 Other Various Various 10,254 502 2,043 12,799 7,468 Total $ 408,072 $ 552 $ 5,091 $ 413,715 $ 16,768 65 2015 Annual Report NOTES TO CONSOLIDATED FINANCIAL. STATEMENTS The following table summarizes the estimated fair values of the aggregate assets and liabilities acquired as of the date of each acquisition. (in thousands) Rollins Beecher ICA Other Total Cash Other current assets Fixed assets Goodwill Purchased customer accounts Non -compete agreements Other assets — $ 40,360 $ — $ — $ 40.360 393 57,632 — 1,573 59,598 30 1,786 75 24 1.915 12,697 265.174 12.377 5,696 295.944 3,878 101,565 7,917 5,623 118,983 31 2,758 21 76 2,886 — — 107 1 108 Total assets acquired 17,029 469,275 20,497 12,993 519,794 Other current liabilities (866) (80,090) -- (194) (81,150) Deferred income tax, net — (22,764) — — (22,764) Other liabilities — (2,165) — — (2,1651 Total liabilities assumed (866) (105,019) — (194) (106,079) Net assets acquired $ 16,163 $ 364,256 $ 20,497 $ 12,799 $ 413,715 The weighted average useful lives for the acquired amortizable intangible assets are as follows: purchased customer accounts, 15 years; and non -compete agreements, 5 years. Goodwill of $295.9 million was allocated to the Retail, National Programs, Wholesale Brokerage and Services Segments in the amounts of $257.2 million, $27.1 million, $(0.8) million and $12.4 million, respectively. Of the total goodwill of $295.9 million, $41.6 million is currently deductible for income tax purposes and $249.2 million is non -deductible. The remaining $5.1 million relates to the recorded earn -out payables and will not be deductible until it is earned and paid. For the acquisitions completed during 2013, the results of operations since the acquisition dates have been combined with those of the Company. The total revenues and income before income taxes, including the inter -company cost of capital, from the acquisitions completed through December 31, 2013, included in the Consolidated Statement of Income for the year ended December 31, 2013, were $63.8 million and $0.9 million, respectively. If the acquisitions had occurred as of the beginning of the respective periods, the Company's results of operations would be as shown in the following table. These unaudited pro forma results are not necessarily indicative of the actual results of operations that would have occurred had the acquisitions actually been made at the beginning of the respective periods. (UNAUDfTED) For the Year Ended December 31, (in thousands, except per share data) 2013 2012 Total revenues $ 1,439,918 $ 1,329,262 Income before income taxes $ 373.175 $ 329.291 Net income $ 226,562 $ 198,826 Net income per share: Basic $ 1.57 $ 1.39 Diluted $ 1.55 $ 1.36 Weighted average number of shares outstanding: Basic 141,033 139,634 Diluted 142,624 142.010 Brown & Brown. Inc. 66 For acquisitions consummated prior to January 1, 2009, additional consideration paid to sellers as a result of the purchase price earn -out provisions are recorded as adjustments to intangible assets when the contingencies are settled. The net additional consideration paid by the Company in 2015 as a result of those adjustments totaled $0. The net addi- tional consideration paid by the Company in 2014 as a result of these adjustments totaled $26,000, all of which was allocated to goodwill. Of the $26,000 net additional consideration paid, $26,000 was recorded in other payables. As of December 31. 2015, the maximum future contingency payments related to all acquisitions totaled $137.4 million, all of which relates to acquisitions consummated subsequent to January 1, 2009. ASC Topic 805-Business Combinations is the authoritative guidance requiring an acquirer to recognize 100% of the fair values of acquired assets, including goodwill, and assumed liabilities (with only limited exceptions) upon initially obtaining control of an acquired entity.Additionally, the fair value of contingent consideration arrangements (such as earn -out purchase arrangements) at the acquisition date must be included in the purchase price consideration. As a result, the recorded purchase prices for all acquisitions consummated after January 1, 2009 include an estimation of the fair value of liabilities associated with any potential earn -out provisions. Subsequent changes in these earn -out obligations will be recorded in the Consolidated Statement of Income when incurred. Potential earn -out obligations are typically based upon future earnings of the acquired entities, usually between one and three years. As of December 31, 2015, the fair values of the estimated acquisition earn -out payables were re-evaluated and measured at fair value on a recurring basis using unobservable inputs (Level 3) as defined in ASC 820-Fair Value Measurement. The resulting additions, payments, and net changes, as well as the interest expense accretion on the estimated acquisition earn -out payables, for the years ended December 31, 2015, 2014 and 2013 were as follows: (in thousands} For the Year Ended December 31, 2015 2014 2013 Balance as of the beginning of the period $ 75,283 $ 43,058 $ 52,987 Additions to estimated acquisition earn -out payables 36,899 34,356 5,816 Payments for estimated acquisition earn -out payables (36,798) (12,069) (18,278) Subtotal 75,384 65,345 40,525 Net change in earnings from estimated acquisition earn -out payables: Change in fair value on estimated acquisition earn -out payables 2,990 7,375 570 Interest expense accretion 13 2,563 1,963 Net change in earnings from estimated acquisition earn -out payables 3,003 9,938 2,533 Balance as of December 31, $ 78,387 $ 75,283 $ 43,058 Of the $78.4 million estimated acquisition earn -out payables as of December 31, 2015, $25.3 million was recorded as accounts payable and $53.1 million was recorded as other non -current liabilities. Included within additions to estimated acquisition earn -out payables are any adjustments to opening balance sheet items prior to the one-year anniversary date and may therefore differ from previously reported amounts. Of the $75.3 million estimated acquisition earn -out payables as of December 31, 2014, $26.0 million was recorded as accounts payable and $49.3 million was recorded as an other non -current liability. Of the $43.1 million estimated acquisition earn -out payables as of December 31, 2013, $6.3 million was recorded as accounts payable and $36.8 million was recorded as an other non -current liability. 67 2015 Annual Report NOTES TO CONSOLIDATED FINANCIAL STATEMENTS NOTE 3 Goodwill The changes in the carrying value of goodwill by reportable segment for the years ended December 31, are as follows: (in thousands) National Wholesale Retail Programs Brokerage Services Total Balance as of January 1, 2014 $1.141,485 $ 475,596 $ 268,562 $ 120,530 $ 2,006.173 Goodwill of acquired businesses 94,080 420,063 47 (239) 513.951 Goodwill disposed of relating to sales of businesses (3,696) (9,564) (46,253) — (59,513) Balance as of December 31, 2014 $ 1,231,869 $ 886.095 $ 222,356 $ 120.291 $ 2,460,611 Goodwill of acquired businesses 113,767 18,009 4,605 — 136,381 Goodwill disposed of relating to sales of businesses — (2,238) -. (8.071) (10,309) Balance as of December 31, 2015 $1,345,636 $ 901,866 $ 226,961 $ 112,220 $ 2,586,683 NOTE 4 Amortizable Intangible Assets Amortizable intangible assets at December 31, 2015 and 2014 consisted of the following: December 31, 2015 (in thousands) December 31, 2014 Weighted- Weighted - Grass Net Average Gross Net Average Carrying Accumulated Carrying Life Carrying Accumulated Carrying Life Value Amortization Value (years)" Value Amortization Value (years)" Purchased customer accounts $1.398,986 $ (656,799) $ 742,187 15.0 $1,355,550 $ (574,285) $ 781,265 14.9 Non -compete agreements 29,440 (26,947) 2,493 6.8 29.139 (25,762) 3,377 6.8 Total $1,428,426 $ (683,746) $ 744,680 $1,384,689 $ (600,047) $ 784,642 (1) Weighted average life calculated as of the date of acquisition. Amortization expense for amortizable intangible assets for the years ending December 31, 2016,2017, 2018, 2019 and 2020 is estimated to be $84.5 million, $81.6 million, $76.3 million, $71.8 million, and $64.5 million, respectively. NOTE 5 Investments At December 31, 2015. the Company's amortized cost and fair values of fixed maturity securities are summarized as follows: Gross Gross Unrealized Unrealized (in thousands) Cost Gains Losses Fair Value U.S. Treasury securities, obligations of U.S. Government agencies and Municipals $ 11,876 $ 6 S (26) $ 11.856 Foreign government 50 — — 50 Corporate debt 4,505 7 (16) 4.496 Short duration fixed income fund 1,663 27 — 1,690 Total $ 18,094 $ 40 $ (42) $ 18,092 Brown & Brown. Inc, 68 For securities in a loss position, the following table shows the investments' gross unrealized loss and fair value, aggre- gated by investment category and length of time that individual securities have been in a continuous unrealized loss position as of December 31, 2015: Less than 12 Months 12 Months or More Total Unrealized Unrealized Unrealized (in thousands) Fair Value Lasses Fair Value Losses Fair Value Losses U.S. Treasury securities, obligations of U.S. Government agencies and Municipals $ 8,998 $ 26 $ — $ — $ 8,998 $ 26 Foreign Government 50 — — — 50 — Corporate debt 2,731 14 284 2 3,015 16 Total $ 11,779 $ 40 $ 284 $ 2 $ 12,063 $ 42 The unrealized Posses from corporate issuers were caused by interest rate increases. At December 31, 2015, the Company had 35 securities in an unrealized loss position. The corporate securities are highly rated securities with no indicators of potential impairment. Based on the ability and intent of the Company to hold these investments until recovery of fair value, which may be maturity, the bonds were not considered to be other -than -temporarily impaired at December 31, 2015. At December 31, 2014, the Company's amortized cost and fair values of fixed maturity securities are summarized as follows: (in thousands) Cost Gross Gross Unrealized Unrealized Gains Losses Fair Value U.S. Treasury securities, obligations of U.S. Government agencies and Municipals $ 10,774 $ 7 $ (1) $ 10,780 Foreign government 50 — — 50 Corporate debt 5,854 9 (11) 5,852 Short duration fixed income fund 3,143 37 — 3,180 Total $ 19,821 $ 53 $ (12) $ 19,862 The following table shows the investments' gross unrealized loss and fair value, aggregated by investment category and length of time that individual securities have been in a continuous unrealized loss position as of December 31, 2014: Less than 12 Months 12 Months or More Total Unrealized Unrealized Unrealized {in thousands) Fair Value Losses Fair Value Losses Fair Value Losses U.S. Treasury securities, obligations of U.S. Government agencies and Municipals $ 3,994 $ 1 $ -- $ — $ 3,994 $ 1 Foreign Government 50 — — — 50 — Corporate debt 4.439 11 — — 4,439 11 Total $ 8,483 $ 12 $ — $ 8,483 $ 12 69 2015 Annual Rectort NOTES TO CONSOLIDATED FINANCIAL STATEMENTS The unrealized losses in the Company's investments in U.S. Treasury Securities and obligations of U.S. Government Agencies and bonds from corporate issuers were caused by interest rate increases. At December 31, 2014, the Company had 38 securities in an unrealized loss position. The contractual cash flows of the U.S. Treasury Securities and obligations of the U.S. Government agencies investments are either guaranteed by the U.S. Government or an agency of the U.S. Government. Accordingly, it is expected that the securities would not be settled at a price less than the amortized cost of the Company's investment. The corporate securities are highly rated securities with no indicators of potential irnpairment. Based on the ability and intent of the Company to hold these investments until recovery of fair value, which may be matu- rity, the bonds were not considered to be other -than -temporarily impaired at December 31, 2014. The amortized cost and estimated fair value of the fixed maturity securities at December 31, 2015 by contractual maturity are set forth below: (in thousands) Amortized Cost Fair Value Years to maturity: Due in one year or less $ 5,726 $ 5,722 Due after one year through five years 12,038 12,041 Due after five years through ten years 330 329 Total $ 18,094 $ 18,092 The amortized cost and estimated fair value of the fixed maturity securities at December 31, 2014 by contractual maturity are set forth below: (in thousands) Amortized Cost Fair Value Years to maturity: Due in one year or less $ 5,628 $ 5,628 Due after one year through five years 13,863 13,897 Due after five years through ten years 330 337 Total $ 19,821 $ 19,862 The expected maturities in the foregoing table may differ from the contractual maturities because certain borrowers have the right to calf or prepay obligations with or without penalty. Proceeds from sales of the Company's investment in fixed maturity securities were $5.6 million including maturities for the year ended December 31, 2015. The gains and losses realized on those sales for the year ended December 31, 2015 were insignificant. Proceeds from sales of the Company's investment in fixed maturity securities were $0.2 million including maturities for the year ended December 31, 2014. There were no gains and losses realized on those sales for the year ended to December 31, 2014. Realized gains and losses are reported on the Consolidated Statement of Income, with the cost of securities sold determined on a specific identification basis. At December 31, 2015, investments with a fair value of approximately $4.0 million were on deposit with state insur- ance departments to satisfy regulatory requirements. Brown & Brown. Inc. 70 NOTE 6 Fixed Assets Fixed assets at December 31 consisted of the following: (in thousands) 2015 2014 Furniture, fixtures and equipment $ 169,682 $ 161,539 Leasehold improvements 32,132 30,030 Land, buildings and improvements 3,370 3,739 Total cost 205,184 195,308 Less accumulated depreciation and amortization (123,431) (110,640) Total $ 81,753 $ 84,668 Depredation and amortization expense for fixed assets amounted to $20.9 million in 2015, $20.9 million in 2014, and $17.5 million in 2013. NOTE 7 Accrued Expenses and Other Liabilities Accrued expenses and other liabilities at December 31 consisted of the following: (in thousands) 2015 2014 Accrued bonuses $ 76,210 $ 76,891 Accrued compensation and benefits 39,366 36,241 Accrued rent and vendor expenses 29,225 29,039 Reserve for policy cancellations 9,617 9,074 Accrued interest 6,375 6,527 Other 31,274 23,384 Total $ 192,067 $ 181,156 71 2015 Annual Report NOTES TO CONSOLIDATED FINANCIAL STATEMENTS NOTE 8 Long -Term Debt Long-term debt at December 31, 2015 and 2014 consisted of the following: (in thousands) Current portion of long-term debt: Current portion of 5-year term loan facility expires 2019 5.370% senior notes, Series D, quarterly interest payments, balloon due 2015 5.660% senior notes, Series C. semi-annual interest payments, balloon due 2016 December 31, December 31, 2015 2014 $ 48,125 $ 20,625 25.000 25,000 — Total current portion of long-term debt 73,125 45,625 Long-term debt: Note agreements: 5.660% senior notes, Series C, semi-annual interest payments, balloon due 2016 — 25,000 4.500% senior notes, Series E, quarterly interest payments, balloon due 2018 100,000 100,000 4.200% senior notes, semi-annual interest payments. balloon due 2024 498,628 498,471 Total notes 598,628 623.471 Credit agreements: 5-year term -loan facility, periodic interest and principal payments, currently LIBOR plus up to 1.75%, expires May 20.2019 481.250 529.375 5-year revolving -loan facility. periodic interest payments, currently LIBOR plus up to 1.50%. plus commitment fees up to 0.25%. expires May 20, 2019 — — Revolving credit loan, quarterly interest payments, LIBOR plus up to 1.40% and availability fee up to 0.25%, expires December 31, 2016 — — Total credit agreements 481.250 529,375 Total long-term debt 1,079,878 1,152.846 Current portion of long-term debt 73,125 45,625 Total debt S 1,153,003 $ 1,198,471 On December 22, 2006, the Company entered into a Master Shelf and Note Purchase Agreement (the "Master Agreement") with a national insurance company (the "Purchaser"). The initial issuance of notes under the Master Agreement occurred on December 22, 2006, through the issuance of $25.0 million in Series C Senior Notes due December 22, 2016, with a fixed interest rate of 5.66% per year. On February 1, 2008, $25.0 million in Series D Senior Notes due January 15, 2015, with a fixed interest rate of 5.37% per year, were issued. On September 15, 2011, and pursuant to a Confirmation of Acceptance {the "Confirmation"), dated January 21, 2011, in connection with the Master Agreement, $100.0 million in Series E Senior Notes were issued and are due September 15, 2018, with a fixed interest rate of 4.50% per year. The Series E Senior Notes were issued for the sole purpose of retiring existing senior notes. On January 15, 2015, the Series D Notes were redeemed at maturity using cash proceeds to pay off the principal of $25.0 million plus any remaining accrued interest. As of December 31, 2015, there was an outstanding debt balance issued under the provisions of the Master Agreement of $125.0 million. On July 1, 2013. in conjunction with the acquisition of Beecher Carlson Holdings. Inc.. the Company entered into a revolving loan agreement (the "Wells Fargo Agreement") with Wells Fargo Bank, N.A. that provided for a $50.0 million revolving line of credit (the "Wells Fargo Revolver"). The maturity date for the Wells Fargo Revolver is December 31, 2016, at which time all outstanding principal and unpaid interest will be due. On April 16, 2014, in connection with the signing of Brown & Brown. Inc. 72 the Credit Facility (as defined below) an amendment to the agreement was established to reduce the total revolving loan commitment from $50.0 million to $25.0 million. The Wells Fargo Revolver may be increased by up to $50.0 million (bring- ing the total amount available to $75.0 million). The calculation of interest and fees for the Wells Fargo Agreement is generally based on the Company's funded debt-to-EBITDA ratio. Interest is charged at a rate equal to 1.00% to 1.40% above LIBOR or 1.00% below the Base Rate, each as more fully described in the Welds Fargo Agreement. Fees include an up -front fee, an availability fee of 0.175% to 0.25%, and a letter of credit margin fee of 1.00% to 1.40%. The obligations under the Wells Fargo Revolver are unsecured and the Wells Fargo Agreement includes various covenants, limitations and events of default that are customary for similar facilities for similar borrowers. There were no borrowings against the Wells Fargo Revolver as of December 31, 2015 and 2014. On April 17.2014, the Company entered into a credit agreement with J PMorgan Chase Bank, N.A. as administrative agent and certain other banks as co -syndication agents and co -documentation agents (the "Credit Agreement"). The Credit Agreement in the amount of $1,350.0 million provides for an unsecured revolving credit facility (the "Credit Facility") in the initial amount of $800.0 million and unsecured term loans in the initial amount of $550.0 million, either or both of which may, subject to lenders' discretion, potentially be increased by up to $500.0 million. The Credit Facility was funded on May 20, 2014 in conjunction with the closing of the Wright acquisition, with the $550.0 million term loan being funded as well as a drawdown of $375.0 million on the revolving loan facility. Use of these proceeds was to retire existing term loan debt and to facilitate the closing of the Wright acquisition as well as other acquisitions. The Credit Facility terminates on May 20, 2019, but either or both of the revolving credit facility and the term loans may be extended for two additional one-year periods at the Company's request and at the discretion of the respective lenders. Interest and facility fees in respect to the Credit Facility are based on the better of the Company's net debt leverage ratio or a non-credit enhanced senior unsecured long-term debt rating. Based on the Company's net debt leverage ratio, the rates of interest charged on the term loan are 1.00% to 1.75%, and the revolving loan is 0.85% to 1.50% above the adjusted LIBOR rate for outstanding amounts drawn. There are fees included in the facility which include a facility fee based on the revolving credit commit- ments of the lenders (whether used or unused) at a rate of 0.15% to 0.25% and letter of credit fees based on the amounts of outstanding secured or unsecured letters of credit. The Credit Facility includes various covenants, limitations and events of default customary for similar facilities for similarly rated borrowers. As of December 31, 2015 and 2014, there was an outstanding debt balance issued under the provisions of the Credit Facility in total of $529.4 million and $550.0 million respectively, with no borrowings outstanding relative to the revolving loan. Per the terms of the agreement, scheduled principal payments of $48.1 million are due in 2016. On September 18, 2014, the Company issued $500.0 million of 4.20% unsecured senior notes due in 2024. The senior notes were given investment grade ratings of BBB-/Baa3 with a stable outlook. The notes are subject to certain covenant restrictions and regulations which are customary for credit rated obligations. At the time of funding, the proceeds were offered at a discount of the original note amount which also excluded an underwriting fee discount. The net proceeds received from the issuance were used to repay the outstanding balance of $475.0 million on the revolving Credit Facility and for other general corporate purposes. As of December 31, 2015 and 2014, there was an outstanding debt balance of $500.0 million exclusive of the associated discount balance. The Master Agreement, Wells Fargo Agreement and the Credit Agreement all require the Company to maintain certain financial ratios and comply with certain other covenants. The Company was in compliance with all such covenants as of December 31, 2015 and 2014. The 30-day Adjusted LIBOR Rate as of December 31, 2015 was 0.44%, Interest paid in 2015, 2014 and 2013 was $37.5 million, $25.1 million, and $16.5 million, respectively. At December 31, 2015. maturities of long-term debt were $73.1 million in 2016, $55.0 million in 2017, $155.0 million in 2018, $371.3 million in 2019 and $500.0 million in 2024. 73 2015 Annua Report NOTES TO CONSOLIDATED FINANCIAL STATEMENTS NOTE 9 Income Taxes Significant components of the provision for income taxes for the years ended December 31 are as follows: (in thousands) 2015 2014 2013 Current: Federal State Foreign $ 118,490 $ 109,893 $ 94,007 17,625 15,482 13.438 430 109 805 Total current provision 136,545 125,484 108,250 Deferred: Federal State Foreign 18,416 5,987 28,469 4,280 1,440 3,723 — (58) 55 Total deferred provision 22,696 7,369 32,247 Total tax provision $ 159,241 $ 132,853 $ 140,497 A reconciliation of the differences between the effective tax rate and the federal statutory tax rate for the years ended December 31 is as follows: 2015 2014 2013 Federal statutory tax rate 35.0% 35.0% 35.0% State income taxes, net of federal income tax benefit 3.9 3.3 3.5 Non -deductible employee stock purchase plan expense 0.3 0.3 0.3 Non -deductible meals and entertainment 0.3 0.4 0.3 Other, net 0,1 0.1 0.2 Effective tax rate 39.6% 39.1% 39.3% Deferred income taxes reflect the net tax effects of temporary differences between the carrying amounts of assets and liabilities for financial reporting purposes and the corresponding amounts used for income tax reporting purposes. Significant components of Brown & Brown's current deferred tax assets as of December 31 are as follows: (in thousands) 2015 2014 Current deferred tax assets: Deferred profit-sharing contingent commissions $ 9,767 $ 10,335 Net operating loss carryforwards 10 951 Accruals and reserves 14,858 14,145 Total current deferred tax assets $ 24,635 $ 25,431 & B-owf , -c. 74 Significant components of Brown & Brown's non -current deferred tax liabilities and assets as of December 31 are as follows: (In thousands) 2015 2014 Non -current deferred tax liabilities: Fixed assets $ 8,585 $ 10,368 Net unrealized holding (toss}/gain on available -for -sale securities (9) 56 Intangible assets 393,251 364,938 Total non -current deferred tax liabilities 401,827 375,362 Non -current deferred tax assets: Deferred compensation 38,966 31,580 Net operating loss carryforwards 2,518 2,796 Valuation allowance for deferred tax assets (606) (511) Total non -current deferred tax assets 40,878 33,865 Net non -current deferred tax liability $ 360,949 $ 341,497 Income taxes paid in 2015, 2014 and 2013 were $132.9 million, $118.3 million, and $110.2 million respectively. At December 31, 2015,.Brown & Brown had net operating loss carryforwards of $184,218 and $61,217,003 for federal and state income tax reporting purposes, respectively, portions of which expire in the years 2016 through 2034. The federal carryforward is derived from insurance operations acquired by Brown & Brown in 2001. The state carryforward amount is derived from the operating results of certain subsidiaries and from the 2013 stock acquisition Beecher Carlson Holdings, Inc. A reconciliation of the beginning and ending amount of unrecognized tax benefits is as follows: (in thousands) 2015 2014 2013 Unrecognized tax benefits balance at January 1 Gross increases for tax positions of prior years Gross decreases for tax positions of prior years Settlements $ 113 $ 391 $ 294 773 — 232 — (21) — (302} {257) {135} Unrecognized tax benefits balance at December 31 $ 584 $ 113 $ 391 The Company recognizes interest and penalties related to uncertain tax positions in income tax expense. As of December 31, 2015 and 2014, the Company had $102,171 and $65,772 of accrued interest and penalties related to uncertain tax positions, respectively. The total amount of unrecognized tax benefits that would affect the Company's effective tax rate if recognized was $583,977 as of December 31, 2015 and $113,032 as of December 31, 2014. The Company does not expect its unrecog- nized tax benefits to change significantly over the next 12 months. As a result of a 2006 Internal Revenue Service ("IRS") audit, the Company agreed to accrue at each December 31, for tax purposes only, a known amount of profit-sharing contingent commissions represented by the actual amount of profit- sharing contingent commissions received in the first quarter of the related year, with a true -up adjustment to the actual amount received by the end of the following March. Since this method for tax purposes differs from the method used for book purposes. it will result in a current deferred tax asset as of December 31 each year which will reverse by the following March 31 when the related profit-sharing contingent commissions are recognized for financial accounting purposes. 75 2015 Annual Report NOTES TO CONSOLIDATED FINANCIAL STATEMENTS The Company is subject to taxation in the United States and various state jurisdictions. The Company is also subject to taxation in the United Kingdom. In the United States, federal returns for fiscal years 2012 through 2015 remain open and subject to examination by the IRS. The Company files and remits state income taxes in various states where the Company has determined it is required to file state income taxes. The Company's filings with those states remain open for audit for the fiscal years 2010 through 2015. In the United Kingdom, the Company's filings remain open for audit for the fiscal years 2014 and 2015. The federal income tax returns of The Wright Insurance Group are currently under IRS audit for the year ended December 31, 2013 and the short period ended May 1, 2014. Also during 2015, the previously disclosed 2013 IRS audit of Beecher Carlson Holding, Inc. was closed with no adjustments. The Company's 2009 through 2012 State of Oregon tax returns were under audit in 2014. The audit was settled in early 2015 with the State of Oregon for an insignificant amount. The Company is currently under audit in the State of Kansas for fiscal years 2012 through 2014. There are no other federal or state income tax audits as of December 31, 2015. NOTE 10 Emplojee Savings Plan The Company has an Employee Savings Plan (401(k)) in which substantially all employees with more than 30 days of service are eligible to participate. Under this plan, Brown & Brown makes matching contributions of up to 4.0% of each participant's annual compensation. Prior to 2014, the Company's matching contribution was up to 2.5% of each participant's annual compensation with a discretionary profit-sharing contribution each year, which equaled 1.5% of each eligible employee's compensation. The Company's contributions to the plan totaled $17.8 million in 2015, $15.8 million in 2014, and $14.8 mil- lion in 2013. NOTE 11 Stock -Based Compensation Performance Stock Plan In 1996, Brown & Brown adopted and the shareholders approved a performance stock plan, under which until the suspen- sion of the plan in 2010, up to 14,400,000 Performance Stock Plan ("PSP") shares could be granted to key employees contingent on the employees' future years of service with Brown & Brown and other performance -based criteria estab- lished by the Compensation Committee of the Company's Board of Directors. Before participants may take full title to Performance Stock, two vesting conditions must be met. Of the grants currently outstanding, specified portions will satisfy the first condition for vesting based on 20% incremental increases in the 20-trading-day average stock price of Brown & Brown's common stock from the price on the business day prior to date of grant. Performance Stock that has satisfied the first vesting condition is considered "awarded shares" Awarded shares are included as issued and outstanding common stock shares and are included in the calculation of basic and diluted EPS. Dividends are paid on awarded shares and participants may exercise voting privileges on such shares. Awarded shares satisfy the second condition for vesting on the earlier of a participant's: (i) 15 years of continuous employment with Brown & Brown from the date shares are granted to the participants (or, in the case of the July 2009 grant to Powell Brown, 20 years): (ii) attainment of age 64 (on a prorated basis corresponding to the number of years since the date of grant); or (iii) death or disability. On April 28, 2010, the PSP was suspended and any remaining authorized, but unissued shares, as well as any shares forfeited in the future, will be reserved for issuance under the 2010 Stock Incentive Plan (the "SI P"). At December 31, 2015, 5,266,707 shares had been granted under the PSP. As of December 31, 2015, 8,000 shares had not met the first condition for vesting, 1,594,214 shares had met the first condition of vesting and had been awarded, and 3,664,493 shares had satisfied both conditions of vesting and had been distributed to participants. Of the shares that have not vested as of December 31, 2015, the initial stock prices ranged from $8.75 to $25.68. The Company uses a path -dependent lattice model to estimate the fair value of PSP grants on the grant date. Brown & Brown. I rc. 76 A summary of PSP activity for the years ended December 31, 2015, 2014 and 2013 is as follows: Weighted -Average Shares Grant Date Fair Granted Awarded Not Yet Value Shares Shares Awarded Outstanding at January 1, 2013 $ 8.72 3,691,022 2,394,505 1,296,517 Granted Awarded Vested Forfeited Outstanding at December 31, 2013 Granted Awarded Vested Forfeited Outstanding at December 31, 2014 Granted Awarded Vested Forfeited Outstanding at December 31, 2015 $ $ 10.25 $ 4.01 $ 8.73 $ 8.62 $ $ $ 16.76 $ 9.75 $ 8.71 $ $ 5.55 $ 9.78 $ 9.03 (119,364) (1,200,371) 2,371,287 122,021 (122,021) (119,364) (101,310) (1,099,061) 2,295,852 75,435 (277,009) (277,009) (165,647) (115,630) (50,017) 1,928,631 1,903,213 25,418 (208,889) (208,889) (117,528) (100,110) (17,418) 1,602,214 1,594,214 8,000 The total fair value of PSP grants that vested during each of the years ended December 31, 2015, 2014 and 2013 was $6.8 million, $8.4 million and $3.7 million, respectively. Stock Incentive Plan On April 28, 2010, the shareholders of Brown & Brown, Inc. approved the Stock Incentive Plan ("SIP") that provides for the granting of stock options, stock and/or stock appreciation rights to employees and directors contingent on criteria estab- lished by the Compensation Committee of the Company's Board of Directors. The principal purpose of the SIP is to attract, incentivize and retain key employees by offering those persons an opportunity to acquire or increase a direct proprietary interest in the Company's operations and future success. The SIP includes a sub -plan applicable to Decus Insurance Brokers Limited ("Decus") which, is a subsidiary of Decus Holdings (U.K.) Limited. The shares of stock reserved for issuance under the SIP are any shares that are authorized for issuance under the PSP and not already subject to grants under the PSP, and that were outstanding as of April 28, 2010, the date of suspension of the PSP, together with PSP shares and SIP shares forfeited after that date. As of April 28, 2010, 6,046,768 shares were available for issuance under the PSP, which were then transferred to the SIP. To date, a substantial majority of stock grants to employees under the SIP vest in four -to -ten years, subject to the achievement of certain performance criteria by grantees, and the achievement of consolidated EPS growth at certain levels by the Company, over three -to -five-year measurement periods. In 2010, 187,040 shares were granted under the SIP. This grant was conditioned upon the surrender of 187,040 shares previously granted under the PSP in 2009, which were accordingly treated as forfeited PSP shares. The vesting conditions of this grant were identical to those provided for in connection with the 2009 PSP grant; thus the target stock prices and the periods associated with satisfaction of the first and second conditions of vesting were unchanged. Additionally. grants totaling 5,205 shares were made in 2010 to Decus employees under the SIP sub -plan applicable to Decus. In 2011, 2,375,892 shares were granted under the SIP. Of this total, 24,670 shares were granted to Decus employees under the SIP sub -plan applicable to Decus. In 2012, 814,545 shares were granted under the SIP, primarily related to the Arrowhead acquisition. 77 2015 Ann4.a' Report NOTES TO CONSOLIDATED FINANCIAL STATEMENTS In 2013, 3,719,974 shares were granted under the SIP. Of the shares granted in 2013, 891.399 shares will vest upon the grantees' completion of between three and seven years of service with the Company. and because grantees have the right to vote the shares and receive dividends immediately after the date of grant these shares are considered awarded and outstanding under the two -class method. In 2014, 422,572 shares were granted under the 51 P. Of the shares granted in 2014, 113,088 shares will vest upon the grantees' completion of between three and six years of service with the Company, and because grantees have the right to vote the shares and receive dividends immediately after the date of grant these shares are considered awarded and outstanding under the two -class method. As of December 31, 2014, no shares had met the first condition for vesting. In 2015, 481,166 shares were granted under the SIR Of the shares granted in 2015, 158,958 shares will vest upon the grantees' completion of between five and seven years of service with the Company, and because grantees have the right to vote the shares and receive dividends immediately after the date of grant these shares are considered awarded and outstanding under the two -class method. As of December 31, 2015, no shares had met the first condition for vesting. Additionally, non -employee members of the Board of Directors received shares annually issued pursuant to the SIP as part of their annual compensation. A total of 36,919 SIP shares were issued to these directors in 2011 and 2012, of which 11,682 were issued in January 2011,12,627 in January 2012, and 12,610 in December 2012. The shares issued in December 2012 were issued at that earlier time rather than in January 2013 pursuant to action of the Board of Directors. No additional shares were granted or issued to the non -employee members of the Board of Directors in 2013. A total of 9,870 shares were issued to these directors in January 2014 and 15,700 shares were issued in January 2015. At December 31, 2015, 2,793,832 shares were available for future grants. The Company uses the closing stock price on the day prior to the grant date to determine the fair value of SIP grants and then applies an estimated forfeiture factor to estimate the annual expense. Additionally, the Company uses the path - dependent lattice model to estimate the fair value of grants with PSP-type vesting conditions as of the grant date. SIP shares that satisfied the first vesting condition for PSP-like grants or the established performance criteria are considered awarded shares. Awarded shares are included as issued and outstanding common stock shares and are included in the calculation of basic and diluted EPS. A summary of SIP activity for the years ended December 31, 2015, 2014 and 2013 is as follows: Weighted -Average Shores Grant Date Fair Granted Awarded Not Yet Value Shores Shores Awarded Outstanding at January 1, 2013 22.91 3,157,311 37,408 3,119,903 Granted $ 31.95 3,719,974 — 3,719,974 Awarded $ 30.71 — 966,215 (966,215) Vested $ — — — — Forfeited $ 23.88 (271,184) (7,906) (263,278) Outstanding at December 31, 2013 $ 27.96 6,606,101 995,717 5,610,384 Granted $ 31.02 422,572 113,088 309,484 Awarded 5 — — — — Vested $ — — — — Forfeited $ 27.41 (369,626) (47.915) (321,711) Outstanding at December 31, 2014 $ 28.19 6,659,047 1,060,890 5,598,157 Granted $ 31.74 481,166 164,646 316.520 Awarded $ — — — — Vested $ — — — Forfeited 5 26.32 (863,241) (95,542) (767.699) Outstanding at December 31, 201S $ 28.74 6,276,972 1,129,994 5,146,978 Brown & Brown. I nc. 78 Employee Stock Purchase Plan The Company has a shareholder -approved Employee Stock Purchase Plan ("ESPP") with a total of 17,000,000 authorized shares of which 5,194,928 were available for future subscriptions as of December 31, 2015. Employees of the Company who regularly work more than 20 hours per week are eligible to participate in the ESPP. Participants, through payroll deductions, may allot up to 10% of their compensation, up to a maximum of $25,000, to purchase Company stock between August lst of each year and the following July 31st (the "Subscription Period") at a cost of 85% of the lower of the stock price as of the beginning or end of the Subscription Period. The Company estimates the fair value of an ESPP share option as of the beginning of the Subscription Period as the sum of: {1) 15% of the quoted market price of the Company's stock on the day prior to the beginning of the Subscription Period, and (2) 85% of the value of a one-year stock option on the Company stock using the Black-Scholes option -pricing model. The estimated fair value of an ESPP share option as of the Subscription Period beginning in August 2015 was $6.43. The fair values of an ESPP share option as of the Subscription Periods beginning in August 2014 and 2013, were $6.39 and $8.36, respectively. For the ESPP plan years ended July 31, 2015, 2014 and 2013, the Company issued 539,389, 512,521, and 487,672 shares of common stock, respectively. These shares were issued at an aggregate purchase price of $14.4 million, or $26.62 per share, in 2015, $13.4 million, or $26.16 per share, in 2014, and $10.5 million, or $21,44 per share, in 2013. For the five months ended December 31, 2015, 2014 and 2013 (portions of the 2015-2016, 2014-2015 and 2013- 2014 plan years), 231,803; 235,794; and 222,526 shares of common stock (from authorized but unissued shares), respectively, were subscribed to by ESPP participants for proceeds of approximately $6.8 million, $6.3 million and $5.9 million, respectively. Incentive Stock Option Plan On April 21, 2000, Brown & Brown adopted, and the shareholders approved, a qualified incentive stock option plan (the 'ISOP") that provides for the granting of stock options to certain key employees for up to 4,800,000 shares of common stock. On December 31, 2008, the ISOP expired. The objective of the ISOP was to provide additional performance incen- tives to grow Brown & Brown's pre-tax income in excess of 15% annually. The options were granted at the most recent trading day's closing market price and vest over a one -to -ten-year period, with a potential acceleration of the vesting period to three -to -six years based upon achievement of certain performance goals. All of the options expire 10 years after the grant date. The Company uses the Black-Scholes option -pricing model to estimate the fair value of stock options on the grant date. The risk -free interest rate is based upon the U.S, Treasury yield curve on the date of grant with a remaining term approxi- mating the expected term of the option granted. The expected term of the options granted is derived from historical data; grantees are divided into two groups based upon expected exercise behavior and are considered separately for valuation purposes. The expected volatility is based upon the historical volatility of the Company's common stock over the period of time equivalent to the expected term of the options granted. The dividend yield is based upon the Company's best estimate of future dividend yield. 79 2015AnnuaI Report NOTES TO CONSOLIDATED FINANCIAL STATEMENTS A summary of stock option activity for the years ended December 31, 2015, 2014 and 2013 is as follows: Stock Options Outstanding at January 1, 2013 Weighted- Weighted- Average Aggregate Shares Average Remaining Intrinsic Under Exercise Contractual Value Option Price Term (in years) (in thousands) 738,792 $ 18.39 4.9 $ 8,891 Granted Exercised Forfeited Expired (115,847) $ 17.56 — $ — $ — Outstanding at December 31, 2013 622,945 $ 18.55 4.1 $ 7,289 Granted — $ — Exercised (106,589) $ 18.48 Forfeited (46,000) $ 18.48 Expired Outstanding at December 31, 2014 470,356 $ 18.57 3.1 $ 5,087 Granted — $ — Exercised (151.767) $ 18.48 Forfeited (49,000) $ 19.36 Expired — $ — Outstanding at December 31, 2015 269,589 $ 18.48 2.2 $ 2,395 Ending vested and expected to vest at December 31.2015 Exercisable at December 31, 2015 Exercisable at December 31, 2014 Exercisable at December 31, 2013 269,589 $ 18.48 164,589 $ 18.48 316,356 $ 18.48 422,945 $ 18.48 2.2 $ 2,395 2.2 $ 2,241 3.2 $ 4,565 4.2 $ 5,460 The following table summarizes information about stock options outstanding at December 31, 2015: Exercise Price Options outstanding Options Exercisable Weighted - Average Weighted- Weighted - Remaining Average Average Number Contractual Exercise Number Exercise Outstanding Life (gears) Price Exercisable Price $18.48 269.589 2.2 $ 18.48 164,589 $ 18.48 Totals 269,589 2.2 $ 18.48 164,589 $ 18.48 The total intrinsic value of options exercised, determined as of the date of exercise, during the years ended December 31, 2015, 2014 and 2013 was $2.2 million, $1.3 million and $1.6 million, respectively. The total intrinsic value is calculated as the difference between the exercise price of all underlying awards and the quoted market price of the Company's stock for all in -the -money stock options at December 31, 2015.2014 and 2013, respectively. There are no option shares available for future grant under the ISOP since this plan expired as of December 31.2008. Brown & Brown, inc. 80 Summary of Non -Cash Stock -Based Compensation Expense The non -cash stock -based compensation expense for the years ended December 31 is as follows: (in thousands) 2015 2014 2013 Stock Incentive Plan $ 11,111 $ 14,447 $ 15,934 Employee Stock Purchase Plan 3,430 2,425 3,538 Performance Stock Plan 972 2,354 2,310 Incentive Stock Option Plan — 137 821 Total $ 15,513 $ 19,363 $ 22,603 Summary of Unrecognized Compensation Expense As of December 31, 2015, there was approximately $115.0 million of unrecognized compensation expense related to all non -vested share -based compensation arrangements granted under the Company's stock -based compensation plans. That expense is expected to be recognized over a weighted -average period of 5.1 years. NOTE 12 Supplemental Disclosures of Cash Flow Information and Non -Cash Financing and Investing Activities Our Restricted Cash balance is comprised of funds held in separate premium trust accounts as required by state law or, in some cases, per agreement with our carrier partners. In the second quarter of 2015, certain balances that had previously been reported as held in restricted premium trust accounts were reclassified as non -restricted as they were not restricted by state law or by contractual agreement with a carrier. The resulting impact of this change was a reduction in the balance reported on our Consolidated Balance Sheet as Restricted Cash and Investments and a corresponding increase in the balance reported as Cash and Cash Equivalents of approximately $33.0 million as of December 31, 2015 as compared to the corresponding account balances as of December 31, 2014 of $32.2 million which was reflected as Restricted Cash. While these referenced funds are not restricted, they do represent premium payments from customers to be paid to insurance carriers and this change in classification should not be viewed as a source of operating cash. (in thousands( For the Year Ended December 31. 2015 2014 2013 Cash paid during the period for: Interest Income taxes $ 37,542 $ 25,115 $ 16,501 $ 132,874 $ 118,290 $ 110,190 Brown & Brown's significant non -cash investing and financing activities are summarized as follows: (in thousands) For the Year Ended December 31. 2015 2014 2013 Other payables issued for purchased customer accounts Estimated acquisition earn -out payables and related charges Notes received on the sale of fixed assets and customer accounts $ 10,029 $ 1,930 $ 1,425 $ 36.899 $ 33,229 $ 5,091 $ 7,755 $ 6,340 $ 1,108 81 2015 Annual Report NOTES TO CONSOLIDATED FINANCIAL STATEMENTS NOTE 13 Commitments and Contingencies Operating Leases Brown & Brown leases facilities and certain items of office equipment under non -cancelable operating lease arrangements expiring on various dates through 2042. The facility leases generally contain renewal options and escalation clauses based upon increases in the lessors' operating expenses and other charges. Brown & Brown anticipates that most of these leases will be renewed or replaced upon expiration. At December 31, 2015, the aggregate future minimum lease payments under all non -cancel able lease agreements were as follows: (in thousands) 2016 $ 40,900 2017 37,109 2018 31,612 2019 25,962 2020 21,283 Thereafter 38,406 Total minimum future lease payments $ 195,272 Rental expense in 2015, 2014 and 2013 for operating leases totaled $46.0 million, $49.0 million, and $43.0 million, respectively. Legal Proceedings The Company records losses for claims in excess of the limits of, or outside the coverage of, applicable insurance at the time and to the extent they are probable and estimable, In accordance with ASC Topic 450-Contingencies, the Company accrues anticipated costs of settlement, damages, losses for liability claims and, under certain conditions, costs of defense, based on historical experience or to the extent specific losses are probable and estimable. Otherwise, the Company expenses these costs as incurred. If the best estimate of a probable loss is a range rather than a specific amount, the Company accrues the amount at the lower end of the range. The Company's accruals for legal matters that were probable and estimable were not material at December 31, 2015 and 2014. We continue to assess certain litigation and claims to determine the amounts, if any, that management believes will be paid as a result of such claims and litigation and, therefore, additional losses may be accrued and paid in the future, which could adversely impact the Company's operating results, cash flows and overall liquidity. The Company maintains third -party insurance policies to provide coverage for certain legal claims, in an effort to mitigate its overall exposure to unanticipated claims or adverse decisions. However, as (i) one or more of the Company's insurance carriers could take the position that portions of these claims are not covered by the Company's insurance, (ii) to the extent that payments are made to resolve claims and lawsuits, applicable insurance policy limits are eroded and (iii) the claims and lawsuits relating to these matters are continuing to develop, it is possible that future results of operations or cash flows for any particular quarterly or annual period could be materially affected by unfavorable resolutions of these matters. Based on the AM Best Company ratings of these third -party insurers, management does not believe there is a substantial risk of an insurer's material nonperformance related to any current insured claims. On the basis of current information, the availability of insurance and legal advice. in management's opinion, the Company is not currently involved in any legal proceedings which, individually or in the aggregate, would have a material adverse effect on its financial condition, operations and/or cash flows. Brown & Brown, Inc. 82 NOTE 14 Quarterly Operating Results (Unaudited) Quarterly operating results for 2015 and 2014 were as follows: (in thousands, except per share data) First Second Third Fourth Quarter Quarter Quarter Quarter 2015 Total revenues $ 404,298 $ 419,447 $ 432,167 $ 404,597 Total expenses $ 310,520 $ 318,533 $ 319,337 $ 309,560 Income before income taxes $ 93,778 $ 100,914 $ 112,830 $ 95,037 Net income $ 56,951 $ 61,005 $ 67,427 $ 57,935 Net income per share: Basic $ 0.40 $ 0.43 $ 0.48 $ 0.41 Diluted $ 0.39 $ 0.43 $ 0.47 $ 0.41 2014 Total revenues $ 363,594 $ 397,764 $ 421,418 $ 393,020 Total expenses $ 276,757 $ 295,983 $ 308,733 $ 354,574ItI Income before income taxes $ 86,837 $ 101,781 $ 112,685 $ 38.446'1'' Net income $ 52,415 $ 61,755 $ 68,331 $ 24,3951" Net income per share: Basic $ 0.36 $ 0.43 $ 0.47 $ 0.17 Diluted $ 0.36 $ 0.42 $ 0.47 $ 0.17 (1) The Company recognized a pre-tax loss on disposal of $47.4 million as a result of the sale of Axiom effective December 31, 2014. The sale was part of the Company's strategy to exit the reinsurance brokerage business. Quarterly financial results are affected by seasonal variations. The timing of the Company's receipt of profit-sharing contingent commissions, policy renewals and acquisitions may cause revenues, expenses and net income to vary signifi- cantly between quarters. NOTE 15 Segment Information Brown & Brown's business is divided into four reportable segments: (1) the Retail Segment, which provides a broad range of insurance products and services to commercial, public and quasi -public entities, and to professional and individual custom- ers: (2) the National Programs Segment, which acts as a MGA, provides professional liability and related package products for certain professionals, a range of insurance products for individuals, flood coverage, and targeted products and services designated for specific industries, trade groups, governmental entities and market niches, all of which are delivered through nationwide networks of independent agents, and Brown & Brown retail agents; (3) the Wholesale Brokerage Segment, which markets and sells excess and surplus commercial and personal lines insurance, primarily through independent agents and brokers, as well as Brown & Brown retail agents; and (4) the Services Segment, which provides insurance -related services, including third -party claims administration and comprehensive medical utilization management services in both the workers' compensation and all -lines liability arenas, as well as Medicare Set -aside services, Social Security disability and Medicare benefits advocacy services and claims adjusting services. 83 2015 Annual Report NOTES TO CONSOLIDATED FINANCIAL. STATEMENTS Brown & Brown conducts all of its operations within the United States of America, except for a wholesale brokerage operation based in London, England, and retail operations in Bermuda and the Cayman Islands. These operations earned $13.4 million, $13.3 million and $12.2 million of total revenues for the years ended December 31, 2015, 2014 and 2013, respectively. Long-lived assets held outside of the United States during each of these three years were not material. The accounting policies of the reportable segments are the same as those described in Note 1. The Company evaluates the performance of its segments based upon revenues and income before income taxes. Inter -segment revenues are eliminated. Summarized financial information concerning the Company's reportable segments is shown in the following table. The "Other" column includes any income and expenses not allocated to reportable segments and corporate -related items, including the inter -company interest expense charge to the reporting segment. Segment results for prior periods have been recast to reflect the current year segmental structure. Certain reclassifica- tions have been made to the prior -year amounts reported in this Annual Report on Form 10-K in order to conform to the current year presentation. (in thousands) For the year ended December 31.2015 National Wholesale Retail Programs Brokerage Services Other Total Total revenues $ 870,346 $ 428,734 $ 216,996 $ 145,365 $ (932) $1,660,509 Investment income $ 87 $ 210 $ 150 $ 42 $ 515 $ 1,004 Amortization $ 45,145 $ 28,479 $ 9,739 $ 4,019 $ 39 $ 87,421 Depreciation $ 6,558 $ 7,250 $ 2.142 $ 1,988 $ 2,952 $ 20,890 Interest expense $ 41,036 $ 55,705 $ 891 $ 5,970 $ (64,354) $ 39,248 Income before income taxes $ 181,938 $ 67,673 $ 64,708 $ 19,713 $ 68,527 $ 402,559 Total assets $ 3,507,476 $2,505,752 $ 895,782 $ 285,459 $ (2,181,730) $5,012,739 Capital expenditures $ 6,797 $ 6,001 $ 3,084 $ 1,088 $ 1,405 $ 18,375 (in thousands) For the year ended December 31, 2014 National Wholesale Retail Programs Brokerage Services Other Total Total revenues $ 823,686 $ 404,239 $ 211,911 $ 136,558 $ (598) $1,575,796 Investment income $ 67 $ 164 $ 26 $ 3 $ 487 $ 747 Amortization $ 42.935 $ 25,129 $ 10,703 $ 4,135 $ 39 $ 82,941 Depreciation $ 6,449 $ 7,805 $ 2,470 $ 2,213 $ 1,958 $ 20,895 interest expense $ 43,502 $ 49,663 $ 1,294 $ 7,678 $ (73,729) $ 28,408 Income before income taxes $ 157,491 $ 73,178 $ 8.276 $ 17,870 $ 82.934 $ 339,749 Total assets $ 3,229,484 $2,455,749 $ 857,804 $ 296,034 $ (1,882,613) $4,956,458 Capital expenditures $ 6,873 $ 14,133 $ 1,526 $ 1.210 $ 1.181 $ 24.923 Brown & Brown. Inc. 84 For the year ended December 31. 2013 National Wholesale (in thousands} Retail Programs Brokerage services Other Total Total revenues $ 737,349 $ 301,372 $ 193,710 $ 131,489 $ (641) $1,363,279 Investment income $ 82 $ 19 $ 22 $ 1 $ 514 $ 638 Amortization $ 38,523 $ 14,953 $ 10,719 $ 3,698 $ 39 $ 67,932 Depreciation $ 5,874 $ 5,492 $ 2,674 $ 1,623 $ 1,822 $ 17,485 Interest expense $ 34,658 $ 24,014 $ 2,316 $ 7,322 $ (51,870) $ 16,440 Income before income taxes $ 161.787 $ 61,223 $ 47,501 $ 25,791 $ 61,307 $ 357,609 Total assets $ 3,012,688 $1,377,404 $ 865,731 $ 277,652 $ (1,883,967) $3,649,508 Capital expenditures $ 6,886 $ 4,810 $ 1,825 $ 1,811 $ 1,034 $ 16,366 NOTE 16 Losses and Loss Adjustment Reserve Although the reinsurers are liable to the Company for amounts reinsured, our subsidiary, Wright Flood remains primarily liable to its policyholders for the full amount of the policies written whether or not the reinsurers meet their obligations to the Companywhen they become due. The effects of reinsurance on premiums written and earned at December 31, are as follows: (in thousands) 2015 2014 Written Earned written Earned Direct premiums $ 599,828 $ 610,753 $ 439,828 $ 408,056 Assumed premiums - 18 (1) 199 Ceded premiums 599,807 610,750 439,819 408,246 Net premiums $ 21 $ 21 $ 8 $ 8 All premiums written by Wright Rood under the National Flood Insurance Program are 100% ceded to FEMA, for which Wright Flood received a 30.8% expense allowance from January 1, 2015 through September 30, 2015 and 30.9% from October 1, 2015 through December 31, 2015. As of December 31, 2015 and 2014, the Company ceded $598.4 million and $439.1 million of written premiums, respectively. Effective April 1, 2014, Wright Flood is also a party to a quota share agreement whereby it cedes 100% of its gross excess flood premiums, which excludes fees, to Arch Reinsurance Company and receives a 30.5% commission. Wright Flood ceded $1.4 million and $0.8 million for the years ended December 31, 2015 and 2014. No loss data exists on this agreement. Wright Flood also ceded 100%, to Arch Reinsurance Company, of the Homeowners, Private Passenger Auto Liability, and Other Liability Occurrence to Stillwater Insurance Company, formerly known as Fidelity National Insurance Company. This business is in runoff. Therefore, only loss data still exists on this business. As of December 31, 2015, ceded unpaid losses and loss adjustment expenses for Homeowners, Private Passenger Auto Liability and Other Liability Occurrence was $8,698, $16,132 and $4,179, respectively. The incurred but not reported balance was $10,335 for Homeowners, $14,383 for Private Passenger Auto Liability and $8,456 for Other Liability Occurrence. 85 NOTES TO CONSOLIDATED FINANCIAL STATEMENTS The reinsurance recoverable balance as of December 31, 2015 was $341.6 million and was comprised of recoverables on unpaid losses and loss expenses of $32.0 million and prepaid reinsurance premiums of $309.6 million. The reinsurance recoverable balance as of December 31, 2014was $333.6 million that is comprised of recoverables on unpaid losses and loss expenses of $13.0 million and prepaid reinsurance premiums of $320.6 million There was no net activity in the reserve for losses and loss adjustment expense for the years ended December 31, 2015 and 2014. as Wright Flood's direct premi- ums written were 100% ceded to three reinsurers. The balance of the reserve for losses and loss adjustment expense, excluding related reinsurance recoverable was $32.0 million as of December 31, 2015 and $13.0 million as of December 31, 2014. NOTE 17 Statutory Financial Information Wright Flood maintains minimum amounts of statutory capital and surplus of $7.5 million as required by regulatory authorities. Wright Flood's statutory capital and surplus exceeded their respective minimum statutory requirements. The statutory capital and surplus of Wright Flood was $15.1 million as of December 31, 2015 and $10.9 million as of December 31, 2014. As of December 31, 2015 and 2014, Wright Flood generated statutory net income of $4.1 million and $2.3 million, respectively. NOTE 18 Subsidiary Dividend Restrictions Under the insurance regulations of Texas, the maximum amount of ordinary dividends that Wright Flood can pay to share- holders in a rolling twelve month period is limited to the greater of 10% of statutory adjusted capital and surplus as shown on Wright Flood's last annual statement on file with the superintendent of the Texas Department of Insurance or 100% of adjusted net income. As an extraordinary dividend of $7.0 million was paid on May 20, 2014, no ordinary dividend could be paid until May 21, 2015. There was no dividend payout in 2015 and the maximum dividend payout that may be made in 2016 without prior approval is $4.1 million. NOTE 19 Shareholders' Equity On July 18, 2014, the Company's Board of Directors authorized the repurchase of up to $200.0 million of its shares of common stock. This was in addition to the $25.0 million that was authorized in the first quarter and executed in the second quarter of 2014. On September 2, 2014, the Company entered into an accelerated share repurchase agreement ("ASR") with an investment bank to purchase an aggregate $50.0 million of the Company's common stock. The total number of shares purchased under the ASR of 1.539,760 was determined upon settlement of the final delivery and was based on the Company's volume weighted average price per its common share over the ASR period less a discount. On March 5, 2015, the Company entered into an ASR with an investment bank to purchase an aggregate $100.0 million of the Company's common stock. As part of the ASR, the Company received an initial delivery of 2,667,992 shares of the Company's common stock with a fair market value of approximately $85.0 million, On August 6, 2015, the Company was notified by its investment bank that the March 5, 2015 ASR agreement between the Company and the investment bank had been completed in accordance with the terms of the agreement. The investment bank delivered to the Company an addi- tional 391,637 shares of the Company's common stock for a total of 3,059,629 shares repurchased under the agreement. The delivery of the remaining 391,637 shares occurred on August 11, 2015. At the conclusion of this contract the Company had authorization for $50.0 million of share repurchases under the original Board authorization. On July 20, 2015, the Company's Board of Directors authorized the repurchase of up to an additional $400.0 million of the Company's outstanding common stock. With this authorization, the Company had total available approval to repur- chase up to $450 million. in the aggregate, of the Company's outstanding common stock. Brown 6, Brown, rc, 86 On November 11, 2015, the Company entered into a third ASR with an investment bank to purchase an aggregate $75 million of the Company's common stock. The Company received an initial delivery of 1,985,981 shares of the Company's common stock with a fair market value of approximately $63.75 million. On January 6. 2016 this agreement was completed by the investment bank with the delivery of 363,209 shares of the Company's common stock. After completion of this third ASR, the Company has approval to repurchase up to $375.0 million, in the aggregate, of the Company's outstanding common stock. Under the authorization from the Company's Board of Directors, shares may be purchased from time to time, at the Company's discretion and subject to the availability of stock, market conditions, the trading price of the stock, alternative uses for capital, the Company's financial performance and other potential factors. These purchases may be carried out through open market purchases, block trades, accelerated share repurchase plans of up to $100.0 million each (unless otherwise approved by the Board of Directors), negotiated private transactions or pursuant to any trading plan that may be adopted in accordance with Rule 10b5-1 of the Securities Exchange Act of 1934. 87 2015 Annual Reocrt GAAP RECONCILIATION GAAP Reconciliation -Income Before Income Taxes to Operating Profit and Adjusted Operating Profit tin thousands. except per share data) 2015 2014 2013 2012 2011 Retail Total revenues $ 870,346 $ 823.686 $ 737,349 $ 652,064 $ 614,093 Income before income taxes 181,938 157,491 161,787 141,918 135,856 Amortization 45,145 42.935 38.523 35,117 33,806 Depreciation 6,558 6,449 5.874 5.209 5.064 Interest 41.036 43,502 34,658 27,021 28,197 Change in estimated acquisition earn -out payables 2,006 7,458 (1,427) 1.988 (5.415) Operating Profit $ 276.683 $ 257.835 $ 239.415 $ 211,253 $ 197,508 Operating Profit Margin 31.8% 31.3% 32.5% 32.4% 32.2% Less non -cash stock -based compensation adjustment (5,524) - - - - Adjusted Operating Profit Adjusted Operating Profit Margin $ 271.159 31.2% $ 257,835 31.3% $ 239,415 32.5% $ 211,253 32.4% $ 197,508 32.2% National Programs Total revenues $ 428,734 $ 404,239 $ 301,372 $ 260,368 $ 169,666 Income before income taxes 67.673 73.178 61,223 53.986 61.980 Amortization 28,479 25,129 14,953 14,296 8,130 Depreciation 7,250 7,805 5,492 4.671 2,983 Interest 55,705 49,663 24,014 25,697 1,548 Change in estimated acquisition earn -out payables 158 315 (808) (1,075) (508) Operating Profit S 159.265 $ 156,090 $ 104,874 $ 97.575 $ 74.133 Operating Profit Margin 37.1% 38.6% 34.8% 37.5% 43.7% Less non -cash stock -based compensation adjustment - (3.700) - - - Adjusted Operating Profit Adjusted Operating Profit Margin $ 159.265 37.1% $ 152.390 37.7% $ 104.874 34.8% $ 97.575 37.5% $ 74.133 43.7% Wholesale Total revenues $ 216,996 $ 211,911 $ 193,710 $ 168,239 $ 161,948 Income before income taxes 64,708 8,276 47,501 37,834 31.666 Amortization 9,739 10,703 10,719 10,441 10,239 Depreciation 2,142 2,470 2,674 2,619 2,529 Interest 891 1.294 2,316 3,594 6,819 Change in estimatedacquisition earn -out payables 830 2.550 1.986 110 691 Operating Profit $ 78,310 $ 25.293 $ 65.196 $ 54,598 $ 51,944 Operating Profit Margin 36.1% 11.9% 33.7% 32.5% 32.1% Less loss on disposal - 47,425 - - - Adjusted Operating Profit Adjusted Operating Profit Margin $ 78.310 36.1% $ 72,718 34.3% $ 65,196 33.7% $ 54,598 32.5% $ 51,944 32.1% Services Total revenues $ 145,365 $ 136,558 $ 131,489 $ 117,486 $ 65,822 Income before income taxes 19,713 17,870 25,791 17,233 8,099 Amortization 4.019 4,135 3.698 3.680 2.541 Depreciation 1.988 2,213 1.623 1,278 591 Interest 5,970 7,678 7,322 8,602 5,746 Change in estimated acquisition earn -out payables 9 (385) 2.782 395 3,026 Operating Profit $ 31,699 $ 31,511 $ 41,216 $ 31,188 $ 20,003 Operating Profit Margin 21.8% 23.1% 31.3% 26.5% 30.4% Less non -cash stock -based compensation adjustment - (821) - - - Adjusted Operating Profit $ 31,699 $ 30,690 $ 41,216 $ 31,188 Adjusted Operating Profit Margin 21.8% 22.5% 31.3% 26.5% GAAP Earnings Per Share Reconciliation to Earnings Per Share -Adjusted 201$5» 2014 f Change %Change GAAP earnings per share -as reported $ 1.70 $ 1.41 $ 0.29 Loss on disposal - 0.21 (0.21) Non -cash stock based compensation adjustment (0.03) (0.03) - Change in estimated acquisition earn -out payables 0.01 0.04 (0.03) Earnings per share -adjusted $ 1.67 $ 1.63 $ 0.04 (1) Column does not add. due to the cumulative effect of rounding on individual items 20.6% 2.5% $ 20,003 30.4% Brown & Brown, Inc. 88 REPORT OF INDEPENDENT REGISTERED PUBLIC ACCOUNTING FIRM To the Board of Directors and Shareholders of Brown & Brown, Inc. Daytona Beach, Florida We have audited the accompanying consolidated balance sheets of Brown & Brown, Inc. and subsidiaries (the "Company") as of December 31, 2015 and 2014, and the related consolidated statements of income, shareholders' equity, and cash Flows for each of the three years in the period ended December 31, 2015. These financial statements are the responsibility of the Company's management. Our responsibility is to express an opinion on the financial statements based on our audits. We conducted our audits in accordance with the standards of the Public Company Accounting Oversight Board {United States). Those standards require that we plan and perform the audit to obtain reasonable assurance about whether the financial statements are free of material misstatement. An audit includes examining, on a test basis, evidence supporting the amounts and disclosures in the financial statements. An audit also includes assessing the accounting principles used and significant estimates made by management, as well as evaluating the overall financial statement presentation. We believe that our audits provide a reasonable basis for our opinion. In our opinion, such consolidated financial statements present fairly, in all material respects, the financial position of Brown & Brown, Inc. and subsidiaries as of December 31, 2015 and 2014, and the results of their operations and their cash flows for each of the three years in the period ended December 31, 2015, in conformity with accounting principles generally accepted in the United States of America. We have also audited, in accordance with the standards of the Public Company Accounting Oversight Board (United States), the Company's internal control over financial reporting as of December 31, 2015, based on the criteria established in Internal Control - Integrated Framework (2013) issued by the Committee of Sponsoring Organizations of the Treadway Commission and our report dated February 25, 2016 expressed an unqualified opinion on the Company's internal control over financial reporting. Certified Public Accountants Miami, Florida February 25, 2016 89 REPORT OF INDEPENDENT REGISTERED PUBLIC ACCOUNTING FIRM To the Board of Directors and Shareholders of Brown & Brown, Inc. Daytona Beach, Florida We have audited the internal control over financial reporting of Brown & Brown, Inc. and subsidiaries (the "Company") as of December 31, 2015, based on criteria established in Internal Control - Integrated Framework (2013) issued by the Committee of Sponsoring Organizations of the Treadway Commission. As described in Management's Report on Internal Control Over Financial Reporting, management excluded from its assessment the internal control over financial reporting at Spain Agency, Inc, Strategic Benefit Advisors, LLC, Bellingham Underwriters, Inc., MBA Insurance Agency of Arizona, Inc. and Smith Insurance, Inc. (collectively the "2015 Excluded Acquisitions"), which were acquired during 2015 and whose financial statements constitute 2.91% of total assets, 1.03% of revenues, and (0.03%) of net income of the consolidated financial statement amounts as of and for the year ended December 31, 2015. Accordingly, our audit did not include the internal control over financial reporting of the 2015 Excluded Acquisitions. The Company's management is responsible for maintaining effective internal control over financial reporting and for its assessment of the effectiveness of internal control over financial reporting, included in the accompanying Management's Report on Internal Control Over Financial Reporting. Our responsibility is to express an opinion on the Company's internal control over financial reporting based on our audit. We conducted our audit in accordance with the standards of the Public Company Accounting Oversight Board (United States). Those standards require that we plan and perform the audit to obtain reasonable assurance about whether effective internal control over fi nancial reporting was maintained in all material respects. Our audit included obtaining an under- standing of internal control over financial reporting, assessing the risk that a material weakness exists, testing and evaluating the design and operating effectiveness of internal control based on the assessed risk, and performing such other procedures as we considered necessary in the circumstances. We believe that our audit provides a reasonable basis for our opinion. A company's internal control over financial reporting is a process designed by, or under the supervision of, the com- pany's principal executive and principal financial officers, or persons performing similar functions, and effected by the company's board of directors, management, and other personnel to provide reasonable assurance regarding the reliability of financial reporting and the preparation of financial statements for external purposes in accordance with generally accepted accounting principles. A company's internal control over financial reporting includes those policies and proce- dures that (1) pertain to the maintenance of records that, in reasonable detail, accurately and fairly reflect the transactions and dispositions of the assets of the company; (2) provide reasonable assurance that transactions are recorded as necessary to permit preparation of financial statements in accordance with generally accepted accounting principles, and that receipts and expenditures of the company are being made only in accordance with authorizations of management and directors of the company; and (3) provide reasonable assurance regarding prevention or timely detection of unauthorized acquisition, use, or disposition of the company's assets that could have a material effect on the financial statements. Because of the inherent limitations of internal control over financial reporting, including the possibility of collusion or improper management override of controls, material misstatements due to error or fraud may not be prevented or detected on a timely basis. Also, projections of any evaluation of the effectiveness of the internal control over financial reporting to future periods are subject to the risk that the controls may become inadequate because of changes in conditions, or that the degree of compliance with the policies or procedures may deteriorate. In our opinion, the Company maintained, in all material respects, effective internal control over financial reporting as of December 31, 2015, based on the criteria established in internal Control - Integrated Framework (2013) issued by the Committee of Sponsoring Organizations of the Treadway Commission. We have also audited, in accordance with the standards of the Public Company Accounting Oversight Board (United States), the consolidated financial statements as of and for the year ended December 31, 2015 of the Company and our report dated February 25, 2016 expressed an unqualified opinion on those financial statements. Certified Public Accountants Miami, Florida February 25, 2016 Brown & Brown, Inc. 90 MANAGEMENT'S REPORT ON INTERNAL CONTROL OVER FINANCIAL REPORTING The management of Brown & Brown, Inc. and its subsidiaries ("Brown & Brown') is responsible for establishing and maintaining adequate internal control over financial reporting, as such term is defined in Securities Exchange Act Rule 13a-15(f). Under the supervision and with the participation of management, including Brown & Brown's principal executive officer and princi pal financial officer, Brown & Brown conducted an evaluation of the effectiveness of internal control over financial reporting based on the framework in Internal Control - Integrated Framework (2013) issued by the Committee of Sponsoring Organizations of the Treadway Commission ("COSO"), In conducting Brown & Brown's evaluation of the effectiveness of its internal control over financial reporting, Brown & Brown has excluded the following acquisitions completed during 2015: Spain Agency, Inc, Strategic Benefit Advisors, LLC, Bellingham Underwriters, Inc., MBA Insurance Agency of Arizona, Inc. and Smith Insurance, Inc. (collectively the "2015 Excluded Acquisitions"), which were acquired during 2015 and whose financial statements constitute 2.91% of total assets,1.03°% of revenues, and (0.03%) of net income of the Consolidated Financial Statement amounts as of and for the year ended December 31, 2015. Refer to Note 2 to the Consolidated Financial Statements for further discussion of these acquisitions and their impact on Brown & Brown's Consolidated Financial Statements. Based on Brown & Brown's evaluation under the framework in Internal Control - Integrated Framework (2013) issued by the Committee of Sponsoring Organizations of the Treadway Commission, management concluded that internal control over financial reporting was effective as of December 31, 2015. Management's internal control over financial reporting as of December 31, 2015 has been audited by Deloitte & Touche LLP, an independent registered public accounting firm, as stated in their report which is included herein. Brown & Brown, Inc. Daytona Beach, Florida February 25, 2016 J. Powell Brown Chief Executive Officer l LAC R. Andrew Watts Executive Vice President, Chief Financial Officer and Treasurer 91 20_S Annu.) Reuort PERFORMANCE GRAPH The fallowing graph is a comparison of five-year cumulative total stockholder returns for our common stock as compared with the cumulative total stockholder return for the NYSE Composite Index, and a group of peer insurance broker and agency companies (Aon plc, Arthur J. Gallagher & Co, Marsh & McLennan Companies, and Willis Towers Watson Public Limited Company). The returns of each company have been weighted according to such companies' respective stock market capitalizations as of December 31, 2010 for the purposes of arriving at a peer group average. The total return calculations are based upon an assumed $100 investment on December 31, 2010, with all dividends reinvested. 12/10 12/11 12/12 12/13 12/14 12/15 Brown & Brown, Inc. 100.00 95.89 109.34 136.39 144.78 143.21 NYSE Composite 100.00 96.52 112.00 141.19 150.78 144.91 Peer Group 100.00 114.10 122.00 174.63 193.51 191.50 Comparison of 5 Year Cumulative Total Return* Among Brown & Brown, Inc., the NYSE Composite Index, and a Peer Group $250 $225 $200 $175 $150 $125 $100 $75 $50 $25 so 12/10 12/11 12/12 12/13 12/14 12/15 • Brown & Brown, Inc. NYSE Composite ■ Peer Group '$100 invested on 12/31/10 in stock or index. including reinvesting of dividends. Fiscal year ending December 31. Brown & Brown, Inc. 92 SHAREHOLDER INFORMATION Corporate Offices 220 South Ridgewood Avenue Daytona Beach, Florida 32114 (386) 252-9601 Outside Counsel Holland & Knight LLP 200 South Orange Avenue Suite 2600 Orlando. Florida 32801 Corporate Information and Shareholder Services The Company has included, as Exhibits 31.1 and 31.2, and 32.1 and 32.2 to its Annual Report on Form 10-K for the fiscal year 2015 Bled with the Securities and Exchange Commission, certificates of the Chief Executive Officer and Chief Financial Officer of the Company certifying the quality of the Company's pub- lic disclosure. The Company has also submitted to the New York Stock Exchange a certificate from its Chief Executive Officer certifying that he is not aware of any violation by the Company of New York Stock Exchange corporate governance listing standards. A copy of the Company's 2015 Annual Report on Form 10-K will be furnished without charge to any shareholder who directs a request in writing to: Corporate Secretary Brown & Brown, Inc. 220 South Ridgewood Avenue Daytona Beach, Florida 32114 A reasonable charge will be made for copies of the exhibits to the Form 10-K. Annual Meeting The Annual Meeting of Shareholders of Brown & Brown. Inc. will be held: May 4, 2016 9:00 a.m. (EDT) The Shores Resort 2637 South Atlantic Avenue Daytona Beach, Florida 32118 des:greda raproducedbysee see eye ANaraySwArDru Transfer Agent and Registrar Amer.can S:ock Transfer & Trust Company, LLC 6201 15tn Ave. Brooklyn, New York 11219 (800) 937-5449 email: info@amstock.com www.amstock.com Independent Registered Public Accounting Firm Deloitte & Touche LLP 333 SE 2nd Avenue Suite 3600 Miami, Florida 33131 Stock Listing The New York Stock Exchange Symbol: BRO On February 22, 2016, there were 138,616.818 shares of our common stock outstanding, held by approximately 1,119 shareholders of record. Market Price of Common Stock Stock Price Range 2015 High Cash Dividends per Low Common Share First Quarter $ 33.34 $ 30.47 $ 0.11 Second Quarter $ 33.81 $ 31.50 $ 0.11 Third Quarter $ 34.59 $ 29,67 $ 0.11 Fourth Quarter $ 33.09 $ 30.39 $ 0.12 2014 Firs: Quar:er S 32.88 $ 27.77 $ 0_10 Second Quarter $ 31.29 $ 28.27 $ 0,10 Third Quarter $ 33 G6 $ 30.02 $ 0.10 Fourth Quarter $ 33.40 $ 30.96 $ 0.11 Additional Information Information concerning the services of Brown & Brown, Inc., as well as access to current financial releases. is available at www.dbinsurance.com. TEN-YEAR STATISTICAL SUMMARY (in thousands, except per share data and other information) 2015 2014 2013 Revenues Commissions & fees Investment income Other income, net $ 1,656,951 1,004 2,554 $ 1,567,460 747 7,589 $ 1,355,503 638 7,138 Total revenues 1,660,509 1,575,796 1,363,279 Expenses Employee compensation and benefits Non -cash stock -based compensation Other operating expenses (Gain) Loss on disposal Amortization Depreciation Interest Change in estimated acquisition earn -out payables 841,439 15.513 251,055 (619) 87,421 20,890 39,248 3,003 791,749 19.363 235,328 47,425 82.941 20,895 28,408 9,938 683.000 22.603 195,677 67,932 17.485 16,440 2,533 Total expenses 1,257,950 1,236,047 1,005,670 Income before income taxes Income taxes 402,559 159,241 339,749 357.609 132,853 140,497 Net income $ 243,318 $ 206,896 217,11 " Employee compensation and benefits as % of total revenue 50.7% Other operating expenses as % of total revenue 15.1% Earnings per Share Information Net income per share -diluted Weighted average number of shares outstanding -diluted Dividends paid per share Year -End Financial Position Total assets Long-term debt Total shareholders' equity Total shares outstanding Other Information Number of full-time equivalent employees at year-end Total revenues per average number of employees'3' Stock price at year-end Stock price earnings multiple at year-end f51 Return on beginning shareholders' equity 1.70 140,112 0,45 $ 5,012,739 $ 1,079,878 $ 2,149,776 138,985 50.2% 50.1,- 14.9% 14.4% $ 1.41 142,891 $ 0.41 $ 1.48 142.624 $ 0.37 $ 4,956,458 $ 3,649.508 $ 1,152,846121 $ 380,000 $ 2,113,745 $ 2,007,141 143,486 145,419 7,807 7,591 6,992 $ 215,679 $ 216,114 $ 203,020 $ 32.10 $ 32.91 $ 31.39 18.9 23.3 21.2 12% 10% 12% (1) Includes on 578.664gain an the safe of our investment in Rock -Tenn Company f2)1 Represents the incremental new debt associated with the acquisi-tion of Wright and evolution of our capital structure. Please refer to Part 1. )tern 7 "Managemer_ Discusiton indAnaiysis o'Financial Condition and Results of Ocerations' and Note 8 'Long -Term Debt' for mare de:airs. (3) Represents total revenues divided by the average of the number of furl -time equivalent employees at the beginning of the year and the number of Putt -time equivalent employees at the end of the year. (4) Of the 881 increase n the number of full-time eauivalent employees from 2011 to 2012. 523 employees related to the January 9.2012 acquisition of arrowhead. and therefore. are considered to oe ft,ll-rime equivalent as of January 1. 2012 Thus. the average number of full-time equivalent employees ror 2012 is considered to be 6,259 Year Ended December 31. 2012 2011 2010 2009 2008 2007 2006 $ 1,189,081 $ 1,005,962 $ 966,917 $ 964,863 $ 965,983 $ 914,650 $ 864,663 797 1,267 1,326 1,161 6,079 30,494 f11 11,479 10,154 6,313 5,249 1,853 5,492 14,523 1,862 1,200,032 1,013,542 973,492 967,877 977,554 959,667 878,004 608,506 508,675 487,820 484,680 485,783 444,101 404,891 15,865 11,194 6,845 7,358 7,314 5,667 5,416 174,389 144,079 135,851 143,389 137,352 131,371 126,492 63,573 54,755 51,442 49,857 46,631 40,436 36,498 15,373 12,392 12,639 13,240 13,286 12,763 11,309 16,097 14,132 14,471 14,599 14,690 13,802 13,357 1,418 (2,206) (1,674) - - - - 895,221 743,021 707,394 713,123 705,056 648,140 597,963 304,811 270,521 266,098 254,754 272,498 311,527 280,041 120,766 106,526 104,346 101,460 106,374 120,568 107,691 $ ' 14,045 $ 163,995 $ 161,752 $ 153,294 $ 166,124 $ 190,959 $ 172,350 50.7% 50.2% 50.1% 50.1% 49.7% 46.3% 46.1% 14.5% 14.2% 14.0% 14.8% 14.1% 13.7% 14.4% 1.26 $ 1.13 $ 1.12 $ 1.08 $ 1.17 $ 1.35 $ 1.22 142,010 140,264 139,318 137,507 136,884 136,357 135,886 0.35 $ 0.33 $ 0.31 $ 0.30 $ 0.29 $ 0.25 $ 0.21 3,128,058 $ 2,607,011 $ 2,400,814 $ 2,224,226 $ 2,119,580 $ 1,960,659 $ 1,807,952 $ 450,000 $ 250,033 $ 250,067 $ 250,209 $ 253,616 $ 227,707 $ 226,252 $ 1,807,333 $ 1,643,963 $ 1,506,344 $ 1,369,1374 $ 1,241,741 $ 1,097,458 $ 929,345 143,878 143,352 142,795 142,076 141,544 140,673 140,016 6,438 5,557 5,286 5,206 5,398 5,047 4,733 191,729'41 $ 186,949 $ 185,568 $ 182,549 $ 187,181 $ 196,251 $ 189,368 5 25.46 $ 22.63 $ 23.94 $ 17.97 $ 20.90 $ 23.50 $ 28.21 20.2 20.0 21.4 16.6 17.9 17.4 23.1 11% 11% 12% 12% 15% 21% 23% (51 Stock price at year-end divided by net income per share -diluted. (6) Represents net income divided by total shareholders` equity as of the beginning of the year. UVeighted average number of shores outstanding -diluted has been adjusted to give effect for the two -class method of calculating earnings per share as described in to 1 to the Consolidated Financial Statements. 220 South Ridgewood Avenue Daytona Beach, Florida 32 (386) 252-9601 ATTACHMENT 2 Cardiac -Exposure Protocol A ni eriSys * Handbook for the BADGE Program `'°0y (Cardiac & Exposure Claims) Experts in the Presumption Law Claims Administration and Medical Management Specializing in Florida's Heart and Lung Bill and Exposure and Infectious Disease Claims For more information please call 1-800-752-0886 TABLE OF CONTENTS Section Page Presumption Law 1 First Responder Program 2 Heart and Lung Program 3-4 Cardiac Stages 5-7 Exposure Program and Protocol 5-12 AmeriSys Commitment 13 Flow Chart 14 Cardiac Specialized Network 15 AmeriSys is one beat ahead. FLORIDA HEART AND LUNG BILL Cardiac Disease State Management as it relates to the Florida Heart and Lung Bill of 2003 1) Any condition or impairment of health orally Florida state, municipal, county, port authority, special tax district. or _fire control district firefighter or any lcrw enforcement officer or correctional officer as defined in s. 943.10(1), (2), or (3) caused by tuberculosis, heart disease, or hypertension resulting in total or partial disability or death shall be presumed to have been accidental and to have been suffered in the line of duty unless the contrary be shown by competent evidence. However, any such .firefighter or law enforcement officer shall have successfully passed a physical examination upon entering into any such service as a. firefighter or law enforcement officer, which examination failed to reveal any evidence of any such condition. Such presumption shall not apply to benefits payable under or granted in a policy of life insurance or disability insurance, unless the insurer and insured have negotiated for such additional benefits to be included in the policy contract. (2) This section shall be construed to authorize the above governmental entities to negotiate policy contracts for life and disability insurance to include accidental death benefits or double indemnity coverage which shall include the presumption that any condition or impairment of health of any firefighter, law enforcement officer, or correctional officer caused by tuberculosis, heart disease, or hypertension resulting in total or partial disability or death was accidental and suffered in the line of duty, unless the contrary be shown by competent evidence. Page 1 B.A.D.G.E (Better Administration Dedication Guaranteeing Excellence) Specialty Medical Director/Physician Advisor AmeriSys utilizes a Medical Director and/or Physician Advisor with Board Certification in Cardiology to assist and direct the medical management team. It is extremely important that the treating physician has experience in dealing with Workers' Compensation and knowledge of the components of the Heart and Lung Bill. We are pleased to have a Cardiac Medical Director/Physician Advisor to assist with the follow ing: . . Reviewed and approved the BADGE program. Treating Physician for employees in this cachement area. Physician Advisor for IMEs, Peer Reviews and other Utilization Review Issues. Medical Director for general technical advice, Liaison activity with other Cardiology or other specialty related providers. Assist with grievances associated with heart and lung claims. Assist in identifying and facilitating recruitment or providers of excellence for these services. Cardiac Case -Manager In addition to the Cardiac Medical Director/Physician Advisor, we utilize Registered Nurses with cardiac patient experience to implement, monitor and assess all presumption claims. Specialty Facilities and/or Specialty Providers contracted for Workers' Compensation We believe to best impact the ultimate outcomes you must recruit and train providers of excellence who demonstrate their willingness to customize and/or modify their program to meet the unique needs of the claimants covered by the Florida Heart and Lung Bill. We recruit and train physician specialists in Workers' Compensation requirements and the components of the Heart and Lung Bill. These specialists include the following to name a few: • Cardiology • Cardiovascular Surgeons • Pulmonologists • Nephrologists We must also identify facilities that are able to provide quick and reliable services related to: • Cardiac Diagnostics Services Cardiac Rehab Facilities Thoracic Surgery Transplant Programs THE HEART AND LUNG PROTOCOLS Newly Diagnosed The purpose of this protocol is to provide the county/district with a direct means for emergent care if needed. To provide both employee and the county/district with proactive case management regarding assisting with the Emergent discharge needs, arrangement of cardiac diagnostics and treatment. If the following occur: • Employee begins to feel ill at work or off duty, and is transported to Physician's Office. Physician, on exam, discovers Employee is in danger and determines it is Emergent. Employee is transported to Emergency Room. After Occurrence • Notice of Injury is completed by supervisor. Cardiac Case Management is notified. Authorization is called to treating facility. Adjusters for claim are notified. A Field Case -Manager is assigned a task assignment of retrieving information, if necessary (approval from adjuster or Government entity required). Request pre -employment records and preliminary information from hospital. Pre -determination will be made at this time as to Causality and Major Contributing Cause, notify the adjuster on file. Upon discharge, the treating physicians' orders are reviewed by the Cardiac Case - Manager, assess work status at this time and notify adjuster. Field Case -Manager will be used to arrange care as needed. Once the IW is stable, the Cardiac Case -Manager will attempt to transfer the claimant's care into the Network for treatment with a cardiologist if the situation allows. Further investigation into Causality and Major Contributing Cause, as needed. Once the claim has been deemed compensable by the adjuster, proceed with cardiac case management for intermediate care status. Page 3 ROUTINE EXAM Employee finds out on a routine exam, either fit for duty or their own personal physician that there is subjective/objective information requiring a further cardiac evaluation, if it is determined by the physician that this is not of an emergent nature proceed with the following protocol: I . Notice of Injury is completed by the supervisor. 2. Cardiac Case -Manager and adjuster notified. 3. Arrange for Employee to be seen by a Network Provider. 4. Request the pre -employment physical. Have the Network Provider review initial testing and determine if a cardiology referral is necessary at this time. Have the Network Provider make a determination of work status at this time. 6. If the Network Provider feels he/she is capable of monitoring the employee for the time being, have the physician address Causality and Major Contributing Cause. 7. The Cardiac Case -Manager will arrange and authorize appropriate diagnostics and treatment as needed. AmeriSys is one beat ahead Page 4 ACUTE CARDIAC STAGE The purpose of this protocol is to provide management to those claims which remain in an Acute Cardiac condition. They require significant medical intervention and/or diagnostics. Acute Cardiac Case Management may include, but not be limited to ensuring hospital discharge planning, scheduling and coordination of additional proper diagnostic testing, arrangement of second opinions and secondary providers, treatment, treatment compliance and recognition of a deteriorating condition. Acute Cardiac Case Management will also include conferencing with the treating physician regarding appropriate referrals, additional diagnostics as well as work status, and identifying projections for permanent restrictions, MMI and PIR. Once the above has been determined the employee will be processed to Intermediate Cardiac Care. These types of claims are: • Identified as being compensable and/or under review based upon the "Presumption Law". • Determined by the physician that the employee is in an Acute Cardiac state at this time. • The employee has been or is being processed through the Emergent Protocol. Treatment 1. Establish a personalized care plan for the employee. 2. Arrange and monitor any further diagnostics by the treating physician. 3. Assist in the coordination for any second opinions and/or secondary provider evaluations or treatments. 4. Assist in Discharge Planning if applicable. 5. Monitor treatment and medications as ordered by the treating physician. 6. Provide for and/or arrange transportation if required for follow-up diagnostics and/or treatment. 7. Identify the projected MMI/PIR and projected future work related information. 8. Consult with the Cardiac Medical Director as required (and approved) to facilitate proper treatment, evaluating treating physician's MMI, PIR and RTW projections, identifying additional needs to promote best medical outcomes. 9. Move file toward Intermediate Cardiac Case Status. Page 5 INTERMEDIATE CARDIAC CASE MANAGEMENT The purpose of this protocol is to provide management to those claims which are no longer emergent, but require further medical intervention. intermediate Cardiac Case Management will include, but will not be limited to ensuring proper diagnosis, treatment, treatment compliance and recognition of a deteriorating condition. Intermediate Cardiac Case Management will also include conferencing with the treating physician regarding appropriate work status, permanent restrictions, MMI and PIR. Once the above has been determined the employee will be processed to Cardiac Maintenance Care. Types of Claims Include: • Have been accepted by the county/district prior to the establishment of a specialty cardiac division. • It is determined the employee is not in an acute cardiac state at this time and has not reached MMI. • The claim has been processed through Newly ©iagnosed/Etnergent Protocol, and it has been determined that the file will be accepted by the Employer/Carrier. • The employee is no longer in a state of acute cardiac illness. Treatment 1. Establish a personalized care plan for the employee. 2. Establish goals for the employee. If claim is not litigated, include and discuss goals with the employee. 3. Arrange and monitor any further diagnostics by the treating physician. 4. Ensure a work status is obtained for the employee. 5. Monitor treatment and medications as ordered by the treating physician. 6. Arrange any other specialty referrals as ordered. 7. Monitor compliance with treatment, medications, diet and exercise. Educate on those topics as necessary. 8. Notify the physician and adjuster/employer with concerns of non-compliance. 9. Once the employee as reached MMI/PIR and a permanent work status has been determined, and the cardiac condition is controlled and stable, move file to Cardiac Maintenance Status. Page 6 CARDIAC MAINTENANCE CARE The purpose of this protocol is to establish management guidelines for those employees with HNL claims that have reached MMUPIR and there permanent work status has been established. The employee that would be placed in this category is one who we are currently managing that has reached the above criteria or the employee who is processed through Newly Diagnosed, Intermediate Care and now has stabilized to proceed to Cardiac Maintenance Care. The Cardiac Case -Manager will establish and maintain a care plan for each employee. The goals of this plan will be monitored by the Cardiac Case -Manager. 2. Physician appointments will be monitored. 3. The Physicians assessment will be reviewed for compliance with medication, treatment and diet. 4. lithe employee maintains stability, their file will remain in this category. If not, their file will be moved to the appropriate category. Page 7 EXPOSURE PROGRAM These exposures usually occur in the course of performing their normal job duties as First Responders. Some of the exposures are readily evident and demonstrable, such as exposure to chemicals, while others may not be as readily evident, such as Tuberculosis and Hepatitus. These claims have the potential of representing significant expense both in Human Resources as well as economic impact. This type of claim is similar to the Heart/Lung Claims, are handled as a "presumption claim". The exposure program allows for: • Claims research and analysis for newly reported claims to identify whether they are related to pre-existing medical conditions. Management of those claims to assure proper diagnosis, treatment, treatment compliance and early intervention and recognition of deterioration or complication. We have developed the enclosed protocols for the county/district. • Blood Borne Pathogens Tuberculosis MRSA (Methicillin Resistant Staphylococcus Aureus) Page 8 MEDICAL DIRECTOR/PHYSICIAN ADVISOR We believe that it is imperative, to address these claims aggressively, to utilize a Medical Director and/or Physician Advisors with experience dealing with issues related to Cardiology, Epidemiology and/or Toxicology. Very often this type of physician lacks significant experience in dealing with Workers' Compensation, therefore it is critical that the program, the Case - Managers and adjusters are coordinated and clear in their support and dealing with these Medical Providers. Our medical directors and physician advisors are readily available to assist in the decision making on these difficult claims. Role of the Cardiac Nurse We utilize Registered Nurses with cardiac experience and workers' compensation experience. These nurses participate in the ongoing recruitment and education of medical providers. The Cardiac Case -Managers participates in the Workers' Compensation education of the physicians recruited. Specialty Facilities and/or Specialty Providers contracted for Workers' Compensation These services are unique and may not be a part of general workers' compensation provider networks or systems. We believe to best impact the ultimate outcomes you identify and train providers of excellence who demonstrate their willingness to customize and/or flex their program to meet the unique needs of a workers' compensation claim that involves exposure issues. The provider network offers physician specialties such as toxicology and infectious disease. We have also established relationships with ancillary providers to facilitate the specialty diagnostics needed to diagnose and threat these unique conditions. Page 9 TUBERCULOSIS EXPOSURE PROTOCOL Purpose: The purpose of this protocol is to provide the injured worker who has been exposed to tuberculosis in the workplace consistent guidelines for treatment and follow up. Policy: An effective TB infection control program requires early identification and isolation of persons who have active TB. This includes the monitoring and evaluation of employee compliance with PPD testing, radiological examination and follow up with infectious disease physicians as needed. Procedure: ]) All employees with newly recognized PPD tests will be evaluated promptly for TB. 2) Any employee who reports a persistent cough lasting greater than three weeks in combination with weight loss, night sweats, bloody sputum, anorexia or fever should be evaluated promptly for TB. 3) All employees should be encouraged to have a PPD test done on an annual basis. It is noted that under the Presumptive Illness Legislation, employees diagnosed with TB will be presumed to have become infected while performing duties unless proven by baseline testing at the pre -employment stages. 4) While the results of a tuberculin skin test alone cannot confirm an active TB infection. Other tests, such as a chest X-ray and sputum culture, should be done to confine an active TB infection when a skin test is positive. If active TB is confirmed, the injured worker should be immediately referred to the designated physician that has been assigned to handle TB exposures for treatment and follow up. 5) An employee, who has a positive skin test or chest X-ray, but no TB symptoms, is usually thought to have a TB infection that cannot be passed to others (latent TB). Once a physician has confirmed the injured worker has latent TB, it is recommended that the injured worker is evaluated and has a chest x-ray annually. 6) It is the responsibility of the Case -Manager to communicate all medical findings to the employer and can-ier. 7) It is the responsibility of the Case -Manager to monitor for treatment compliance and report any incidents of non-compliance with TB protocol immediately to the employer and carrier. Page 10 MRSA (Methicillin Resistant Staphylococcus Aureas) Protocol Purpose: The purpose of this policy is to provide the injured worker who has been exposed to MRSA in the workplace the appropriate and current treatment. It is also the purpose of this policy to assist in the prevention of the spread of MRSA in the workplace. Policy: Once the diagnosis of MRSA has been identified in an employee, aggressive measures will be taken stabilize the injured worker's infection, assist the employer in preventing the spread of the infection and assist the carrier in addressing the compensability of the infection. Proced a re: Prevention of MRSA Infections: Keep hands clean by washing thoroughly with soap and water or using an alcohol based sanitizer. Keep cuts and scrapes covered with a bandage until healed. Avoid contact with open wounds and bandages. Avoid sharing personal items such as towels or razors. Guidelines for treating and Case Management of MRSA or potential MRSA 1) Once MRSA has been identified in the workplace, refer all injured workers who present with an infection that may appear as a pimple, boil or abscess to a designated worker's compensation physician for evaluation. 2) Obtain and review culture and sensitivity results when available, notify the employer and carrier of the results. 3) Until the culture reports are available, assist the physician in determining work status, and inform the employer and carrier of the work status. 4) Educate the injured worker on ways to prevent the spread of infection. For example, frequent hand washing, keeping wounds covered, and avoid the sharing of personal items. 5) Monitor the tolerance and compliance with all prescribed antibiotics. Educate the injured worker on the importance of the completion antibiotic therapy. 6) Ensure the injured worker complies with all physician follow up appointments. 7) Collaborate with all treating physicians regarding the an-angement of possible IV antibiotic therapy and wound care needing home health services. 8) Confirm with all treating physicians that the injured worker is safe to return to work. Page 1 1 BLOOD BORNE PATHOGEN EXPOSURE Purpose: The purpose of this policy is to provide the employee who is exposed to blood and body fluids in the work place the established measures to confirm a diagnosis and provide the appropriate treatment. A significant exposure is defined as an injury during which one person's blood or other high -risk body fluid comes in contact with someone else's body cavity. Injuries of concern include but are not limited to needle sticks, other sharps, splashes and bites. Policy: Employees who report exposure to blood and body fluids in the workplace will be promptly sent to the designated physician to have the appropriate testing and treatment. The Case -Manager will notify the employer and carrier of medical updates, compensability issues and the current work status. The Case - Manager will monitor for compliance with all testing and treatment protocols. Procedure: 1) If the exposure is emergent in nature, immediately direct the injured worker to emergency treatment and/or initiate the EMS system. 2) If there is no serious injury involved with the exposure, the injured worker should be directed to the designated physician or facility for testing and treatment. 3) Ensure that both the injured worker and the source are tested as soon as possible. If the source is not available. the treating physician will determine the appropriate plan of treatment. If chemoprophylaxis is to be implemented in order to prevent the transmission of HIV, it should ideally be started between 2-4 hours post exposure, however it can be initiated up to 72 hours post exposure. Once the determination has been made that the source is HIV negative, the chemoprophylaxis can be discontinued. Follow up labs and or chemoprophylaxis may be indicated if there is concern that the source may be in the window period sero-conversion phase or if the source is unavailable. HIV testing should be done at baseline, 3 months, and 6 months. Counseling should be provided as to the prevention of a possible secondary infection. 4) The lab work performed should include an anti-HB level in relation to Hepatitis B exposure protection. The physician will determine if the injured worker is sufficiently protected. If it is determined the injured worker is not protected, the HBIG and/or HBV vaccine can be administered. Testing should occur at least one month after the receipt of the last dose of the vaccination, or four months after the receipt of HBIG, whichever is longer. If the injured worker's lab work continues to show insufficient protection, a second dose may be offered. 5) Although there is not a vaccination available to offer protection from Hepatitis C, a lab value should be obtained. 6) Follow up counseling and medical evaluation should be provided for all injured workers who are given chemoprophylaxis. 7) The Case -Manager will aggressively monitor compliance with all treatment and testing, notifying the employer and carrier of all non-compliance issues. Page 12 AmeriSys recognizes the importance of "quality of life" and therefore will exert every effort to educate every employee with a potential for heart disease regarding healthy diet, weight loss and proper medication usage. They will be monitored for compliance in all areas of their care. Serving those who protect Page 13 EXAMPLE OF CARDIAC DISEASE STATE MANAGEMENT FLOW CHART If Yes Cardiac Claim Cardiac TCM FCM Field Case Management Cardiac Occurance Report to Intake Coordinator Evaluation of claim statu Cardiac; Yes1No Triage Claims Adjuster 2 Point Contact Same Day (FEUD) 3 Point Contact Within 24 hrs. (ER) Medical Only Nurse UR or Precert Closure of File 1 Lost Time Nurse UR or Precert Closure of File Large Catastrophic Claims Field Nurse Claims Link Field Case Management Triage Nurse UR of Pieced Claims Link Achievement of Medical Stability Access needed for Continued FCM Involvement Addressing MMI/PIR. PTA Status, Life Care Plan, Cost Projection, Excess Updates and if applicable. Medicare Set Aside Closure of File Page 14 CARDIAC SPECIALIZED NETWORK We currently V+'ork with a network that can help create and develop a network, for your needs. Page 15 AmeriSys 1-800-752-0886 ATTACHMENT 3 Innovative Programs APRIL 2014 First Edition Newsletter Program Administered by: Arne riSys S ECUI&E� Services for the Effective Control and Utilization of Rx through Evidence -based Criteria TEAM BASED APPROACH AmeriSys'SECUN,E})is leading the way with quality - centered cost effective management of pain treatment programs. By joining forces with some of the industry's leaders in pain treatment guidelines, pharmacy controls and alerts. functional restoration initiatives and specialized case -managers, AmeriSys has developed unique protocols and criteria for managing these complex and cost -driving claims. This program will maximize the injured employees' comfort level by working closely with physicians who practice according to nationally -approved standards, In utilizing these best practices, the risk of addiction is minimized and costs associated with the addiction are decreased. In doing this. not only do we benefit our industry but our community as well. FEATURES • Unique/• contracted medical provider network C Sfrict protocol adherence • Intenliseiplinart,.4ch isoty Board (phi°sicia ns•. physical therapist. pharmacists. ntases. rani=utiott review .specialists. psychologists. claim prof rssionalsl • Custom computer system to identifs. pain mcntagetnent candidates • Specialized Case -Managers • Pharmacy STEP program BENEFITS • Cost Containment • Reduce the costs associated with addiction • Return injured employees back to work • Minimize the risk of addiction • rl farinrize the injured employees' comfort level • Reasonable expectations related to pain relief and functionality • Benefit the injured enrployees'.farnily life • Reduce overall claim costs both medical and indemnity 140 Alexandria Blvd. Suite N. Oviedo, Florida 32765. 800. 752.0886 April 2014 VOL. # ONE ISSUE #1 ADVISORY BOARD • Cheryl Gulasa. VP AmeriSys • Dr. Matthew Imfeld, AmeriSys Medical Director • Dr. Sanford Silverman, Board Certified Pain Medicine and Anesthesiology • Dr. Michael Creamer Board Certified Pain Medicine and PMR • Dr. Michael Coupland, CPsych, CRC. • Kendra Karagozian Pharm.D. myMatrixx • Brian Imler, Physical Therapist • Kathy Heitinz Garcia, Peer Review Consultant A D VISORY BOARD SPOTLIGHT r -Michael Coupland CPsych, CRC Expert Physician Panel Locations • Certified Psychologist specializing for 30 years in Workers' Compensation and Personal Injury Developer of 3 Natianai Networks that have performed over 150,000 evaluations • Author AMA Guides Companion Text • Key speaker at over 100 Work Comp and medicnlegal conferences • Expert to the Federal Government Social Security Disability Determination projects April 2014 SPRING INTO ACTION Here are three quick -and -easy tips to help you clean up your act this spring: Freshen up your diet: With new found space in your refrigerator, start eating more fresh fruits and vegetables. Studies show that Americans aren't consuming enough fruits and vegetables. A recent "Life...supplemented" consumer study2 found that only 32 percent of Atnerican adults claim, "I love vegetables and easily eat two cups each day," and just 27 percent say, "1 eat at least two pieces (or cups) of fruit each day." IVIs. Forberg suggests aiming for a minimum of four cups of fruits and vegetables daily, and favoring non -dried fruits and non -starchy vegetables. Take inventory of your kitchen cabinets: Be proactive and check expiration dates on your multivitamins and other dietary supplements. While supplements are not required by law to list expiration dates, most companies do So to ensure that consumers take them before the ingredients lose their full potency. Say "hello again" to Mother Nature: As temperatures warm up across the country, take the time to enjoy the scenery. Jogging, power -walking and exercise -it could be as simple as biking to the neighborhood store for a few small items or taking a jog through the nearby park while your children are at sports practice. VOL. # ONE ISSUE #1 myMatrlxx ' 1 Click Pharmacy myMatnxx is a pharmacy and ancillary benefit management company focused on workers' compensation. By combining advanced technology and proactive clinical inanagernient throughout the claims process. rylkAatrixx delivers a fast. Simple, Effective sututsor, with proven Results. NEW DRUG SPOTLIGHT:is -415 ZohydroTM ER (hydrocodone bitartrate extended -release) Backgrounds": Zohydro ER was approved by the U.S. Food and Drug Administration (FDA) on October 25. 21113. Zohydro ER is a Schedule II controlled substance and is the first and only extended -release dosage loam of hydrocodone that is not combined with acetaminophen. Zohydro ER does not possess any abuse -deterrent properties. the new chug will be part of the ER I_A Opioid Analgesics Risk Evaluation and Mitigation Strategy (RENISi. According to the manufacturer, an abuse -deterrent formulation is currently being developed and will likely become available within the next three years pending FDA approval. Zohydro ER is available in pharmacies this month (March 2014 FIA Approved Indications: Zohydro ER is indicated to manage pain severe enough to require daily. around -the -clock. long -torn opioid treatment and for which alternative treatment options are inadequate. Zohydro ER is not approved for as -needed { I'R N I pain relief. Why is this relevant for workers' comp? As with all opioids, there are concerns for the potential risks of misuse, abuse. increased sensitivity to pain. addiction and overdose. Zohydro ER is not expected to be superior to existing therapies that are available in safer Itwinulations, and will likely result in increased use and increased cost for chronic pain patients. Fornudarc consideration: Due to the risks of addiction, abuse, and misuse with opioids, even at recommended doses. and because of the gneisson,c ndose and death with extended -release opiaicl tbnnulattons. Zohydro lilt should be reserved tier use in patients for whom ahemalive treatment options are ineffective, not tolerated. or would be otherwise inadequate to provide sufficient pain management. iherefiore. it is recommended that Zohyclro ER be excluded from fonnularies and or require prior SECURE* AmeriSys' SECURE is leading the way with quality -centered cost-effective management of pain treatment programs.` 13y joining forces with some of the industry's leaders in pain treatment guidelines, phannacy controls and alerts, functional restoration initiatives and specialized case -managers, AmeriSys has developed unique protocols and criteria for managing these complex and cost -driving claims. This program will maximize the injured employees' comfort level by working closely with physicians who practice according to nationally -approved standards. In utilizing these best practices, the risk of addiction is minimized and costs associated with the addiction are decreased. In doing this, not only do we benefit our industry but our community as well. Background: Today it is reported that approximately 19% of medical spend in Workers' Compensation claims goes to pharmacy. Of that, 38% goes toward opioid medications. The utilization and the resultant impact of opioid analgesics has created a crisis within the Workers' Compensation community. Some states have enacted legislation to curtail the rampant "mis-utilization" of these medications, The resounding cry in the industry by its leading consultants is to develop programs, procedures, protocols and methodologies to address the misuse of these drugs for the treatment of work -related conditions. The misuse of these drugs is responsible for significant challenges both in functional and economic outcomes. Improper utilization of these drugs can and does lead to: • Addiction • Family Dysfunction • Increased Disability Duration • Physical health consequences associated with long tern narcotic utilization and addiction such as: o Depression o Loss of libido o Lower testosterone levels o Weaken the immune system o Pulmonary function (secondary to decreased respirations) o Liver functions o Hyperalgesia o Constipation AmenSys* www.AmeriSys-Secure.cotn 800.752.088E ia� .u0813 SECURE The SECURE*l, program's goals are to improve/enhance return -to -work outcomes, reduce disability s—c� li-ation; prevent unnecessary, dangerous and costly consequences of inappropriate or prolonged utilization of opioid medications while reducing the costs of handling pain management claims. Features: • Uniquely contracted medical provider network ✓ Strict protocol adherence • Interdisciplinary Advisory Board (physicians, physical therapist, pharmacists, nurses, utilization review specialists, psychologists, claim professionals) • Custom computer system to identify pain management candidates • Specialized Case -Managers • Pharmacy STEP program Benefits: • Cost Containment • Reduce the costs associated with addiction • Return injured employees back to work • Minimize the risk of addiction • Maximize the injured employees° comfort level • Reasonable expectations related to pain relief and functionality • Benefit the injured employees' family life • Reduce overall claim costs both medical and indemnity Services for the Effective Control and Utilization of Rx through Evidence -based Criteria A ni e riSys * www.AmeriS s-Secure.com 800.752.0886 RXMu0Al3 AineriSys_4C) The . meriSt:s-C� goal is to provide a comprehensive multi -disciplinary approach in the management o ATASTROPHIC COMPLEX claims. This approach will provide exceptional CARE in a cost efficient manner to injured employees, while easing the burden of coordination and handling these challenging claims for employers and carriers. The 4C program will provide exceptional care in a cost-effective manner to severely injured or critically ill employees. AmeriSys will ease the burden of cost and management in dealing with these very challenging claims on behalf of employers and carriers. These claims may arise out of truly catastrophic injury events (accounting for only 1% of claims) or they may be the "Creeping Catastrophic Claim". In either case, the AmeriSys team can help. Features: Benefit: • Prioritize the needs of the injured employee • Provide all aspects of care to the injured employee • Ensure high quality and quantity of care required in a cost effective manner • Cost analysis for the employer and carrier - current and projected • Coordination from centralized point • Industry leaders in one network • Competitive pricing • Streamlined payment system from a central point • Employee Advocate as coordinator providing multidisciplinary specialized services • Vocational rehabilitation assessment • Community Safety evaluation • Specially trained professionals, knowledgeable of the local resources and outstanding case management techniques • Reduce the claim cost by proactively facilitating the injured worker to the most appropriate and cost efficient care of services. Controlling Costs for Complex Claims AmeriSys* www.AnleriSys-Secure.com 800.752.0886 4COSL BADGE PROGRAM In 2003, Florida Legislature expanded the fire fighters' "Heart and Lung Bill" to include police, deputies and correction officers. This change in law presented the Worker's Compensation claims and medical management community with increased challenges. AmeriSys developed a specialized legal and medical program approach in addressing the uniqueness and special needs of handling claims. This was appropriately named BADGE (Better Administration Dedication Guaranteeing Excellence). This team recognizes the importance of "quality of life" and therefore will exert every effort to educate every employee with a potential for heart disease regarding healthy diet, weight loss and proper medication usage, The program consists of an interdisciplinary approach to manage and provide quality services to our employees and clients. • The combination of disease state management and worker's compensation case management, allows the employee to benefit from the latest in quality cardiac healthcare providing a constant source of support and education. It improves/enhances return to work outcomes, reduces disability duration, prevents unnecessary, dangerous and costly consequences of inappropriate use of cardiac medications while reducing the cost of handling presumption claims. The BADGE Program Features include: • Medical Director and/or Physician Advisor with Board Certification in Cardiology to assist and direct the medical management team • Registered Nurses with cardiac patient experience to implement, monitor and assess all presumption claims • Specialty Facilities and/or Specialty Providers contracted for Workers' Compensation to best impact the ultimate outcomes you must recruit and train providers of excellence within their specialty and/or modify their program to meet the unique needs of the claimants covered by the Florida Heart and Lung Bill • Most current quality of Cardiac Care while maintaining compliance with the Heart and Lung Bill 112.18 and WC Statute 440 The cardiac registered nurse works directly with the adjuster, employer and employee assisting in the following: • Gathering medical data required to properly determine the compensability by the adjuster • Manage the initial diagnostics and treatment to most effectively diagnose condition • Works with the employee through diagnostics and moving them toward a stable position • Provide education and establish goals with the employee in making lifestyle changes in order to reduce or eliminate future costly events associated with their work -related illness • Conference with the treating physician regarding the job description, and assist in the determination of when the claimant can safely return to work • During the maintenance phase of the program, the cardiac nurse case manager monitors physician's findings, diagnostics, lab values and medications • Coordinates care and provides education. The goal is to maintain the claimant at this stable state, acting proactively when necessary • Facilitates communication with employees, physicians, employers and adjusters, keeping them apprised of any changes ATTACHMENT 4 Reference Letters SHERIFF'S OFFICE R!C L_ BRADSHAW, SHERIFF CATHERINE ADRIANCE SECTION MANAGER — RISK MANAGEMENT PHONE 561-688- 4335 August 26, 2013 To Whom It May Concern: E-MAIL: ADRIANCEC@PBSO.ORG The Palm Beach County Sheriffs Office is proud to have worked closely with Amerisys for the past several years in the management of our workers' compensation program. In its partnership with PBSO, Amerisys has played a key role in the success of this program. From the beginning of our working relationship, Amerisys personnel have listened and responded to our every need, making adjustments along the way as appropriate for changing technology as well as personnel. Their pride in service is reflected in the quality of their personnel, all of whom have continuously displayed a high degree of integrity and responsibility, as well as the compassion and dignity required to appropriately assist our deputies and civilian personnel. We consider Amerisys to be an extension of our Risk Management staff, which is evidenced by the teamwork and commitment to excellence displayed by the staff of Amerisys. If you have any specific questions that you would like to discuss, please do not hesitate to contact me. Sincerely. Catherine Adriance Section Manager — Risk Management 3228 Gun Club Road • West Palm Beach, Florida 33406-3001 • (561) 688-3000 http:/fwww.pbsc.org P.O. Box 2118 DeLand (386) 734-7190 Mr. James T. Russell, Superintendent of Schools November 10, 2016 • 200 North Clara Avenue Daytona Beach (386) 255-6475 City of Miami Purchasing Department Procurement Supervisor 444 SW 2"d Avenue Miami, FL 33130 Reference: Letter of Reference for AmeriSys • DeLand, Florida 32721-2118 New Smyrna Beach (386) 427-5223 Osteen (407) 860-3322 School Board of Volusia County Mrs. Ida D. Wright, Chairman Mrs. Melody Johnson, Vice Chairman Mrs. Linda Costello Mrs. Linda Cuthbert Dr. John Hill Please accept this correspondence as a formal Letter of Reference for AmeriSys and Mr. Ron Warble, Executive Vice President of AmeriSys. AmeriSys became our Workers' Compensating Managed Care Provider (by way of a Request of Proposal) on July 1, 2007. Prior to July 1, 2007 we had another managed care provider however, we were looking for a company that would work much more closely with us to help us obtain our goals of constant monitoring and cost containment on our existing Workers' Compensation claims as well as future claims. Mr. Warble worked with us extensively in the beginning of this contract to help us establish our unique criteria and work flow to ensure we effectively reach our goals. He and his staff are always readily available for any questions, concerns or situations that arise. They have continued to proactively anticipate future needs while providing options and solutions to those matters. They are very compliant with timelines, deadlines, budget concerns and legislative changes all while providing quality service. We have not only obtained our goals but have exceeded expectation as AmeriSys works very closely with our Third Party Administrator so we have exceptional coordination of case oversight. Should you have further questions please feel free to contact me at your convenience at (386) 734-7 1 90, extension 20300. Sincerely, Sandra Higginbotham, Director Insurance & Employee Benefits An Fn ial flnnnrtiinpW Fmnlmodar �' FLORIDA CITRUS, ,AVAINAWALIZIPHATRIW U. Np, FCBIPost Office Box 189 * Alachua Florida 32616 Office (386)462-5171 *Fax (386)462-5767 111111111111.1 Email: debra.ruedisili@febifund.com FLORIDA CITRUS BUSINESS & INDUSTRIES FUND Debra Ruedisili Chef Executive Officer To Whom It May Concern: Re: AmeriSys June 27, 2016 We have been requested to provide a Letter of Reference regarding the services being provided by AmeriSys as a certified managed care organization. We initiated our partnership with AmeriSys in 2002. Speaking on behalf of the Board and Management of Florida Citrus, Business & Industries Fund (FCBI), we continue to be very pleased with the service provided by AmeriSys as our MCO provider. Along with their network services, AmeriSys also provides FCBI with bill re -pricing through their Cost Containment Department, which has further benefited the Fund through additional cost savings. Likewise, AmeriSys' Nurse Case Managers are engaged in daily monitoring of our injured workers' medical treatment utilizing one of our preferred networks. As you deliberate this important decision, if I can be of any further assistance to you regarding the attributes and quality service provided by AmeriSys to our organization, please feel free to contact me directly at (561) 308-9751. Thank you. Sincerely, Debra Cerre-Ruedisili CEO Sponsored by: U B A Florida united 113 V440*11167 Aatocialion FHmCOMPANYINSURANCE A POLICY i'. > DO MORE Workers' Comp Since 1954 August 2, 2016 Re: AmeriSys 4601 Touchton Road East, Ste 3160 • Jacksonville, FL 32246 904-854-2777 Office • 904-463-3234 Cell www.thmic.ccm • Matt_Lupino@fhmic.com Matthew J. Lupino President & Chief Executive Officer Since 2005, FHM Insurance Company has contracted with AmeriSys for our Medical Care Management Services. Throughout the years, we have experienced the highest levels of service and responsiveness from the AmeriSys team. In addition, the AmeriSys team has consistently delivered excellent outcomes with respect to their ability to manage the costs associated with the various medical components of our workers compensation claims. The AmeriSys team is comprised of highly qualified individuals with expertise in their respective fields. Our entire management team highly recommends the AmeriSys organization. Sincerely, Matthew J. Lupino, CPCU President & CEO ATTACHMENT 5 Resume/Licenses CHERYL GULASA, R.N., CPHM, CCM Orlando, Florida Currently Manager of Medical Services overseeing all functions relating to Case Management (Telephonic and Field), Utilization Management including Cost Containment Services and Provider Relations. CAREER SUMMARY Serving as the Manager of Medical Services, directly supervises the Nurse Case -Manager Supervisors, ensuring al! state requirements are met, assisting with nurse recruitment and training. Created Policy and Procedures for the challenging health care needs of the injured employee, including but not limited to cardiac, pulmonary, pain and catastrophic issues . Created Policy and Procedure for medical bill review, ensuring all parameters are met., including pricing is appropriate for equipment and procedures performed. Previously served as the Nurse Case -Manager Supervisor for seven accounts, assisting with management responsibilities, legal issues and training. Worked as lead telephonic case -manager for a public municipality account. Worked as a Circulator, Pre -Op and PACU Nurse in various ambulatory surgery centers. Worked as care nurse of Medicare patients, duties included case management, supervisory visits, and any nursing skills required. Health Care Coordinator for Service Merchandise Company. Ran an onsite clinic. while managing workers' compensation cases and ensuring compliance with OSHA. CREDENTIALS & LICENSES ■ Florida, Georgia and North Carolina Registered Nurse ■ Certified Professional in Healthcare Management • Certified Case Manager EXPERIENCE 2003 - AmeriSys PRESENT 140 Alexandria Blvd., Suite H., Oviedo, FL 32765 Manager, Utilization Management Services 2001-2003 Corvel Corporation, Orlando, Florida. Utilization Review EDUCATION • Broward College, Coconut Creek, Florida • A.S. Degree in Nursing, 1984 • ACLS May 2001-2003 RELEVANT PROJECTS CLIENT NAME PROJECT DESCRIPTION ROLE OF THE INDIVIDUAL PROJECT ACTUAL OR EXPECTED COMPLETION DATE RELEVANT PROJECTS Columbus Consolidated Government Third Party Claims Administration Services Responsibilities include intergrating all Medical Managgement services and setting up protocol for CCG's Workers' Compensation program MCO program. TPA Services began 3/1/2014 and continue to date. CLIENT NAME PROJECT DESCRIPTION ROLE OF THE INDIVIDUAL PROJECT ACTUAL OR EXPECTED COMPLETION DATE Forsyth County Third Party Claims Administration Services, Medical Management Services and Medical Bill Review. Responsibilities include intergrating all Medical Managgement services and setting up protocol for Forsyth's Workers' Compensation program. Services started 1/1/2016 and continue to date. FL, DOH MQA Search Portal Paue I of I --- -- Department of Health HEALTH CHERYL ANN GULASA License Number: RN1559902 Data As Of 11/10/2016 Profession Registered Nurse License RN1559902 License Status CLEAR/ACTIVE License Expiration Date 7/31/2018 License Original Issue Date 09/03/1984 Address of Record 140 ALEXANDRIA BLVD SUITE H OVIEDO, FL 32765 UNITED STATES Controlled Substance Prescriber No Discipline on File No Public Complaint No The information on this page is a secure, primary source for license verification provided by the Florida Department of Health, Division of Medical Quality Assurance. This website is maintained by Division staff and is updated immediately upon a change to our licensing and enforcement database, https://appsiiiga.doll.state.t1.us/MQASear'chSery ices/HealthcarcProviclers/LicenseVerifica... I 1 / l0/2()16 JENNIFER WHITE, RN, CCM Orlando, Florida EXPERIENCE 2013 — USIS, Inc. PRESENT Program Supervisor, Telephonic Nurse Case Management Directly supervises a unit of Nurse Case -Managers, ensuring all state requirements, client and company policy and procedure are met, assisting with development, recruitment and training. Created Policy and Procedure for the challenging health care needs of the injured employee, including but not limited to cardiac, pulmonary, pain and catastrophic issues, working with public entity employers and catastrophic claims. 2012 - 2013 2010 — 2012 2009-2010 1999-2007 Health Direct RN Case -Manager Assessed medical conditions of injured workers; coordinated medical care and physician referral; coordinated information with adjuster, client and physician. Assigned to Multi -State National Accounts. Clermont Health and Rehabilitation RN Director of Nursing Responsible for all day to day operations of clinical services of 182-bed skilled rehabilitation facility. Ensured compliance with all state and federal regulations. Responsible for management of all nursing staff including but not limited to supervision and hiring. Head of Quality Assurance to ensure that best practice and quality of care was provided. Responsible for the financial management of the nursing budget and accurate billing for clinical services. The Parks HealthCare Center RN Assistant Director of Nursing and Skilled Unit Manager Assisted Director of Nursing with all day to day operations of clinical services of 120-bed skilled rehabilitation facility. Ensured compliance with all state and federal regulations. Responsible for management of all nursing staff including but not limited to supervision and hiring. Head of Quality Assurance to ensure that best practice and quality of care was provided. Responsible for the financial management of the nursing budget and accurate billing for clinical services. Sandy River Nursing Care Center RN Director of Nursing Responsible for all day to day operations of clinical services of 90- bed skilled rehabilitation facility and 90-bed Assisted Living facility. Ensured compliance with all state and federal regulations. Responsible for management of all nursing staff. Head of Quality Assurance to ensure that best practice and quality of care was provided. Responsible for the financial management of the nursing budget and accurate billing for clinical services, 1987-1996 EDUCATION QUALIFICATIONS Stevens Real Estate Business Office Manager Responsible for all of the daily business and financial functions for a large commercial and residential real estate office. Responsibilities included AP/AR, budget management, payroll, HR as well as oversight of the Marketing functions for the business. University of Maine at Augusta Associate Degree of Nursing - 1999 University of Southern Maine Certificate in Case Management- 2006 Public Entity and Multi -State Workers' Compensation Telephonic Case -Manager Experience • Registered Nurse • Licensed: RN FL RN9281363 • NC -RN 259823 (currently inactive) • Maine and Compact State License R043510 (currently inactive) PROFESSIONAL DESIGNATION • CCM — Certified Case Manager 4205300 FL D011 MQA Search Portal Page 1of1 HEALTH Department of Health JENNIFER LEIGH W—ITE License Number: RN9281363 Data As Of 11/10/2016 Profession License License Status License Expiration Date License Original Issue Date Address of Record Controlled Substance Prescriber Discipline on File Public Complaint Registered Nurse RN9281363 CLEAR/ACTIVE 7/31/2018 08/07/2008 2700 Woodlawn dr WINTER HAVEN, FL 33881 UNITED STATES No No No The information on this page is a secure, primary source for license verification provided by the Florida Department of Health, Division of Medical Duality Assurance. This website is maintained by Division staff and is updated immediately upon a change to our licensing and enforcement database. https://appsniga.doh.state.f1.us/byIQASearchServices/1lealthcareProviders/LicenseVeriflca... 11/10/2016 AMY KRIETEMEYER Orlando, Florida CAREER SUMMARY Supervisor responsible for the overall technical and quality oversight and supervision of field case -management services. Primary duties include planning and directing field case -management services, assisting in development of long range plans for the department, promoting staff education and development, meeting with current and prospective customers and clients as required, overseeing compliance with all governmental agencies as it relates to field case -management services and day to day management of the field case -management departments. Also serves as a resource to all departments, assisting in the development of service proposals for prospective clients and certifying cases as catastrophic as indicated by state law and in-house procedures. Additional responsibilities include performing field case management nursing duties to include but not limited to coordination of care as ordered by treating physicians as well as attend physician conferences for purpose of obtaining future plans of treatment including addressing major contributing cause and estimating maximum medical improvement. EXPERIENCE 2007 — Brown and Brown Inc. / AmeriSys PRESENT Supervisor, Field Case -Management • Plan and direct field case management services • Promote staff education and development • Meet with current and prospective customers and clients as required • Assist in the development of proposals for prospective customers and clients • Oversee compliance with all governmental and agency requirements and policies related to field case management services • Determination of cases as catastrophic in accordance with applicable state laws and AmeriSys procedures as needed. • Responsible for day to day management of the FCM dept, including personnel reviews and all other personnel -related functions - coordinated with manager & HR • Perform on site field case management services 2003-2006 Corvel Telephonic / Field Case Manager Field Case -Management Supervisor • Provided telephonic case -management in a Workers' Compensation environment with a focus on medical appropriateness of care to injured worker with cost savings by coordination and utilization of all services, ensuring that as soon as medically feasible, return -to -work status was achieved. • Evaluated the recovery needs of an injured employee after the initial contact assessment and incorporated into the initial plan information obtained from the employer and provider. • Facilitated communication between the employee, the employee representative, employer, employer representative, insurer, health care provider, the managed care organization and when authorized, any 1996-2003 1992-1996 EDUCATION qualified rehabilitation consultant, to achieve the goals • Identified barriers to recovery and formulated action plans to overcome them. Initial employment was as a telephonic case manager with advancement to field case management and ultimate advancement to Field Case - Management Supervisor. In that role additional responsibilities included overseeing: • Central Florida Field Division • Dade County School Board Field Division • Also performed extensive employee reviews • Reports prepared and billing audits conducted on a daily basis Carter Case Management Independent Case Manager • As owner, worked with insurance carriers, self insured employers and third party administrators to provide effective medical management services for workers' compensation and general liability claims. • Worked closely with all involved medical entities and injured worker to ensure injured worker's return to work and pre -injury lifestyle in a timely manner. • Conducted file audits to insure cost containment was maintained • Coordinated and assisted employer with implementation of appropriate injury prevention strategies. • Successful resolution of the injured worker's medical files within appropriate and expected time frames as indicated by individual carrier. Bonutti Orthopedic Clinic Office Nurse Registered Professional Nurse (RN) — State of Florida Registered Professional Nurse (RN) — State of Kentucky Certified Case Manager (CCM) — Commission for Case Manager Certification FL. DOH MQA Search Portal 1 Paige I oil Department of Health HEALTH AMY DEANNE CARTE-KRIETEIv L tense Number: RN9202400 EYER Data As Of 11/10/2016 Profession Registered Nurse License RN9202400 License Status CLEAR/ACT1VE License Expiration Date 4/30/2017 License Original Issue Date 06/06/2003 Address of Record 140 ALEXANDRIA BLVD OVIEDO, FL 32765 UNITED STATES Controlled Substance Prescriber No Discipline on FiLe No Public Complaint No The information on this page is a secure, primary source for license verification provided by the Florida Department of Health, Division of Medical Quality Assurance. This website is maintained by Division staff and is updated immediately upon a change to our licensing and enforcement database. https://appsmga.doh.state_11.us/MQASearchServices/L IealthcarcProviders/LicenseVerilica... 1 1/10/2016 EUNICE R O M I C H, RN, BSN Orlando, Florida CAREER SUMMARY Eunice has 12 years of nursing experience, with the last 5 working in the workers' compensation field. Background nursing experience consists of cardiology, orthopedics, and surgery while working in both hospital setting and outpatient surgical setting institutions. Prior to joining AmeriSys in 2014, Eunice worked for an international all lines insurance company in Alpharetta, Georgia, as a telephonic case -manager for workers' comp claims in the states of Georgia and Alabama. EXPERIENCE 2014 — AmeriSys, Orlando, FL PRESENT Telephonic Case -Manager Supervisor Responsible for the supervision of the telephonic nurse case management staff in Orlando, Oviedo and Lake Mary, Florida, locations, assisting the TCM Unit Manager with review of TCM work product and performance evaluations. Responsible for maintenance of all client protocols and AmeriSys standards; assisting the Unit Manager with QA audits and presenting minutes at monthly and quarterly QA/UR meetings. Maintains service standards as liaison with claims staff. Trains staff in job duties as necessary to ensure compliance with policy and procedure for effective business operations. 2010-2014 2008-2010 2003-2007 EDUCATION Travelers Insurance, Alpharetta, GA Telephonic Case -Manager Managed and coordinated medical treatment while collaborating with providers, employers, and their employees. The goal was to facilitate return -to -work by developing an appropriate strategy for medical treatment while staying in compliance with local jurisdictional laws/regulations. The Swan Center of Plastic Surgery, Alpharetta, GA Perimeter Surgery Center, Atlanta, GA Registered Nurse Facilitated in direct patient care while working alongside surgeons and anesthesiologists in both pre -operative and post -operative areas. Surgeries included general, plastic/cosmetic, and ENT procedures. Florida Hospital, Orlando, FL Registered Nurse Participated in direct patient care in critical care settings for cardiac and surgical patients as well as orthopedic patients in partnership with physicians and other medical disciplines. Provided education on recovery process to both patients and their families. Designated preceptor for training of recent graduate nurses. Adventist Health University, Orlando, FL Bachelors of Science in Nursing 2013-2015 Florida Hospital College of Health Sciences - Orlando, FL Associates Degree in Nursing 2001-2003 QUALIFICATIONS Valencia Community College - Orlando, FL Associates Degree in General Education 1999-2001 RN Licensing: FL — RN9208630 GA — RN 194318 RELEVANT PROJECTS CLIENT NAME PROJECT DESCRIPTION ROLE OF THE INDIVIDUAL PROJECT ACTUAL OR EXPECTED COMPLETION DATE RELEVANT PROJECTS CLIENT NAME PROJECT DESCRIPTION ROLE OF THE INDIVIDUAL PROJECT ACTUAL OR EXPECTED COMPLETION DATE RELEVANT PROJECTS Columbus Consolidated Government Third Party Claims Administration Services Responsibilities include managing and coordinating issues involving provider networks utilized by USIS/AmeriSys, and educating and training adjusters, case managers and CCG risk management regarding utilization, access, and grievances for network providers. TPA Services began 3/1/2014 and continue to date. Forsyth County Third Party Claims Administration Services, Medical Management Services and Medical Bill Review. Responsibilities include managing and coordinating issues involving provider networks utilized by USIS/AmeriSys, and educating and training adjusters, case managers and Forsyth risk management regarding utilization, access, and grievances for network providers. Services started 1/1/2016 and continue to date. CLIENT NAME PROJECT DESCRIPTION ROLE OF THE INDIVIDUAL PROJECT ACTUAL OR EXPECTED COMPLETION DATE RELEVANT PROJECTS MARTA Medical Management Services (MCO) and Medical Bill Review Responsibilities include managing and coordinating issues involving provider networks utilized by USIS/AmeriSys, and educating and training case managers and MARTA risk management regarding utilization, access, and grievances for network providers. Services started 11/2003 and continue to date. CLIENT NAME PROJECT DESCRIPTION ROLE OF THE INDIVIDUAL PROJECT ACTUAL OR EXPECTED COMPLETION DATE State of Georgia (DOAS) Medical Management Services (MCO) Responsibilities include managing and coordinating issues involving provider networks utilized by USIS/AmeriSys, and educating and training case managers and DOAS risk management regarding utilization, access, and grievances for network providers. Services started 8/1/2002 and continue to date. FI.. DO11 MQA Search Portal I Page I of 1 �-- Department of Health HEALTH EUNICE GUTIERREZ ROMICH License Number: R V0208630 Data As 0f 11/15/2016 Profession Registered Nurse License RN9208630 License Status CLEAR/ACTIVE License Expiration Date 4/30/2017 License Original Issue Date 10/09/2003 Address of Record 140 ALEXANDRIA BLVD SUITE H OVIEDO, FL 32765 UNITED STATES Controlled Substance Prescriber No Discipline on File No Public Complaint No The information on this page is a secure, primary source for license verification provided by the Florida Department of Health, Division of Medical Quality Assurance. This website is maintained by Division staff and is updated immediately upon a change to our licensing and enforcement database. hops://appsmga.dc h.stale.fl.us/IviQASearchServices/HealthcareProviders/LicenseVerifica... 11/15/2016 ATTACHMENT 6 Job Descriptions 067/USIS, INC. Job Description USIS/AmeriSys Job Title Telephonic Case -Manager TCM ] Dept #fname 253 Reports to: (mgr/supv) Unit Manager / Supervisor TCM B&B Job Title Sr Case Manager _ B&B Job Code CASMGR FLSA Status f Exempt (Administrative) EEO Code Professional General Description: Responsible for the management and independent decision making on medical claims. Monitors, analyzes, evaluates and coordinates the delivery of high quality, timely, cost effective medical treatment and other health services as needed by an injured employee to promote an appropriate, prompt return to work when medically indicated. Manages all care throughout the continuum of services in order to achieve the highest level of quality medical care in the most cost effective and timely manner possible. Performs ongoing assessments of the injured employee's recovery to ensure high quality of care, reduce recovery time and minimize the effects of injury. Performs Telephonic Case -Management activity on Workers' Compensation cases according to parameters identified. Primary/Essential Duties: • Provide telephonic case -management in a Workers' Compensation environment. Focus on medical appropriateness of care to injured worker with cost savings by coordination and utilization of all services, ensuring that as soon as medically feasible, return -to -work status is achieved, along with increase in productivity. • Facilitate communication between the employee, the employee representative, employer, employer representative, insurer, health care provider, the managed care organization and when authorized, any qualified rehabilitation consultant, to achieve the goals • Clinically evaluate the recovery needs of an injured employee after the initial contact assessment. Incorporate into the initial plan information obtained from the employer and provider. • Identify barriers to recovery and formulates an action plan to overcome these barriers. • Provide ongoing assessment of health and medical records. • Monitor and audit provider and vendor performance and care • Develop case -management care plan, tracks and modifies appropriately • Appropriately document all data received from interviews, contacts and medical records in the computerized system. • Address the return -to -work capability with the injured worker and provider at each medical evaluation. Document appropriately in computerized system. Obtain a job description from the employer and presents to the provider if necessary. Manage the file adhering to treatment guidelines and utilization criteria as determined by the state -mandated guidelines, proprietary and nationally published protocols, as well as account requirements, assuring smooth delivery of services to injured workers or third party claimants • Create, edit and/or revise correspondence • Evaluate treatment plans and documents outcomes. Track protocol management for appropriate utilization and delivery of medical services. Outcomes will be evidenced by patient satisfaction, appropriate delivery and quality of care and timely recovery per evidenced based criteria and clinical guidelines. Return -to -work outcomes and length of disability outcomes are calculated and monitored according to criteria as published in the Official Disability Guidelines. • Manage the file pro -actively, utilizing all appropriate case management tools. • Develop alternative treatment plans when necessary. Demonstrate the ability to accommodate changes on the case - management process for delivery of a more refined and efficient system. • Identify the need for utilization review procedures to claims, such as triggers that might indicate a potential barrier to recovery. UR tools include medical director review, pre -certification, pre -authorization, concurrent review and retrospective review of bills and reports. Communicate the findings determined in utilizing these tools and document appropriately. • Anticipate health needs during case -management process and educate patient and family appropriately. Encourages the injured worker to participate in the recovery plan. • Maintain patient privacy by ensuring that all medical records, case specific information and provider specific information are kept in a confidential manner, in accordance with state and federal laws and regulations. • Serve as a patient advocate adhering to all legal, ethical and accreditation/regulatory standards. • Serve on appropriate committees such as Grievance, duality Assurance and others as directed. • May negotiate fees with providers or channel cases to other vendors as appropriate. • May train claims staff on the identification of medical case mgmt opportunities. • May provide supervision of lower graded staff in the dept. • Perform other duties as needed. Knowledge, Abilities and Skills: Case -management experience desired — Workers' Comp preferred. Maintains knowledge of current trends, standards and law changes Must be self directed and able to work independently Ability to effectively operate a personal computer and related claims and business software. Good communication skills, both oral and written. Team player. Good attendance. Good customer service skills. Minimum Qualifications: RN or LPN (depending on state jurisdiction and client specifications) with 3-5 years clinical experience (medical -surgical, orthopedic, neurological, ICCU, industrial or occupational.) Proof of current State Licensure Additional Notes: Non smoking environment This job description is not intended to be all-inclusive. Employee may perform other related duties as necessary to meet the ongoing needs of the organization. USIS employee(s): (nameldept) 467/USIS, INC. Job Description USIS/AmeriSys Job Title Field Case -Manager Dept #/name 533 AmeriSys FCM Reports to: (mgr/supv) FCM SupvNP of AmeriSys Office Location: Field B&B Job Title Sr. Case Manager B&B Job Code CASMGR FLSA Status Exempt (Administrative) EEO Code Professional General Description: Responsible for revenue production based on professional services rendered. Coordinates medical care and return -to - work status for Workers' Compensation, LTD and other cases. Responsible for the assessment and direction of care which includes both inpatient and outpatient services. Works with and coordinates information for all interested parties including physicians, nurses, therapists, employers, state agencies, attorneys and others. Coordinates returning injured workers to work by direct contact with employer of injury; job search efforts; labor market surveys and job analyses. Work is conducted outside the office; travel is required. Primary/Essential Duties: • Responsible for the direction and management of health care for injured workers. • Responsible for production related to revenue generated by professional services • Maintain and submit timely and accurate billing and reporting documentation. • Document the claim file via written formal reports, email and facsimile. • Document outcomes of treatment and vocational services. • Use applicable third party guidelines or criteria to assess and establish care plans. • Evaluate, implement and monitor the effectiveness of treatment plans including cost projections. • Use professional expertise for opinion in identifying medical reserves on Workers' Compensation cases. • Respond to subpoenas, depositions and provides testimony as required and requested related to the cases assigned. • Perform utilization review procedures on claims, including pre -certification and pre -authorization. • Handle personal visits with the injured worker to determine status and needs, including return -to -work options and goals. • Use professional knowledge of managed care and its components related to Workers' Compensation. • Work independently and with minimal supervision or direction. • Maintain patient privacy by ensuring that all medical records, case -specific information and provider -specific information are kept in a confidential manner, in accordance with state and federal laws and regulations. • Act as a resource to all departments within AmeriSys and USIS • Perform other duties as needed. Knowledge, Abilities and Skills: Field case -management experience desired — Workers' Comp preferred. Ability to maintain knowledge of current trends, standards and law changes Must be self directed, able to work independently and travel as required Ability to effectively operate a personal computer and related claims and business software. Good communication skills, both oral and written. Team player. Good attendance. Good customer service skills. Extended hours may be necessary to accomplish goals of the job. Minimum Qualifications: Registered Nurse or Vocational Consultant with 5 years experience in case management and/or vocational services. Must hold at least one of the following credentials: CRRN, COHN, CDMS, CCM, CRC. Expert knowledge in Workers' Compensation and managed care laws RN with 3-5 years clinical experience (medical -surgical, orthopedic, neurological, ICCU, industrial or occupational.) Proof of current State Licensure To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Reasonable accommodations may be made to enable qualified individuals with disabilities to perform the essential functions. Additional Notes: Production/revenue standards to be met Travel required to accomplish the job duties Smoke -free work place Required to maintain active Florida Driver's License, current auto insurance, safely operate a motor vehicle; maintain authorized vehicle and provide proper licenses and insurance as directed by the company. Physical Requirements Necessary on a Regular Basis: Manual dexterity, arm and upper body range of motion sufficient for use of a keyboard, mouse and telephone 7-8 hours per day. Speech and hearing sufficient for in -person and telephone communication 7-8 hours per day. Vision sufficient for use of computer monitors 7-8 hours per day. Ability to sit at a desk and perform duties effectively 7-8 hours per day. Ability to safely operate a motor vehicle for driving as required to accomplish the duties of the job This job description is not intended to be an all-inclusive statement of the duties of the position listed above. Other appropriate duties may be performed as necessary to meet the ongoing needs of the organization, I acknowledge that I have reviewed this job description and can perform the essential duties with, or without, reasonable accommodation. Signature Print Name Date USIS/AmeriSys Job Title Field Case -Manager Dept #/name 533 AmeriSys FCM 067/USIS, INC. Job Description USIS/AmeriSys Job Title Medical Bill Reviewer Dept #/name 582 AmeriSys Bill Review 531 Cost Containment Reports to: (mgr/supv) Supervisor/Bill Review UR Services ManagerNP/AmeriSys Office Location: Major Blvd, Oviedo B&B Job Title Admin II B&B Job Code ADM 11 FLSA Status Non -Exempt EEO Code Office/clerical Summary/General Description: Review Workers' Compensation provider medical bills via the system for cost containment purposes. Analyze, review and recommend payment to medical providers, hospitals, ancillary medical providers, rehabilitation services and pharmacies and significantly reduce costs to clients. Via system entry and software, process Workers' Compensation medical bills for payment according to state Workers' Compensation fee schedule and beyond. Primary/Essential Duties and Functions: • Accurate data entry and adjudication of provider bills in the Corrus computer system according to state Workers' Compensation Fee Schedule rules, with satisfactory volume and error ratio • Analyze, review and recommend payment to medical providers based upon statutory rules or guidelines and/or provider reimbursement contract amounts to achieve maximum cost savings, to the level appropriate in terms of: • Medical necessity • Treatment actually rendered • Adjuster authorizations • Usual or reasonable and customary charges • Utilization practices • Applicable fee schedules • Contracted agreements • Ensure timely payments to providers meet statutory regulations on the type and amount of reimbursement and significantly reduce costs • Handling of provider and customer phone calls • Training on an on -going basis to increase knowledge with State Fee Schedule, medical terminology, use of reference materials, eg. CPT, ICD-9, HCPCS • Perform other duties as needed. Competencies - Knowledge, Abilities and Skills: Typing 60 wpm110-key by touch. Heavy numerical data entry with high ratio of accuracy Experienced in Florida Workers' Compensation Fee Schedule, medical terminology, CPT, ICD-9, HCPCS coding Familiarity with provisions and contents of other state WC programs, particularly: GA, SC, NC, VA, AL and TN Medical terminology knowledge Ability to work under and accomplish production standards Experience dealing with medical provider offices Data entry proficiency and computer skills —Word, Excel Excellent organizational skills Detail orientated and motivated Ability to effectively operate a personal computer and related claims and business software Good communication skills, both oral and written. Team player. Good attendance. Good customer service skills. Minimum Qualifications: High school diploma Experienced in Florida Workers' Compensation Fee Schedule, medical terminology, CPT, ICD-9, HCPCS coding 1-2 years medical terminology/medical office experience Typing 60 wpm. Heavy numerical data entry with high ratio of accuracy. To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Reasonable accommodations may be made to enable qualified individuals with disabilities to perform the essential functions, Additional Notes: Heavy data entry. Fast paced. Production standards monitored Smoke -free work place Physical Requirements Necessary on a Regular Basis: Manual dexterity, arm and upper body range of motion sufficient for use of a keyboard, mouse and telephone 7-8 hours per day. Speech and hearing sufficient for in -person and telephone communication 7-8 hours per day. Vision sufficient for use of computer monitors 7-8 hours per day. Ability to sit at a desk and perform duties effectively 7-8 hours per day. This job description is not intended to be an all-inclusive statement of the duties of the position listed above. Other appropriate duties may be performed as necessary to meet the ongoing needs of the organization. I acknowledge that I have reviewed this job description and can perform the essential duties with, or without, reasonable accommodation. Signature Print Name Date USIS/AmeriSys Job Title Medical Bill Reviewer Dept #Iname 582 AmeriSys Bill Review 531 Cost Containment O67IUSIS, INC. Job Description USISfAmeriSys Job Title Utilization Review Specialist Dept #/name 535 AmeriSys Reports to: (mgr/supv) UR Manager/VP/AmeriSys Office Location: Major Blvd/Oviedo B&B Job Title Sr Case Mane er B&B Job Code . CASMGR FLSA Status Exempt (Administrative) EEO Code Professional Summary/General Description: Performs precertification reviews in accordance with URAC guidelines utilizing accepted criteria. Ensures the prompt coordination of appropriate care for the approved procedures. To ensure that the medical procedures are causally related to the accidents as reported by the injured workers and that the request comes from the authorized treating physician. Coordination of Peer Reviews as appropriate and facilitate Peer -to -Peer Telephonic Reviews, Precertification, Concurrent Reviews, Appeals, and Retrospective Peer Reviews. Primary/Essential Duties and Functions: • Complete precertification of medical requests assigned by Manager or coordinator. • Review not meeting accepted criteria will be forwarded on to a Peer Review physician. • Pose appropriate questions to the Peer Physician to include concerns expressed by the adjuster and/or TCM. • Upon receipt of the Peer Physician's report, will complete final report and present recommendations to the adjuster and/or TCM. • Complete all documentation and composition of letters as per protocol • Must meet all expectations outlined in the policy and procedure for URAC criteria and AmeriSys standards for peer review. • Duties to include medical bill reviews for appropriateness of codes and fees, Ensuring they are in compliance with state fee schedules and agreements • Appropriately document all data received from interviews, contacts and medical records in the computerized system. • Create, edit and/or revise correspondence • Maintain patient privacy by ensuring that all medical records, case specific information and provider specific information are kept in a confidential manner, in accordance with state and federal laws and regulations. • Serve as a patient advocate adhering to all legal, ethical and accreditation/regulatory standards. • Serve on appropriate committees such as Grievance, Quality Assurance and others as directed. • May negotiate fees with providers or channel cases to other vendors as appropriate. • Perform other duties as needed. Competencies - Knowledge, Abilities and Skills: Must be knowledgeable of the Workers' Compensation laws and how they are integrated into the Managed Care Arrangement or AmeriSys Medical Management Standards. Active membership in local Utilization Review organization preferred Efficient and effective computer literacy Maintains knowledge of current trends, standards and law changes Must be self directed and able to work independently Ability to effectively operate a personal computer and related claims and business software. Good communication skills, both oral and written. Team player. Good attendance. Good customer service skills. Minimum Qualifications: RN with 3-5 years clinical experience in varying hospital specialty units ie: ER, ICU/CCU, Surgery, Trauma, Orthopaedic, Neurology, Psychiatric. Prefer RN with a minimum of 2 years experience in Utilization Review in the areas of Workers' Compensation, Health and Accident or Auto Liability. Certification in Utilization Review, ie: CPUR, ABQUARP is preferred. Proof of current State Licensure To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Reasonable accommodations may be made to enable qualified individuals with disabilities to perform the essential functions. Additional Notes: Smoke -free workplace Physical Requirements Necessary on a Regular Basis: Manual dexterity, arm and upper body range of motion sufficient for use of a keyboard, mouse and telephone 7-8 hours per day. Speech and hearing sufficient for in -person and telephone communication 7-8 hours per day. Vision sufficient for use of computer monitors 7-8 hours per day. Ability to sit at a desk and perform duties effectively 7-8 hours per day. This job description is not intended to be an all-inclusive statement of the duties of the position listed above. Other appropriate duties may be performed as necessary to meet the ongoing needs of the organization. I acknowledge that I have reviewed this job description and can perform the essential duties with, or without, reasonable accommodation. Signature Print Name Date USISIAmeriSys Job Title Utilization Review Specialist Dept #/name 535 AmeriSys ATTACHMENT 7 Policies and Procedures 2017 AMERISYS POLICIES AND PROCEDURES FOR FLORIDA Title: CORE 3 Policy: This Policy and Procedure is updated annually. Vice President '2' / 04,44:, AA) Effective Date 1/1/2005 Most Recent Revision Date 9/30/2016 Review Date 9/30/2016 Approval Date for Calendar year 2017 by Medical Director 10/19/2016 !/0, ► POLICY MASTERLIST WC 1 Quality Assurance / Quality Assurance Program Training of All Personnel 1 WC la Goals of Utilization Management and Quality Assurance 2 WC lb Effecting Return to Work — Four Point Contact 3-4 WC 1 c Qualifications and Duties of the Internal Case -Manager 5-7 WC 1 d Monitoring of Care/Outcomes 8-10 WC 2 Quality Assurance Program 11-13 WC 3 Scope of Quality Assurance 14 WC 4 Quality Assurance — Annual Plan 15 WC 5 Quality Assurance — Remedial Action... 16 WC 6 Quality Assurance Committee 17 WC 7 Quality Assurance Process and Outcomes 18 WC 8 Quality Assurance Organizational Channels 19 WC 9 Quality Assurance Employee Satisfaction 20 WC 10 Quality Assurance Peer Review 21 WC 1 I Quality Assurance — Utilization Management 22-23 WC 1 la Quality Assurance — Utilization Review . 24 WC l 1 b Pre -Certification 25-26 WC 1 lc Quality Assurance First Level Review 27-28 WC 11 d Quality Assurance Second Level Review 29 WC 11 e Quality Assurance Concurrent Review 30 WC 1 1 f Quality Assurance Retrospective Review 31 WC 12 Quality Assurance Utilization Experiential Procedures 32 WC 12a Clinical Peer Review/Disputed Care 33 WC 13 Quality Assurance -Utilization Management Dispute Resolution Reimbursement 34 WC 13a Dispute Resolution — Utilization Review 35 WC 13b Medical Bill Review —Utilization Review 36-38 WC 13c Quality Assurance -Utilization Management Dispute Resolution Reimbursement - Non Managed Care 39 WC 14 Provider Referrals — Network and Non Network 40 WC 14a Monitoring Utilization of Network Services 41 WC 15 Quality Assurance — Utilization Management 42 WC 15a Quality Assurance — Utilization Management Committee 43 WC 16 Case Management — Aggressive Medical Care Coordination ..... 44 WC 17 Case Management — Internal and External Case Management Criteria 45-47 WC 17a Case Management — External Case Management Catastrophic Case Management Criteria 48-49 WC 18 Case Management — Telephonic (internal) Case Management 50-52 WC 18a Standardized Documentation 53-54 WC 18b Pre -Authorization / DME / Guidelines 55 WC I 8c Case Conferencing 56-57 WC 19 Case Management — Field (external) Case Management 58-60 WC 20 Case Management— Communication 61-62 WC 20a Communication with Litigated Claim and/or Claimant Attorney 63 WC 21 Case Management — Medical Care Coordination 64 WC 21a Case Management Injured Worker/Employee Education 65 WC 22 Case Management — MCC 66 WC 22a Case Management— Role of the MCC 67 WC 23 Case Management — Change of Provider 68 WC 24 Second Medical Opinion 69 WC 24a Independent Medical Exam 70 WC 24b EMA 71 WC 25 Physician Choice 72 WC 25a Case Management — Physician Choice 73 WC 26 Case Files 74-75 WC 26a Medical Records — Handling 76 WC 27 Medical Records — Consent 77 WC 27a Confidentiality 78 WC 27b Training of All Personnel 79 WC 27c Role of non -clinical (administrative staff) personnel in data collection 80-81 WC 27d Injured Worker Education 82 WC 28 Medical Record Audit 83 WC 29 Case File System/Corrus System/Coordination of Care 84-87 WC 30 Case Files Confidentiality and Security 88 WC 31 Grievance Procedures Overview 89 WC 32 Grievance Procedures Education 90 WC 33 Request for Service 91 WC 34 Complaint 92 WC 34a Customer Concern 93-96 WC 35 Grievance Form 97 WC 36 Grievance Form Availability 98 WC 37 Written Grievance 99 WC 37a Grievance Process and the Grievance Committee 100-102 WC 38 Grievance Procedure Arbitration 103 WC 39 Grievance Procedures Petitions for Benefits 104 WC 40 Grievance Coordinator 105 WC 41 Grievances — Phone Number 106 WC 42 Grievances — Address 107 WC 43 Grievances --- Physician Review 108 WC 44 Grievances — Meeting 109 WC 45 Grievance Files 110 WC 46 Grievance Log 1 1 1 WC 47 Grievance Analysis 112 WC 48 Grievances — Annual Report 113 WC 49 Education — Employee Procedure 114 WC 50 Education — Employee Written Materials 115 WC 51 Education— Employee Disclosure 116 WC 52 Education Provider 117 WC 53 Education — Provider Annual 118 WC 54 Education — Administrative Staff 1 19- 1 20 WC 55 Provider Network 121 WC 56 Credentialing 122 WC 57 Telemedicine 123 WC 58 Initial Contact 124 Policies and Procedures that apply only to Certified Managed Care accounts will be identified as such. Title: Quality Assurance / Quality Assurance Program Training of All Personnel WC1 Policy All persons involved in the utilization review process will be trained in the principles and standards of utilization management Vice President . ryt,,,J7i Lta2. /-i/t-'� Effective Date 1/1/2005 Most Recent Revision Date 9/22/2016 Review Date 9/22/2016 Approval Date for Calendar year 2017 by Medical Director 10/ 19/2016 r ,,( ,b , Procedure: All persons involved in the utilization review process will be trained in the principles and standards. This training will occur prior to the staff assuming their assigned roles and responsibilities. The persons involved in the utilization review process will include: professional staff, bill review staff, support personnel and intake personnel which includes all persons who answer the telephones. The bill review staff will process claims for proper payment for workers' compensation claims. The support staff will provide clerical assistance to the professional staff. The support personnel may collect data and intake screening. Telephone calls will be directed to the proper source and will be forwarded to the proper person or department. The switchboard personnel will receive specific instruction on directing phone calls to the proper department. The switchboard operator will ask the caller the purpose of the call, which may include but is not limited to verification of benefits, reporting work injuries, seeking pre -certification or medical authorization and reporting a grievance. All persons involved in utilization activity will review the policies and procedures, which meet the standards of the Agency for Healthcare Administration, the Florida Division of Worker's Compensation and URAC. This will include but is not limited to training related to: • Confidentiality and the signing of the Confidentiality statement • Conflict of interests • Utilization Management and the Quality Assurance Manual • Grievance procedures and time frames associated with this process • Satisfaction surveys • Monthly education is provided in related areas and the policy and procedure manual will be reviewed with each person responsible for this activity annually. Education sessions are recorded and reported at the quarterly QA meetings. The policy and procedure manual will be updated annually in September and as needed as the statutory requirements may change and signed by the manager of Utilization Management Services. Title: Goals of Utilization Management and Quality Assurance WC la Policy: The goals of Utilization Management and Quality Assurance are to return the injured worker to pre -injury status and gainful employment by obtaining expedited medical treatment in the most cost-effective manner. Vice President wJA/e)-.4' , /C' Effective Date I/ 1/2005 Most Recent Revision Date 9/11/2012 Review Date 9/22/2016 Approval Date for Calendar year 2017 by Medical Director 10/19/2016 Procedure: The Utilization Management and Quality Assurance programs will provide case management to effect: • Stress quality medical care that will return the injured worker to pre -injury status • An early return to work in either a modified or full duty capacity • In the event that the injury prevents the injured worker from returning to the same job, the program will assist in the re-employment process through rehabilitation of the injured worker and will comply with the appropriate state programs. • The program will stress wellness and prevention to lower the number of injuries sustained. It is the goal of utilization managgemcnt to minimize or eliminate through quality assurance monitoring: • Inappropriate level of care • Inappropriate admissions • Inappropriate stay • Inappropriate procedures • Inappropriate discharges • Inappropriate quality of care Title: Effecting Return to Work — Four Point Contact WC lb Policy: The internal Case -Manager will affect an early return to work program for all clients. Early return to work program can be cost effective to client and carrier. Vice President L. ..A 0 4, 1, Effective Date 1/1/2005 Most Recent Revision Date 9/1 1 /2012 _ Review Date 9/22/2016 Approval Date for Calendar year 2017 by Medical Director 10/19/2016 11(r Ji Procedure: The Case -Manager will initiate the return to work activity with the initial four -point contact. Contact the employer to: • Ask for job description for injured worker • Ask for light duty availability • If no light duty available— explain the advantage of providing some form of light duty Contact provider to: • Ask for completion of the DWC-25 that will include: • Major Contributing Cause of Injury • initial treatment request • What restrictions the injured worker has in performing their job • What is the anticipated MMI date Contact injured employee to: • Educate on the physician's plan of treatment • Educate on the benefits of early return to work program • Educate on the role of the Case -Manager and Rehabilitation Provider when indicated Contact the insurer to: • Make the insurer aware of the current work status • Verify compensability • Review First Report of injury (FROI) and nature of the injury • Communicate case management activity and include the results of contact with the employer, provider and injured employee • Communicate the treatment plan and follow up activity to include but not be limited to any referrals from the primary care provider to other or specialty providers • Where the internal Case -Manager is onsite with the insurer. the insurer utilizes the proprietary software program Corrus. • Where the internal Case -Manager is not onsite with the insurer. explain the ability to access their claims and case management activity in the proprietary software program Corrus currently in use. Document: • All case management activity and medical care including the primary care physician. the treatment plan and restrictions in the case note section of Corrus • Document the Major Contributing Cause of Injury • Document computer program with disability guidelines based on established third party guidelines • Document computer program with projected return to work date • Document return to work light duty • Document computer with return to work full duty • Document cost savings as indicated • Document MMI and PIR Return to Work Follow Up Activity: • After an injured worker returns to work the internal Case -Manager will follow up with the employer and the injured worker at 7-30-60 day intervals based on the insurer's guidelines until the claimant reaches Mil anWor the claim is closed. 4 Title: Qualifications and Duties of the Internal Case -Manager WC Ic Policy: The utilization management team is properly qualified and trained to function as an internal Case -Manager performing those duties as required of an internal Case -Manager. Vice President 7. j " Effective Date 1/1/2005 Most Recent Revision Date 9/11/2012 Review Date 9/22/2016 Approval Date for Calendar year 2017 by Medical Director 10/19/20I6 /11 ). Procedure: Overview • The internal Case -Manager shall monitor, evaluate and coordinate the delivery of high quality, timely. cost effective medical treatment and other health services as needed by an injured employee. and shall promote an appropriate. prompt return to work when medically indicated. • The internal Case -Manager must facilitate communication between the employee. the employee representative, employer, employer representative, insurer. health care provider, and the managed care organization and when authorized. any qualified rehabilitation consultant to achieve the goals. • The internal Case -Manager manages all care throughout the continuum of services in order to achieve the highest level of quality medical care in the most cost effective and timely manner - possible. • The primary purpose of medical care coordination is to ensure high quality of care, reduce recovery time and minimize the effects of injury. • The internal Case -Manager performs ongoing assessments of the injured employee's recovery. • Treatment and anticipated recovery period are modified as indicated. • The internal Case -Manager updates medical treatment information with all involved parties. facilitating the return to work of injured employees when appropriate and to identify and assist in identifying the rehabilitation needs where indicated. Objectives • Act as an advocate for the injured employee in the medical management process • Provide assistance and information to the employee regarding medical issues and provider selection • Ensure high quality of medical care in a cost effective manner. • Identify medical or return to work issues to minimize medical and disability costs. • Consult with providers to determine appropriate level of internal case management intervention. • Assure efficient and timely service delivery to help the injured employee reach maximum medical recovery and return to work as soon as medically appropriate. Qualifications: • Health professional that possesses a current valid professional license as a RN or LPN. • Have 3-5 years of case management. critical care. intensive care, orthopaedic, neuromuscular, or occupational health experience. • May possess certification as a CCRN, CCM, COHN, COHN-S. General Job Duties of Internal Case -Manager: • Acts as an advocate for employee concerns. • Obtains basic demographic and injury -related data. • Informs the injured employee of his right to choose from a network medical provider directory. (MCA participants only) • Informs the employee that a list of providers is available and assists the employee in obtaining the list if necessary. (MCA participants only) • Assists the employee in choosing a provider appropriate to the injury. (MCA participants only) • Contacts the network providers' office staff to provide demographic and type of injury information and schedule the employee for an initial evaluation within 24 hours after the employee's initial request for treatment. • Facilitates prompt flow of information between the physician and the parties to the case. Seeks objective medical findings from the provider, projected number of days needed for recovery, release to return to work. and /or maximum medical improvement. • In cases where the injured employee has received treatment by a non -network provider, schedules employee to be seen by network provider for initial evaluation or treatment within 5 working days of the employee's request for referral to the managed care plan. • Monitors medical care by review proposed treatment plans and medical reports of authorized treating physicians. • Coordinates all referrals. • In catastrophic cases. initiates rehabilitation services and assists in the selection of an appropriate rehabilitation provider. • Initiates inpatient/outpatient, concurrent/retrospective utilization review as indicated. • Initiates utilization review or dispute resolution as indicated. • Documents all internal case management activities. • Conducts limited on -going assessment to determine ability of employee to return to pre -injury position. transitional duty, or alternative job with the same employer. • Accountable for adherence to all applicable laws and regulations governing the provision of managed care services. • Arranges discounted durable medical equipment when appropriate. • Evaluates employee's adjustment to injury and acceptance of medical treatment plan. • Communicates with provider to address treatment options, diagnosis prognosis and work capacity when there is documented lack of case progress. • Under limited circumstances. may utilize external Case -Managers for medical management when indicated. Other Duties of the Internal Case -Manager • Includes the general job duties listed above. • Initiates telephone assessment upon First Report of Injury (FROI). The assessment includes contacting the injured employee, the employer, and the treating provider to determine the fol lowing. • Educates the injured employees in regards to of the diagnosis, prognosis, and medical care needs. 6 • Reviews medical treatment plan and estimated costs. • Reviews diagnosis -based work restrictions of employee and projected return to work date with conditions as appropriate. • Assess the feasibility of returning injured employee to a transitional duty position during recovery. • Coordinates medical management services appropriate to the injured employees needs. These include: • Referrals to medical providers and other consultants when appropriate • Provides information to carriers. employers. employees. regulatory agencies, care providers. and others involved in the employee's case. • Coordinates return to work activity. • Pursue the achievement of MMl and PIR to assist in the resolution of the claim. 7 Title: Monitoring of Care/Outcomes Reporting WC I Policy: All care rendered to an injured worker will be assessed for quality assurance that includes the monitoring of care and documentation to identify patterns of care. Vice President '� Effective Date 1 / 1 /2005 Most Recent Revision Date 9/22/2016 Review Date 9/22/2016 Approval Date for Calendar year 2017 by Medical Director 10/19/2016 fi /A. , r Procedure: Based on the insurers criteria either the internal Case -Manager designated to triage injuries or the insurer will assign cases for case management activity based on the early intervention criteria set forth and agreed to by the insurer to facilitate return to wellness and return to work. Early intervention criteria will include, but not be limited to: • Severe lacerations. especially tendons and muscles • Eye injuries • Back injuries with anticipated lost time exceeding statutory waiting period • Knee injuries with anticipated lost time exceeding statutory waiting period • Cumulative trauma (including carpal tunnel syndrome and tendonitis) • Concussion. head injuries • Chemical inhalation/poisoning • Severe sprains. strains (major body area such as ankle, shoulder or wrist) • Dislocations (major body area such as ankle, shoulder. wrist) • Rotator cuff injuries • Second/third degree burns not considered catastrophic • Injuries involving immediate inpatient hospitalization • Psychological claims/stress claims • History of protracted recovery from prior indices or illnesses • Repeater claimants if prior claims involved the same body part and same or similar type of injury • Any type of injury with lost time exceeding statutory waiting period • Cases with multiple providers • Crush injuries • Fractures • Amputations • Significant cardiac events for the worker's covered under the Heart and Lung Bill 8 Currently the criteria utilized for determining necessity of care includes, but is not limited to: • Official Disability Guidelines • McKesson's InterQual • Presley Reed's Medical Disability Advisor • State and/or Nationally Accepted Practice Parameters for other states • Health Care Management Guidelines • Practice Parameters adopted by the state regulatory agency • Health Care Finance Administration Criteria • American College of Orthopaedics • Community and Industry standards • Criteria developed through experience • American Heart Association Monitoring of individual cases: • The internal Case -Manager shall monitor, evaluate and coordinate the delivery of high quality. timely. cost effective medical treatment and other health services as needed by an injured employee. and shall promote an appropriate, prompt return to work when medically indicated. • The internal Case -Manager manages all care throughout the continuum of services in order to achieve the highest level of quality medical care in the most cost effective and timely manner possible based on each individual case. • The primary purpose of medical care coordination is to ensure high quality of care that is based on third party guidelines and reduce recoverytime and minimize the effects of injury. • The internal Case -Manager performs ongoing assessments of the injured employee's recovery and documents in the Corrus case notes (see attachment) • Treatment. anticipated recovery period. as well as return to work activity. work restrictions and plan of action are modified as indicated and documented in the Corrus case notes. • The internal Case -Manager updates medical treatment information with all involved parties. facilitating the return to work of injured employees when appropriate and to identify and assist in identifying the rehabilitation needs where indicated. Outcomes Reporting The internal Case -Manager will document the Corrus claim screen with: • Date of injury • Date of referral for internal case management • Date of overall MMI and PIR • Date of case closure • ICD-IO Code The internal Case -Manager will document the rehabilitation screen of Corrus (see attachment) with the following information: Date of the expected length of disability based on the Occupational Disability Guidelines • Date of projected return to work from the treating provider • Date of transitional (modified or light) duty • Date of release to return to full duty • Date of actual return to work if available • Contributing co -morbidities 9 Provider bill review activity will capture: • Treating provider • Dates of service • Service code submitted by the treating provider which is indicative of the professional activity rendered to the injured worker • Total amount billed by the treating provider • Amount of recommended payment • EOBR information • Total savings Outcomes Report • Corrus report of outcomes may be produced by claim or provider • Corrus outcomes reports will also indicate • Number of days assigned to the internal case manager • Number of days assigned to the Field Case manager if applicable • Number of days from date of injury to return to work • Number of days from date of injury to date of MMI • Dollar amounts saved by case management intervention • Dollar amounts saved by Utilization Management Intervention • Each Corrus report of outcomes may be filtered by • Payor • Diagnosis • CPT code • Claim • Open claim • Closed claim Outcomes reports will be run on based on any of the above on a monthly basis Submitted service codes submitted by the treating provider which is indicative of the professional activity rendered to the injured worker and the amount billed per claim will be reviewed Claims or providers will be reviewed based on the outcomes report and the type of case to be reviewed as per the Quality Assurance. Utilization Review Committee and Provider Relations Coordinator. to Title: Quality Assurance Program WC2 Policy: The Quality Assurance Committee will oversee and be responsible for the Quality Assurance program To identify important aspects of care, identify indicators and establish the threshold for evaluation and to collect and organize data to evaluate care issues, assess action and make recommendations for changes to improve the overall quality of care, Vice President / Effective Date 1/1/2005 Most Recent Revision Date 9/22/2016 Review Date 9/22/2016 Approval Date for Calendar year 2017 by Medical Director 10/19/2016 Procedure: Authority: Objectives: The Quality Assurance Committee will oversee and be responsible for the Quality Assurance Program To identify important aspects of care, identify indicators and established the threshold for evaluation and to collect and organize data to evaluate care issues, assess action and make recommendations for changes to improve the overall quality of care. Members The Quality Assurance Committee will include representatives from the insurer, the managed care arrangement. medical management team members. claims representatives, utilization management department and when necessary the medical director. Meetings The Quality Assurance Committee will meet on a quarterly basis to identify any significant quality issues and on a quarterly basis to present the findings from the prior quarters utilization review studies. The meeting may be conducted in person or by teleconferencing. Remedial Action The Quality Assurance Committee will be responsible for the remedial or corrective action. This may include but is not limited to taking action for inappropriate or sub care. This action may include but is not limited to contacting the attending physician, contacting the leased network. or contacting the appropriate state agency. All involved personnel will be informed as to any quality or utilization issue identified and the resolution obtained. It Documentation The minutes will be clear, understandable and accurate. The records will reflect the tracking of identified scopes and network key issues; the results of the studies, the related follow up activities and communication with the providers and members. Meeting Format The following will be the format utilized for the quarterly Quality Assurance Meetings: Review of providers • Network issues presented to the leased network • How many were reviewed • Evaluate outcome report for selection of providers for utilization file review and possible QA issues • Summarize findings • Identify QA issues • Identify UR issue • Corrective action plan • Action to be taken • Responsible party • Follow up activity and results of prior plan Medical record reviews • Identify records to be reviewed • Complete review form • Summarize results • Identify QA issues • Corrective action plan • Action to be taken • Responsible party • Follow up activity and results of prior plan Satisfaction Surveys • How many were sent • How many returned • Summarize findings • [dentify QA issues • Corrective action plan • Action to be taken • Responsible part. • Follow up activity and results of prior plan 13 Grievances • How many were received and from whom • Summary of grievances • Identify QA issue • Corrective action plan • Action to be taken • Responsible party • Follow up activity and results of prior plan Network Issues • Review reports from leased network • Identify new problems or issues • Corrective action • Action to be taken • Responsible party • Follow up activity and results of prior plan QIPs (URAC MANDATE) • Review outcomes related to current programs • Identify new problems or issues related to specific QIP • Tabulate ongoing statistics • Modify QIP as needed Other issues • Identify any other problems • Corrective action • Action to be taken • Responsible party • Follow up activity and results of prior plan 13 Title: Scope of Quality Assurance WC 3 Policy: The scope of quality assurance is to assure that all care provided is of a high level of quality, is rendered under reasonable standards of care and is consistent with the prevailing standards of medical practice in the medical community. Quality assurance activity will also be in accordance with the statutes of the applicable state. Vice President Cil ;5L/.27f114: iix Effective Date 1 / I /2005 Most Recent Revision Date 1 /24/201 1 Review Date 9/22/2016 Approval Date for Calendar year 2017 by Medical Director 10/19/20I6 la; -----)1- Procedure: The scope of the quality assurance program includes: • Outcomes reflective of clinical performance of medical providers performed by the internal Case - Manager and noted in the case notes on a monthly/quarterly basis. • Utilization management • Peer Review • Case management • Cost analysis • Data collection • Outcomes studies • Education • Provider dispute resolution • Complaints and grievances • Satisfaction surveys • Return to work The scope of the program also includes but will be conducted by the leased network: • Medical record review • Credentialing and recredentialing The QA minutes will be requested from our contracted networks. 14 Title: Quality Assurance — Annual Plan WC 4 Policy: The written quality assurance plan will be updated annually to monitor, evaluate and make recommendations for improvement of medical services and to effect return to work of the injured worker. Vice President liti, - 4� GZ.:r�' � Effective Date 1 / 1 /2005 Most Recent Revision Date 9/ 1 1 /2012 Review Date 9/23/2016 Approval Date for Calendar year 2017 by Medical Director I0/19/2016 71;-) 6 Procedure: An annual review of the Quality Assurance Plan will be reviewed by each entity covered under the managed care arrangement. • The annual plan will include review of clinical performance based on review of the outcomes of care from the COMM' Outcomes Reports. The review of physician (PEER review) will be based on the length of disability. return to work efforts and overall billing policies. An internal auditing system will continually monitor the Case -Manager's documentation of medical progress to MMI and return to work efforts. • The managed care arrangement/medical case management division does not have access the complete medical record kept by the providers and usually receives office notes. Treatment plans are often contained within the body of the notes received. The entities will hold the leased network responsible for the primary responsibility for medical record review and require that the results be shared on an annual basis. The annual plan will include: • Criteria and standards for internal monitoring and problem solving activities. • Specific activities which be reviewed in the upcoming year. • Methods and time frames for implementing the plan. • Responsible person • Follow-up activities • Tracking and trending 15 Title: Quality Assurance — Remedial Action WC5 Policy: The Quality Assurance Committee will be responsible for the remedial or corrective action. Vice President /-" i4ilno2 11; Effective Date 1/1/2005 Most Recent Revision Date 9/11/2012 Review Date 9/23/2016 Approval Date for Calendar year 2017 by Medical Director 10/ 19/2016 ifr- 100 Procedure: • The Quality Assurance Committee will be responsible for the remedial or corrective action when inappropriate or sub care is identified by the outcomes report and utilization file review activity • This action may include but is not limited: • Review of third party guidelines • Contacting the attending physician • Notifying the AmeriSys Director of Provider Services • Contacting the leased network that is responsible for provider relations and education of the provider. • Contacting the appropriate state agency • Contacting the AmeriSys Medical Director • All involved personnel will be informed as to any quality or utilization issue identified. • The internal Case -Manager will assist in the education of the provider and/or other appropriate parties when performing case management activity. • All parties involved will be notified of the resolution agreed upon. 16 Title: Quality Assurance Committee WC6 _ Policy: The Quality Assurance Committee will oversee and be responsible for the Quality Assurance program Vice President "' Effective Date 1 / 1 /2005 Most Recent Revision Date Review Date 9/23/2016 Approval Date for Calendar year 2017 by Medical Director 10/19/2016 A( i Procedure: The quality assurance committee will: • Identify important aspects of care, • Identify indicators and establish the threshold for evaluation • Collect and organize data to evaluate care issues • Assess action • Make recommendations for changes to improve the overall quality of care The quality assurance committee may meet on a monthly basis to identify any significant quality issues but will meet on quarterly basis to present the findings from the prior months utilization review studies. The meeting may be in person or by teleconference. The quality assurance committee will keep minutes to document all activity. The minutes will be clear, understandable and accurate. The minutes will reflect: • Responsible person • Tracking of key issues • Outcomes • Recommendations • Action to be taken • Related follow up activities and communication with the providers and members • Due dates • Completion The insurer has the ultimate overall responsibility for the oversight of all medical services authorized as well as the quality assurance activity. Reports from all subcontractors will be reviewed and included in the minutes. 17 Title: Quality Assurance Process and Outcomes WC 7 Policy: The Quality Assurance Committee will oversee and be responsible for the Quality Assurance program Vice President 4 �'e 11 ilk' Effective Date 1/1/2005 Most Recent Revision Date 9/11/2012 Review Date 9/23/2016 Approval Date for Calendar year 2017 by Medical Director 10/19/2016 �, if jb gli I I) Procedure: Quality assurance review must be conducted on an annual basis but may be conducted quarterly or as needed. The procedure has been implemented to monitor for compliance with statutory regulations and URAC standards. Currently the criteria utilized for determining necessity and of care include but is not limited to: • State and/or Nationally Accepted Practice Parameters • Presley Reed's Medical Disability Advisor • Mc Kesson"s lnterQual Guidelines • Official Disability Guidelines • American Medical Association Health Care Nlanagement Guidelines • Practice Parameters adopted by the state regulatory agency • Health Care Finance Administration Criteria • Guidelines for Chiropractic Quality Assurance and Practice Parameters • American College of Orthopaedics • Community and Industry Standards • Criteria developed through experience Outcomes Report • Corrus report of outcomes may be produced by claim or provider • Corrus outcomes reports will also indicate: • Number of days from date of injury to return to work • Number of days from date of injury to date of MMI • Savings achieved by the case management process • Savings achieved by the utilization review process • Each Corrus report of outcomes may be filtered by • Payor • Diagnosis • CPT code • Claim • Open claim • Closed claim • Outcomes reports will be run on based on any of the above on a monthly basis • Submitted service codes submitted by the treating provider which is indicative of the professional activity rendered to the injured worker and the amount billed per claim will be reviewed • Claims or providers will be reviewed based on the outcomes report and the type of case to be reviewed as per the Quality Assurance and Utilization Review Committee. 18 Title: Quality Assurance Organizational Channels WC8 Policy: The Quality Assurance Committee will oversee and be responsible for the Quality Assurance program and will share all information with contracted entities. Vice President 6,)it „ s , Effective Date 1/1/2005 Most Recent Revision Date 9/11/2012 Review Date 9/30/2016 Approval Date for Calendar year 2017 by Medical Director I0/19/2016 I ii /f Procedure: The Quality Assurance Committee will meet on a quarterly basis to discuss and document any significant findings. The QA Committee will produce a memo of concerns. actions, responsible party and results to be distributed and shared with all persons involved in the mana=ed care arrangement including but not limited to: Internal Case -Managers. External Case -Managers, provider network, other parties as needed. The memo will be sent out within 30 days after the quarterly meeting and will become part of the minutes of the session or will be verbally discussed with all appropriate parties within 30 days post the QA meeting. This will be completed by the QA Coordinator or the responsible person. 19 Title: Quality Assurance Employee Satisfaction WC9 Policy: The quality assurance program by sending and trending employee satisfaction with the managed care arrangement Vice President Effective Date 1/1/2005 Most Recent Revision Date Review Date 9/23/2016 _ Approval Date for Calendar year 2017 by Medical Director 10/19/2016 iiiIr /ter.'+' Procedure: Satisfaction surveys will be sent to the injured worker upon closure of the medical treatment. The surveys will be sent to per the carrier's protocol. The surveys will be reviewed and tracked for trends. When provider problems are identified on the survey, the results will be reported to the leased network. Survey results will be compiled and sent to the quality assurance committee on a quarterly basis. EMPLOYEE SATISFACTION SURVEY ;LONG DATE 2; Today's Date: Name: Social Security PLEASE COMPLETE AND RETURN TO: Date of Injury: Provider: Treating Physician Name: Was your provider/physician courteous' Y N Were you satisfied with the treatment you received from your physician'? Y N Did your physician explain your condition and treatment plan to you? Y N Did your physician discuss %our return to work status'? Y N What was the usual waiting time at your physicians office" Immediate/No Wait Less than 30 minutes More than 30 minutes but less than 1 hour Longer than 1 hour Case Manager: Was Your Nurse Case Manager courteous. attentive and informative? Y N Did you receive prompt medical attention when you requested treatment'? Y N Your calls to the Case Manager were returned within 24 hrsl(1) business day? Y N Utilization Review Ifyou received correspondence from the AmeriSys UR departtnent_ was it clear and understandable? Y N low would you rate your overall care? (POOR) (VERY GOOD) 2 3 4 5 Other Comments: 20 Title: Quality Assurance Peer Review wC'o Policy: "Peer review" means the evaluation of the treatment plan or clinical performance of providers by one or more licensed professionals with the same authority or similar specialty when potential quality of care issues have been identified through case management or quality assurance processes. 59A-23.002(12) F.A.C. Vice President =/ ` Effective Date 1/1/2005 Most Recent Revision Date 9/1 1 /2012 Review Date 9/23/20 1 b _ Approval Date for Calendar year 2017 by Medical Director 10/19/2016 ,�/ �`' lr / Procedure: Peer review will be conducted: to resolve issues involving the medical services and medical care. • Per the leased network, clinical performance of providers should be reviewed at least annually. The evaluation should include: • Medical records audit • Appropriateness and medical necessity of treatment • The use of current state and nationally accepted parameters • A peer reviewer will be of the same specialty and same authority of the treating provider in question. • The peer reviewer is responsible for providing technical direction to the Case -Manager and either directly or indirectly assessing the medical care of an injured worker including determining other health care providers or facilities to which the injured worker will be referred for evaluation or treatment. • The peer reviewer is an integral part of the managed care and claims team and shall be utilized in any and all instances where the Case -Manager feels it appropriate. 21 Title: Quality Assurance - Utilization Management WC 11 Policy: "Utilization Management is the evaluation of appropriateness in terms of both the level and the quality of health care and health services provided a patient, based upon medically accepted standards. practice parameters and accepted third party guidelines.- 59A-23.002(16). F.A.C. Vice President C� f, ././.4ad , ' Effective Date 1/1/2005 Most Recent ' Revision Date 9/11/2012 Review Date 9/23/2016 Approval Date for Calendar year 2017 by Medical Director 10/19/2016 fG( Policy. AmeriSys has a written description for its quality management program that is approved by the Vice President. The Quality Assurance Plan defines the scope. objectives, activities, and structure of the quality management program. The QA plan is reviewed and updated by the Quality Management Committee annually. The plan defines the roles and responsibilities of the Quality Management Committee and designates the manager of UM Services with the authority and responsibility for the overall operation of the quality management program and who serves on the Quality Management Committee. Procedures Objectives: • Uphold the injured workers" rights • To assure that injured workers receive care in the setting determined to be appropriate and cost effective by current local practice patterns • To assure that clients receive treatment and services that is medically necessary and causally related to the reported injury • To maintain quality of health care • To generate savings to the various employer groups and its members. by reducing the unnecessary utilization of health care services • identify cost- effective treatment alternatives where appropriate • Promotion and maintenance of quality of care through analysis and evaluation of clinical practices • Assurance of the cost-effective utilization of hospital services and facilities • Facilitation of timely discharge • identification of inappropriate use • Assurance of compliance with requirements or third party payers of services and facilities and implementation of corrective action external regulatory agency requirements and utilization • The organization's utilization review activity incorporates procedures for prospective. concurrent and retrospective reviews. • State regulatory guidelines will be met by incorporating these procedures into claims management. Emphasis is placed on obtaining medical information in a timely manner effectively to address medical necessity and causal relationship at the onset of the injury. The Case Manager under the direction of the medical care coordinator will monitor ongoing treatment and obtain current medical status to prevent unnecessary and/or unrelated treatment while ensuring quality of care in the most cost-effective manner to return the injured employee to work. • The organization's goal in performing utilization review is to ensure that each of its clients receives high quality. medically necessary care, in the most appropriate setting. and in the most cost- effective manner possible. • The internal case manager designated as the team leader for the organization will have the primary responsibility of ongoing utilization review of cases and facilitating the clinical performance and random reviews as indicated. Any internal case manager may conduct utilization file review when indicated or as requested and present the issues to the medical care coordinator or medical director of the organization. • The internal case manager will contact the medical director of the organization as necessary to discuss any current medical, utilization or quality issues. Title: Quality Assurance - Utilization Review WC 11a Policy: Medical care is reviewed to ensure that an ill or injured worker is returned to their optimum level of health. to their optimum level of functioning and receive care in the most efficient and cost-effective way possible. The method to review a claim will include but not be limited to the randomly and focused method. This will be reviewed for necessity, relatedness, appropriateness of care. and specific requests. Vice President , ,'p f t ,�G0.[t� / n /_1 Jl rl 11 f 'J�. Effective Date 1/1/2005 Most Recent Revision Date 10/26/2010 Review Date 9/23/2016 Approval Date for Calendar year Medical 2017 by r Director 10/ 19/20 16 Procedure: Methods of Review: • Prospective Review —* (Pre-Certification/Pre-Authorization). Prior to treatment being rendered. planning the future direction of the file. • Concurrent Peer Review —> (Continued Stay Review). A review of the claim while the treatment is ongoing. Review for appropriateness of care. • Retrospective Peer Review —> (Bill Review/Peer Review). A review of the claim after the care is provided. 24 Title: Pre -Certification WC llb Policy: To authorize medical and surgical services before treatment is rendered based on established third party guidelines. Vice President ( /s� Effective Date 1/1/2005 Most Recent Revision Date 9/12/2012 Review Date 9/23/2016 Approval Date for Calendar year by Medical Director 10/19/2016 Procedure: • Pre -Certification Overview • Pre -certification is the timely authorization of medical/surgical services before treatment is rendered based on established third party guidelines. practice parameters and accepted standards in the medical community. An experienced utilization review specialist completes all reviews and utilizes physician advisors when the decision to certify cannot be made. • Pre -certification services address: • Appropriateness of setting (inpatient versus outpatient); • Appropriateness of surgical procedure, diagnostic study, or treatment prescribed (non - emergent) • Appropriate length of stay or treatment • Pre -certification of elective hospital admissions can: • reduce unnecessary hospitalizations • reduce the length of stay (especially where per diem reimbursement is established for hospitals) • foster a shift from inpatient to outpatient care • provide a mechanism for timely identification of patients who require discharge planning and case management. • Procedure • A nurse, who is a Registered Professional Nurse trained in utilization review, will obtain the demographic data and relevant information to the clinical conditions to be treated and procedures to be performed from the provider. • The nurse reviewer will consult acceptable established guidelines — established and accepted state practice parameters. McKesson's lnterQual. Presley Reed Disability Advisor and Official Disability Guidelines, and/or the Length of Stay By Region. • Urgent care determinations will be made within 72 hours of the receipt of request. • Non urgent cases will have a determination made within 15 calendar days of the receipt of request. • For non -urgent cases this period may be extended one time for up to 15 calendar days: Provided that a determination is made that an extension is necessary because of matters beyond the control of the utilization management department. ?5 • The Utilization Review Specialist will notify the injured worker, prior to the expiration of the initial 15 calendar day period. The injured worker will be notified of the causes requiring the extension and the date when the expected decision should be rendered. • When an injured worker fails to submit necessary information to make determination regarding a procedure. the notice of extension must specifically describe the required information. and the injured worker will be given at least 45 calendar days from receipt of notification to respond to the Utilization Review Department. • If the data provided meets these criteria the request for service will be determined as medically necessary. • If the data does not meet the criteria, the request is referred to our medical director/physician advisor for a decision. • All parties are notified of decisions by telephone. fax or mail and the carrier is kept informed at all steps. • Pre -certification of outpatient services • A nurse who is a Registered Professional Nurse extensively trained in utilization review will obtain the demographic data and relevant information to the clinical condition to be treated and procedure to be performed from the provider. • The nurse reviewer will review all available diagnostic studies. physical examination findings. the date and mechanism of the injury, the past medical history and treatment to date. • After reviewing this information, the nurse reviewer will consult acceptable established guidelines to determine the medical necessity of the requested service. • If the data provided meets the criteria the request for service will be determined as medically necessary and approved. • If the data does not meet the criteria. the request is referred to the AmeriSys medical director/physician advisor. • The medical director/physician advisor will review all available data from the provider and review the established criteria and may contact the attending physician requesting the services. • The medical director/physician advisor may consult a peer physician of the same specialty as the requesting provider for further investigation and decision on the service. • All parties are notified of decisions by telephone. fax or mail and the carrier is kept informed at all steps. • Precertification will be completed within 3 business day. • All activity related to the pre -certification process is appropriated documented in case notes (Corrus). 26 Title: Quality Assurance First Level Review WC 11c Policy: To authorize medical and surgical services before treatment is rendered based on established third party guidelines. Vice President Ljiit Effective Date 1/1/2005 Most Recent Revision Date 9/ 12/201 2 Review Date 9/23/2016 Approval Date for Calendar year 2017 by Medical Director 10/19/2016 41 04 Procedure: Pre -certification ▪ Utilization review specialist will review all available diagnostic studies. physical examination findings, the date and mechanism of the injury, the past medical history and treatment to date. • Only the information that is needed is collected to make determination. This information is shared within the UM organization to avoid repeat request from provider. • After reviewing this information. the utilization review specialist will examine criteria for specific procedures and consult peers if necessary. • All prospective requests for coverage of hospital admissions and certain outpatient surgeries will be received from the provider or carrier. • A utilization review specialist, who is a Registered Professional Nurse trained in utilization review, will obtain the demographic data and data relevant to the clinical conditions to be treated and procedures to be performed, including physicians' services and facilities. • The utilization review specialist will consult acceptable established guidelines established and accepted practice parameters. Mc Kesson's lnterQual, Presley Reed's Medical Disability Advisor. Official Disability Guidelines or the Length of Stay By Region. • If the data provided meets these criteria the request for service will be determined as medically necessary. • If an immediate decision to certify treatment cannot be made the medical director or medical care coordinator in the same specialty as the attending physician is consulted and given all the available information. The medical director or medical care coordinator makes a recommendation to certify or not certify the surgery or procedure. *Lack of Information Policy and Procedure When requested irlfornsation is not received. It is necessary to request any and all information regarding a requested service before rendering a decision. 77 Procedure: The decision to certify or not certify a service vt,ill he based on the professional review of -the available medical infalranation. lithe information to make a determination is not available or appears to be incomplete it will be requested tunes two (2)from the treating physician. ,if the provider refuses to submit the information, the medical director will be contacted within one (1) business day. The medical director can approve services based on the conversation with the attending provider. If the medical director is unable still to obtain any information, it may be necesscny to: Obtain a second opinion Deny services until the requested information is received — this notification will be sent to the provider and to the patient. The participating nctit•ork tit•ill be notified. ag Title: Quality Assurance Second Level Review WC l l d Policy: To authorize medical and surgical services before treatment is rendered based on established third party guidelines. Vice President , ' ' y q/' Effective Date 1/1/2005 Most Recent Revision Date 1 1 /3/2010 Re . iew Date _ 9/23/2016 Approval Date for Calendar year 20 2017 by Medical Director 10/19/2016 Procedure: • If an immediate decision to pre -certify treatment can not be made the medical director/physician advisor or the medical care coordinator will be consulted within I business day and make a recommendation to certify or not certify the surgery or procedure. • The medical director/physician advisor or the medical care coordinator will contact the attending physician requesting the services, review all data provided by the provider and review the established criteria, • The request for service will be determined not medically necessary by the medical director/ physician advisor or the medical care coordinator if criteria are not satisfied and appropriate extenuating circumstances are not evident. • At the discretion of the medical director a peer who is the same specialty as the requesting provider will be contacted. • The Utilization Review Specialist will notify the carrier by telephone or electronically with written documentation following the same business day. The utilization review specialist will notify by fax or in v, riting within 15 calendar days the provider as to the decision. • The appeals process will be included in the correspondence. Certification Determination — Additional Information. The revieit process is the evaluation of appropriateness in terms of both the level and the quality of health care and health services provided based capon medically accepted standards. The decision not to certify care is based upon a physician review of the medical information on file or available at the time of review. The organisation, will consider any additional or new documentation to support a reversal of original decision. This decision will be made solely on new information received. ?9 Title: Quality Assurance Concurrent Review WC lle Policy: To authorize the continuation of medical and surgical services based on third party guidelines, during the life of a claim. Vice President t. Effective Date 1 /1 /2005 Most Recent Revision Date 2/2/2011 Review Date 9/23/2016 Approval Date for Calendar year 2017 by Medical Director 10/19/2016 �s` itli Iv,H Procedure: • Concurrent Review Overview: • Concurrent review is the timely review of services in progress. An experienced nurse completes the medical summary. Once the summary is completed, it is reviewed by third party guide lines and the AmeriSys Medical Director/Physician Advisor reviews and renders a decision on how to proceed with treatment. • Concurrent Review Services can address: • The need for a continued stay in a hospital/skilled care setting. • The need for continuation of any medical modality in place such as PT, OT, medications. • The review is addressed by the AmeriSys Medical Director/ Physician Advisor on any current treatments being provided to an injured worker that fall out of third party guidelines. This can include, but will not be limited to, the current treatment plan, the current work status, and maximum medical improvement status and impairment ratings. The timeframes for this type of review will be in conjunction with prospective review timeframes of up to 15 calendar days per URAC standards. • Procedure: • The experienced nurse completes the referral form and medical summary, obtaining all information relevant to the issue. • The nurse consults acceptable third party guidelines • If the data provided meets the criteria, the request will be determined as medically necessary. • If the data does not meet the criteria, the request is referred to the AmeriSys Medical Director/ Physician Advisor for a decision. • AmeriSys Medical Director/Physician Advisor will contact the attending physician to conference regarding the request and a determination will be made. • All parties are notified by telephone, fax, mail or email of the decision. The carrier is kept up to date any all review activity. • For requests to extend a current course of treatment, the Utilization Review Department will issue a determination within 24 hours, 30 Title: Quality Assurance Retrospective Review WC 11 f Policy: To determine if provided medical and surgical services were appropriate and treatment was based on established third party guidelines. Vice President Effective Date 1/1/2005 Most Recent Revision Date 11/3/2010 _ Review Date 9/23/2016 Approval Date for Calendar year 2017 by Medical Director 10/19/2016 f'( 1_) Procedure: Standards for Retrospective Review • A Utilization Review Nurse will be assigned within 72 hours of receipt of a referral and copying file. • Utilization Review Nurse to obtain medical records. • Utilization Review Nurse to provide update to adjuster and/or Telephonic Case Manager on a biweekly basis, • Utilization Review Nurse to review file and complete report v ithin 30 calendar days. • Report and records sent to doctor for review addressing; medical necessity relatedness, appropriateness of care and specific requests. • Within five business days of receipt of report from Peer Physician, the Utilization Review Nurse will contact the adjuster or Telephonic Case Manager with the results of the review. • The Utilization Review Nurse to complete the summary report within three business days after receiving the final report from the doctor. • Review and summary reports will be forwarded to adjuster within three business days after finalization. • Utilization Review Nurse to follow up with adjuster and/or Nurse Case Manager regarding the need for further services within one week after submission of final report • The retrospective review process should be completed within 30 calendar days. • The Medical Director/Physician Advisor is available within 1 business day to discuss the review. 31 Title: Quality Assurance Utilization Management Experiential Procedures WC 12 Policy: Revised definition of -Medical Necessity'' deletes requirement. regarding experimental procedures, to obtain prior approval from AHCA and AHCA's charge to adopt rules. providing for approval on a case -by -case basis. Vice President . �' Effective Date 1 /1 /2005 Most Recent Revision Date Review Date 9/23/2016 Approval Date for Calendar year ical 2017 by Medical Director 10/19/2016 fr/ Procedure: Once AHCA develops a guideline in regards to experimental procedures. policy and procedures will be formulated. Until such time claims will be reviewed on case -by -case basis, 32 Title: Clinical Peer Review /Disputed Care WC 12a Policy: A]1 cases where a clinical determination to certify cannot be made by an initial clinical reviewer will be referred for peer clinical review Vice President f, k___ Imo' f /Q' ; Effective Date 1/1/2005 Most Recent Revision Date Review Date 9/30/2015 Approval Date for Calendar year 2017 by Medical Director 10/19/2016 Procedure: • Time Frame • Maximum 1 business day • A request for admission. stay or other service is unable to be authorized by the Case -Manager. • The Case -Manager contacts a clinical peer reviewer. This may be the medical director, the medical care coordinator, and the medical director who is acting as the medical care coordinator or a clinical peer of the same specialty. • The clinical peer reviewer contacts the requesting provider to discuss the service and obtains any additional information. • The clinical peer reviewer authorizes or denies the service. • The clinical peer reviewer notifies the Case -Manager. • The requesting provider is notified by telephone within one business day after all information is received of the decision. • A written notification will be sent within three business days. • If the service is denied, the requesting provider is advised of the grievance process and the right to expedited or appeals process. 33 Title: Quality Assurance -Utilization Management Dispute Resolution — Reimbursement WC 13 Policy: The organization will make every effort to resolve provider bill reimbursement disputes in accordance with Florida Statute 440.134 6(c)7. Vice President Effective Date 1/I/2005 Most Recent Revision Date 07/01/2016 Review Date 9/23/2016 Approval Date for Calendar year 2017 by Medical Director 10/19/20I6 WC/MCA ACCOUNTS ONLY Procedure: • If a health care provider is dissatisfied with a carrier's payment of a bill for medical services reconsideration may be requested by the provider within 45 days. • The provider needs to return the EOB, a copy of the bill and any supporting documentation to substantiate the medical necessity of the service or diagnosis provided. • Review and reevaluate the original bill and accompanying documentation using a consultant if necessary. • Provider needs to be notified within 30 days of the result of the reconsideration. • Cite the reason for the decision or process the billing correction. • If additional payment is due, the bill is processed. • If no additional reimbursement is realized. send a letter stating the reason for the denial or deny it on the EOB with the explanation. • If the provider remains unhappy with the decision, the provider may file a grievance in accordance with the AmeriSys Grievance Process (see WC35- WC48). which is in compliance with the Agency for Healthcare Administration's guidelines. (MCA participants only) • After completion of the Grievance process. the Grievance Coordinator will inform both cost containment and the provider of the decision. • If the MCA upholds Cost Containment's decision to deny payment. The provider will be notified that this decision does not ban them from requesting assistance from legal counsel to achieve resolution. 34 Title: Dispute Resolution — Utilization Review WC 13a Policy: The organization will make every effort to resolve provider utilization review disputes. Vice President � y ,In. ilia) Effective Date I / 1 /2005 Most Recent Revision Date Review Date 9/23/2016 Approval Date for Calendar year 20171100 by Medical Director 10/19/2016 �/ �~ ' Procedure: A request for reconsideration will be conducted within I business day of the request. • When an initial determination not to certify an admission, stay or other service is made. and no peer to peer conversation has been attempted. the attending physician or other ordering physician has the opportunity to request reconsideration by the peer reviewer making the initial determination. The peer reviewer maybe the Medical Director who is functioning as the Medical Care Coordinator. A designated clinical peer reviewer may be contacted if the original clinical peer reviewer cannot be available within 1 business day. • The request for reconsideration may be made to the Case -Manager, Grievance Coordinator or Utilization Review Department. • The Case-Manager/Utilization Review Specialist will contact the initial clinical peer reviewer and arrange for the initial clinical peer reviewer to call the attending or ordering physician. • The initial clinical peer reviewer will obtain additional information from the attending or ordering physician. • The initial clinical peer reviewer will either uphold the denial or authorize the service. • The attending or ordering physician will be notified of the decision within 1 business day. • If the decision is to uphold the denial. the attending or ordering physician will be notified of the grievance process and/or Expedited Appeals Process/Standard Appeals Process. • In the event that the reconsideration request is for workers" compensation claim. the prevailing statutory rules and time frames of the state will apply and will appear as an addendum to the policy and procedures. 35 Title: Medical Bill Review — Utilization Review WC 13b Policy: All licensed persons involved in the medical bill review process will be trained in the principles and standards of medical bill review and its integration into the process of utilization management. Vice President Effective Date 1 / 1 /2005 Most Recent Revision Date 9/30/2015 Review Date 9/23/2016 Approval Date for Calendar year 2017 by Medical Director 10/19/2016 It( Procedure: • The medical bill review process is part of utilization review. Carriers shall submit medical claims submitted by health care providers in order to identify over -utilization and billing errors. The medical bill review staff will evaluate designated medical claims and recommend payment based on application of the Workers' Compensation guidelines for the appropriate State. • All persons involved in the medical bill review process will be trained in the standards of payment and reimbursement as designated by the State of Florida — Florida Workers' Compensation Law. This will include hospital, ambulatory surgical center, surgical, and medical claims. • Support staff will include the UR Program Manager. Bill Reviewers, UR Nurses and Quality Controller. Overview: • The medical bill review department will process Workers' Compensation claims for proper payment based on the guidelines of the State in which the claim should be paid. Objectives: • The medical bill review staff will apply all rules related to the Workers' Compensation guidelines for reimbursement. Assess for areas of concern i.e.: fraudulent billing, over -utilization and relatedness. • All persons involved in the medial bill review process will completed the bill review within 48 hours upon receipt of the bill. Additional time may be allocated with the notification of the Program Manager. • The bill review staff will keep a log of all bills that have been reviewed and document any savings related to their bill review process. • The UR nurse assigned to bill review will act as a resource person for adjusters and telephonic Case -Manager's will regards to reimbursement questions and appropriateness of billing codes for specific procedures. 36 • The UR nurse assigned to bill review will complete independent research as needed in order to accurately code a claim for appropriate reimbursement. This may include communication with the State Utilization Review entity. fee schedule hard copy or online references and appropriate CPT code advisors. Specific diagnoses may be researched online or utilizing a current medical dictionary. Hospital Claims and Ambulatory Surgical Centers: • The UR nurse assigned to bill review will review designated hospital claims to ensure that the date of treatment is related to the date of injury. ICD-I O codes will be reviewed to determine if the diagnosis is related to the Workers' Compensation injury. The date of service will be reviewed to determine if the claim is related to the date of injury. A prescreen process will be completed on designated hospital claims as dictated by the Carrier. The prescreen process will identify areas of concern on the hospital claim to include relatedness. over -utilization, and disallowance of non- compensable (i.e.: comfort) items as identified by the State. • The UR nurse assigned to bill review will communicate with the Adjuster any claims where relatedness is questioned. Upon determination that the claim is compensable the bill review staff will enter a note into the Corrus system outlining the decision for payment. • The UR nurse assigned to bill review will complete a prescreen form that identifies specific items that are non-compensable and other items in question. These disallowed items will be assigned a "disqualifier" which will detail the reason for non-payment at the time of initial reimbursement. • The UR nurse assigned to bill review will utilize reimbursement resources such as the State specific Workers' Compensation Reimbursement for Hospitals and Ambulatory Surgical Centers Fee Schedule. Hard copies or online resources will be made available. Medical and Surgical Claims: • The UR nurse assigned to bill review will review designated medical and surgical claims to ensure that the date of treatment is related to the Workers' Compensation injury. ICD-9 or ICD-I O codes ( dependent on injury date) will be reviewed to determine if the diagnosis is related to the date of injury. The date of service will be reviewed to determine if the claim is related to the date of injury. All CPT codes will be substantiated in the medical/surgical report that accompanies the provider claim. • The UR nurse assigned to bill review will complete a prescreen form that identifies specific CPT codes that are billed in error. These disallowed items will be assigned a disqualifier that will identify the reason for non-payment. Any CPT code that does not have corresponding dictation on the medical/surgical report will be disallowed. Additional documentation will be requested for re- evaluation of payment. • The UR nurse assigned to bill review will utilize reimbursement resources such as the State specific Workers' Compensation reimbursement fee schedule. Guide for Complete Global Service Data to identify unbundling of coding. CPT guidelines and CPT assistant publications as well as Medicare CMS resources when applicable. Hard copies or online resources will be made available. 37 Re -Evaluations: • The UR nurse assigned to bill review will investigate and complete requests for re-evaluation with regards to all hospital. ambulatory. medical and surgical claims. The person will complete a respond in writing to the Provider and enter a note into the Corrus system along with a copy of the written response. Utilization Review Nurse: • RN with 3-5 years clinical experience in varying hospital specialty unites i.e.: ER. ICU/CCU. Surgery. Trauma. Orthopaedic. Neurology or Psychiatric. • RN with a minimum of 2 years experience in Utilization Review in the areas of Workers' Compensation. Health and Accident or Auto Liability. • UR experience preferred, • Certification in Utilization Review i.e.: CPUR. ABQUARP (preferred). • Must be knowledgeable of the Workers' Compensation laws and how they are integrated into the Managed Care Arrangement. • Active member in local Utilization Review Organization (preferred). • Must be self -directed and able to work independently. 38 Title: Quality Assurance -Utilization Management Dispute Resolution — Reimbursement Non -Managed Care programs WC 13c Policy: The organization will make every effort to resolve provider bill reimbursement disputes in accordance with Florida Statute 440.13(7) Vice President '3 ,,,/ .. Effective Date 1 / 1 /2005 Most Recent Revision Date 7/1/2016 Review Date 9/23/2016 Approval Date for Calendar year 2017 by Medical Director 10/19/2016 Procedure: • Any health care provider, carrier, or employer who elects to contest the disallowance or adjustment of payment by a carrier under subsection (6) must, within 45 days after receipt of notice of disallowance or adjustment of payment. petition the agency to resolve the dispute. The petitioner must serve a copy of the petition on the carrier and on all affected parties by certified mail. The petition must be accompanied by all documents and records that support the allegations contained in the petition. Failure of a petitioner to submit such documentation to the agency results in dismissal of the petition. • The carrier must submit to the agency within 30 days after receipt of the petition all documentation substantiating the carrier's disallowance or adjustment. Failure of the carrier to timely submit the requested documentation to the agency within 30 days constitutes a waiver of all objections to the petition. • The response to the agency must be submitted on the Carrier Response to Petition for Resolution of Reimbursement Dispute form. • Within 60 days after receipt of all documentation, the agency must provide to the petitioner, the carrier, and the affected parties a written determination of whether the carrier properly adjusted or disallowed payment. The agency must be guided by standards and policies set forth in chapter 440.13, including all applicable reimbursement schedules, practice parameters, and protocols of treatment, in rendering its determination. • If the agency finds an improper disallowance or improper adjustment of payment by an insurer. the insurer shall reimburse the health care provider, facility. insurer. or employer within 30 days, subject to the penalties provided in the Fl Statute. • All petitions for reimbursement dispute resolution will be logged in the AmeriSys Dispute Resolution Log: this includes the date received. the date of the sent response, a list of all parties communicated to and the Agency's final determination. • The Agency's determination will be complied with and evidence of this compliance will be documented in Corrus. 39 Title: Provider Referrals — Network and Non Network WC 14 Policy: The organization will make every attempt to keep the provider referral within the network. Vice President �?7�•/2J : fix'a Effective Date 1/1/2005 Most Recent Revision Date Review Date 9/30/20I5 Approval Date for Calendar year 2017 by Medical Director 10/19/2016 Wa /`� / "` WC/MCA ACCOUNTS ONLY Procedure: All providers and provider referrals will be made to network providers within the service area whenever possible. The average travel time for injured employees from the employees usual employment site to the nearest primary care delivery site and to the nearest acute care hospital in the provider network will be no longer than 30 minutes under normal conditions. The average travel time from the employee's usual employment site to the nearest provider of specialty physician service. ancillary service, specialty inpatient hospital services and all other heath services will be no longer than 60 minutes under normal circumstances. An injured worker may need to be referred to an out of network provider when. • A network provider is not available within the travel time as listed above • An appointment with a network provider is not available within a reasonable time frame • The network provider refuses to see an injured worker • The suitable provider is not found within the network. • Referral by the Primary Care Provider to a specific provider and approved by the insurer. Authorization of a non -network provider: • The Case-Manager/adjuster will contact the provider to arrange the appointment. • The Case -Manager will attempt to negotiate the fees • The Case -Manager will document the Corr•us case note system explaining the reason for arranging an appointment out of network. • !fa fee is negotiated by the Case -Manager this will be recorded as a "bill review note'". 40 Title: Monitoring Utilization of Network Services WC 14a Policy: To monitor the utilization of services provided to the injured worker by network or non -network providers. Vice President t ' lam ,sit `' Effective Date 1 / 1 /2005 Most Recent Revision Date Review Date 9/23/2016 Approval Date for Calendar year 2017 by Medical Director 10/19/20I6 �� ,4 /P WC/MCA ACCOUNTS ONLY Procedure: It is our policy to utilize network providers to provide care to injured workers. If necessary and indicated the injured worker may be assigned to a non -network provider. The reason for the assignment will be clearly documented in the case file. The organization will monitor the utilization of providers both in and out of network. • The Network Hits Report will be run on a monthly basis • Provider utilization will be checked and tracked and trended for area. specialty and assignment • Areas of concern will be reported to the leased network • Non -network providers will be nominated to become part of the leased network. 41 Title: Quality Assurance — Utilization Management WC15 Policy: Utilization Management is the evaluation of appropriateness in terms of both the level and the quality of health care and health services provided an injured worker, based upon medically accepted standards in the community, practice parameters and accepted third party guidelines such as McKesson's lnterQual and Presley Reed Medical Disability Advisor. Vice President , /�s71d ) Effective Date 1 / 1 /2005 Most Recent Revision Date 11/12/2010 Review Date 9/30/2015 Approval Date for Calendar year 2017 by Medicall Director 10/ 1 9/2016 r /1 0 Procedure: • The organization's utilization review activity incorporates procedures for prospective, concurrent and retrospective reviews. • Currently the criteria utilized for determining necessity and of care includes but is not limited to: • State and/or Nationally Accepted Practice Parameters • Presley Reed's Medical Disability Advisor • Mc Kesson's lnterQual Guidelines • Official Disability Guidelines • Health Care Finance Administration Criteria • Guidelines for Chiropractic Quality Assurance and Practice Parameters • American College of Orthopaedic Surgeons • Community and Industry Standard • Criteria developed through experience • State regulatory guidelines will be met by incorporating these procedures into claims management. Emphasis is placed on obtaining medical information in a timely manner to effectively address medical necessity and causal relationship at the onset of the injury. The internal Case -Manager under the direction of the medical care coordinator will monitor ongoing treatment and obtain current medical status to prevent unnecessary and/or unrelated treatment while ensuring quality of care in the most cost-effective manner to return the injured employee to work. • The organization's goal in performing utilization review is to ensure that each of its clients receives high quality, medically necessary care, in the most appropriate setting, and in the most cost-effective manner possible. • The nurse case manager supervisor for the organization will have the primacy responsibility of facilitating ongoing utilization review of cases and facilitating the clinical performance and random reviews as indicated. Any Internal Case -Manager may conduct utilization file review when indicated or as requested and present the issues to the medical care coordinator or medical director of the organization. • All requests for appeal of denials of treatment will be forwarded and reviewed. • The internal Case-lvlanager/UR Specialist will meet with the medical director of the organization to discuss any current medical. utilization or quality issues. 42 Title: Quality Assurance — Utilization Management Committee/Quality Assurance Committee WC 15a Policy: The utilization management committee will have the responsibility for overall monitoring of utilization review activity. Vice President jirl: (1)1t-, Effective Date 1/1/2005 Most Recent Revision Date 1 1 /9/2010 Review Date 9/23/2016 Approval Date for Calendar year 2017 by Medical Director 10/ 19/2016 f i,,XD _ Policy: The Quality Assurance Committee will oversee and be responsible for the Quality Assurance program Procedure: The quality assurance committee will: • Identilimportant aspects of care • Identify indicators and establish the threshold for evaluation • Collect and organize data to evaluate care issues • Assess action • Make recommendations for changed to improve the overall quality of care The quality assurance committee may meet on a monthly basis to identify any significant quality issues but will meet on a quarterly basis to present the findings from the prior months utilization review studies. The meeting may be in person or by teleconference. The quality assurance committee will keep minutes to document all activity. The minutes will be clear. understandable and accurate. The minutes will reflect: • Responsible person • Tracking of key issues • Outcomes • Recommendations • Action to be taken • Related follow up activities and communication with the providers and members • Due dates • Completion The insurer has the ultimate overall responsibility for the oversight of all medical services authorized as well as the quality assurance activity. Reports from all subcontractors will be reviewed and included in the minutes. 43 Title: Case Management — Aggressive Medical Care Coordination WC 16 Policy: "Medical care coordination" means active case management and coordination of the health care services for an injured employee involving a medical care coordinator to ensure the delivery of necessary services in a manner which will return the individual to work as soon as feasible. 59A-23.002( I l) F.A.C. Vice President ,:ZjlLuP Effective Date 1 / 1 /2005 Most Recent Revision Date 9/12/2012 Review Date 9/23/2016 Approval Date for Calendar year 2017 by Medical Director 10/19/2016 C /f Procedure: All medical care rendered to an injured worker under the managed care plan with the emphasis being on return to work will be under the direction of the Medical Care Coordinator. The Medical Care Coordinator must be a Medical Doctor or Doctor of Osteopathy. The Primary Care Physician or Point of Entry Physician may also be the Medical Care Coordinator as per the network contract. • Where the Primary Care Physician does not hold the designation of Medical Care Coordinator the organizations Medical Director will be utilized as the Medical Care Coordinator. • The Medical Care Coordinator will be designated in computerized system under "Specialty'. • The Medical Care Coordinator is responsible for managing the medical care of an injured worker, including determining other health care providers and health care facilities to which the injured worker will be referred for evaluation or treatment for the purpose of returning the injured worker to work as quickly as possible. • All involved parties will be involved in the early return to work of the injured worker. This includes the claims staff: internal Case -Manager. provider. employer and when needed the external Case -Manager. • However. it is understood that the practicality of a physician directly providing those services is doubtful, understanding the efficiency and decreasing the cost of delivering medical care is the objective of the statute. • Therefore. the organization operates under "standing orders" or procedural format using the acceptable guidelines that includes Case -Managers who are Registered Professional Nurse/LPN's to augment and support the duties of the Medical Care Coordinator. • The Medical Care Coordinator will provide technical direction to the Case -Manager providing the case management. • The Medical Director acting as the Medical Care Coordinator is accessible on a regular and continual basis by telephone or fax and will have regularly scheduled meetings with the Case -Manager and or carrier representatives as needed. 44 Title: Case Management — Internal Case Management Criteria WC 17 Policy: "Internal case management'. means a process for telephonically coordinating, facilitating, and monitoring all aspects of the medical care coordination of the injured employee in consultation with the treating physician and the medical care coordinator. 59A-23.002(10), F.A.C. Vice President ( jIi'i Effective Date 1/1/2005 Most Recent Revision Date 9/12/2012 Review Date 9/23/2016 Approval Date for Calendar year 2017 by Medical Director 10/19/2016 �/` it(11110 , /t Procedure: Assignment to internal Case -Managers will be based upon criteria set and agreed upon by the insurer and the managed care organization. The criteria for assignment of early intervention/telephonic case management will include. but not be limited to: • Severe lacerations. especially tendons and muscles • Severe eye injuries • Back injuries with anticipated lost time exceeding statutory waiting period • Knee injuries with anticipated lost time exceeding statutory waiting period • Cumulative trauma (including carpal tunnel syndrome and tendonitis) • Concussion. severe head injuries • Chemical inhalation/poisoning • Severe sprains. strains (major body area such as ankle. shoulder or wrist) • Dislocations (major body area such as ankle, shoulder, wrist) • Rotator cuff injuries • Second/third degree burns not considered catastrophic • Injuries involving immediate inpatient hospitalization • Psychological claims/stress claims • History of protracted recovery from prior injuries or illnesses • Repeater claimants if prior claims involved the same body part and same or similar type of injury • Any type of injury with lost time exceeding statutory waiting period • Cases with multiple providers • Crush injuries • Fractures • Amputations • If applicable heart and lung disease The criteria for assignment of both internal case management and field case management will include, but not be limited to: 45 All Catastrophic injuries. such as. but not limited to • spinal cord injuries • head injuries • Severe sensory or motor disturbances • Severe communication disturbances • Severe complex integrated disturbances of cerebral function • Severe episodic neurological disorders • Severe brain and closed head injury conditions • Neck injuries (except for minor strains) • Burns of face, hands or greater than 5% of the body and second or third degree burns of 25% or more of the total body surface • Amputations • Loss of hearing • Electrical shock • Multiple fractures Any potential serious back injury: • Failed back syndrome • Multiple fractures in the back • Herniated disc with radiculopathy • Positive neurological findings • Any back injury with any degree of paralysis Chronic Pain Cases Claims with high potential for PT rating including. but not limited to. • Fractures in or near major joints or weight -bearing body parts • Crush injuries • Hand injuries, particularly of the dominant hand • If applicable debilitating cardiac/lung diseases Claimants with a previous history of workers' compensation injury or injuries Difficult pre-existing medical or social problems: • Diabetes • Heart disease • Psychiatric problems • Illiteracy • Mental retardation • Alcoholism and/or chemical dependency • Morbid obesity Cases not fitting an expected recovery time frame: • Not responding to provided care • Time delays in getting appointments • Irregular appointment attendance • Disagreement with the course of treatment • Questionable or experimental treatment recommendations 46 Claimants who are approaching 60 days without returning to work. The need for Re-employment Assessments is decided on a case by case basis. Hospital discharging requiring services as necessary which can include home health and/or significant durable medical goods. Identified location or communication barriers. Claimants in small rural areas with limited local facilities or claimants with language barriers who know limited or no English. All new claims with an initial reserve established of $50,000 or greater. Other cases as discussed and agreed upon with the nurse Case -Manager and claims representative. Internal case management activities shall include: • Coordinating. facilitating, and monitoring all aspects of the ongoing medical care of the injured employee; • Communicating utilization management decisions to the medical care coordinator and treating providers; • Assisting the injured employee in resolving complaints and obtaining medically necessary' services; • Educating injured employees regarding their rights. responsibilities. and limitations of the workers' compensation managed care arrangement: • Coordinating. facilitating. and monitoring the injured employee's return to work status including communicating to the claims representative the services required pursuant to Section 440.491, F.S.; and • Communicating the injured employee's status to the employer and to the injured employee. 59A-23.004(9)(a), F.A.C. 47 Title: Case Management — External Case Management Catastrophic Case Management Criteria IN 17a Policy: Vice President i �,Jida t: /IVO Effective Date 1/1/2005 Most Recent Revision Date Review Date 9/23/2016 Approval Date for Calendar year 2017 by Medical Director 10/19/2016 fil Policy: Management of catastrophic cases is to be considered in the light of the primary mission statement of AmeriSys as it relates to its customers: to provide high quality professional and timely services which allow the customers to manage their high cost disability cases in a cost effective. proactive manner, meeting both long and short range customer objectives. Catastrophic cases offer maximum challenge to the case management professional who is tasked to provide individualized, appropriate and cost effective services for the client to constantly formulate and update case management goals which are measurable, attainable and realistic and to balance the needs of the client and his family within the parameters of restrictions dictated by coverage and by law, Field Case -Managers are selected to be assigned to catastrophic cases based on their backgrounds, educational preparation and experience. The Catastrophic Case Management Product is an extension of our desire to provide high quality, responsive and personalized service to its customers. AmeriSys has qualified Catastrophic Case - Managers in Florida. Caseloads range from 18 to 25 per Case -Manager however caseloads are diverse and are not exclusively catastrophic or non -catastrophic in nature. Procedure: These guidelines have been established to provide AmeriSys' Case -Manager with a framework of acceptable billing and case management standards for catastrophic cases. These standards will serve as a reference point. They are not intended to serve as clinical text. comprehensive case management protocol or replace the ethics involved in providing individualized, appropriate, cost effective services to our clients and customers. In situations where the realities of casework exceed the ranges or protocols described. the Case -Manager will simply provide an explanation in the case record to justify the activities, values and/or billing which fall outside the norms established by AmeriSys. Special ease handling instructions dictated by our customers will always supersede these guidelines. AmeriSys has developed a reputation built on the ability to provide high quality. responsive and personalized service. The goals of Catastrophic Case Management include: I. Achievement of medical stability. 2. Maximization of function. 3. Education about remaining disability. 4. Retention of the client's optimal level of wellness. 48 Catastrophic tiles are managed in a team approach. Cases are assigned to an external Registered Nurse Case - Manager who has expertise with catastrophic and complex medical case management. The Catastrophic Case - Manager and internal Case -Manager review and staff catastrophic files on a regular basis to ensure that the file is progressing in an optimum manner. Case management of the catastrophically injured worker takes the three major components of AmeriSys' medical case management (initial evaluation/assessment and medical planning) and refines the following: Initial Evaluation/Assessment, Acute Treatment Phase The purpose of the initial contact is to determine severity of the injury, obtain medical information, evaluate family support and formulate an estimate of services needed, Problem areas are identified. Status Reporting, Acute Hospital Phase This phase includes frequent contact with the treating facility by phone or in person, frequency dictated by the severity of the injury. to monitor changes in medical status. appropriateness of treatment. and possible need for transfer to another acute care facility. The treatment team is identified by complete name and specialty and personal contact is made with the team as needed. Contact with the family for counseling and support is vital during this phase. A case management plan is developed and discussed with the Employer/Carrier. Contacts are made as the Employer/Carrier directs. Reports are generated after each 8 to 10 hours of billed time or after significant changes in the client's condition. Written and/or verbal case management updates are provided within 24 hours of a physician appointment. Management of Rehabilitation The Case -Manager is active in formulating an appropriate plan with the injured worker, involved medical professionals, the family and the Employer/Carrier to ensure that the client receives post -acute care individualized for their special needs. The treatment may be in -patient rehabilitation facility placement, transitional care or outpatient therapy in a facility or in the home. Needs for supplies. durable medical equipment, medication, transportation. home modification. interpreter services and care provided by home health personnel and/or family are identified by the Case -Manager and their provision is coordinated with the Employer/Carrier and the physician. The possibility of return to work is addressed as medical status stabilizes and the scope of disability from the injury is evaluated. Frequency ol'contact will decrease as the client stabilizes but is at least weekly or more often as needed. Return to the community post maximization of function: The Case -Manager. at the direction of the Employer/Carrier. formulates a plan for community reentry which addresses vocational issues, need for continued medical care, DME upkeep and generally facilitates the client's (or their guardian's) assumption of responsibility for meeting his own needs in the community. The Case - Manager assists the client to identify problems and problem solves to assist him to find solutions. Community resources are identified. Medical cost projections or life care planning will be provided if requested by the Employer/Carrier at this time. Reports are submitted frequently in the early stages of the case. generally after 8 to 10 hours of billed time and monthly as the client progresses along the rehabilitation continuum. Status updates via telephone. fax or email are made frequently to keep the Employer/Carrier apprised of developments. to receive direction and to coordinate care planning. 49 Title: Case Management — Telephonic (internal) Case Management WC 18 Policy: The utilization management staff are properly qualified and trained to function as an internal Case -Manager performing those duties as required of a Case -Manager. "Internal case management" means a process for telephonically coordinating. facilitating, and monitoring all aspects of the medical care coordination of the injured employee in consultation with the treating physician and the medical care coordinator. 59A-23.002(10). F.A.C. Vice President 7 Effective Date 1 / 1/2005 Most Recent Revision Date Review Date 9/23/2016 Approval Date for Calendar year 2017 by Medicalip Director 10/19/2016 ��` ,f+. Procedure: Overview • The Case -Manager shall monitor, evaluate and coordinate the delivery of high quality, timely, cost effective medical treatment and other health services as needed by an injured employee, and shall promote an appropriate, prompt return to work when medically indicated. • The Case -Manager must facilitate communication between the employee. the employee representative, employer, employer representative, insurer, health care provider, the managed care organization and when authorized, any qualified rehabilitation consultant to achieve the goals. • The Case -Manager manages all care throughout the continuum of services in order to achieve the highest level of quality medical care in the most cost effective and timely manner possible. • The primary purposes of medical care coordination are to ensure high quality of care, reduce recovery time and minimize the effects of injury. The medical Case -Manager performs ongoing assessments of the injured employee's recovery. • Treatment and anticipated recovery period are modified as indicated. • The Case -Manager updates medical treatment information with all involved parties, facilitating the return to work of injured employees, when appropriate. Objectives • Act as an advocate for the injured employee in the medical management process • Provide assistance and information to the employee regarding medical issues • Ensure high quality of medical care in a cost effective manner. • Identify medical or return to work issues to minimize medical and disability costs. • Consult with medical providers to determine appropriate level of medical case management intervention • Assure efficient and timely service delivery to help the injured employee reach maximum medical recovery and return to work as soon as medically appropriate. 50 Qualifications • Health professional who possesses a current valid professional license • Have 3-5 years of case management. critical care, intensive care, orthopaedic, neuromuscular or occupational health experience • May possess certification as a CCRN. CCM. COHN. CORN-S General Job Duties of Case -Manager • Acts as an advocate for employee concerns • Obtains basic demographic and injury -related data • Informs the injured employee of his right to choose from a network medical provider directory • Informs the employee that a list of medical providers is available and assist the employee in obtaining the list if necessary • Assists the employee in choosing a medical provider appropriate to the injury • Contacts the network providers' office staff to provide demographic and type of injury information and schedule the employee for an initial evaluation within 24 hours after the employee's initial request for treatment. • Facilitates prompt flow of information between the physician and the parties to the case. Seeks objective medical findings from the provider, projected number of days needed for recovery, release to return to work. and /or maximum medical improvement. • In cases where the injured employee has received treatment by a non -network provider. schedules employee to be seen by network provider for initial evaluation or treatment within 5 working days of the employee's request for referral to the managed care plan. • Monitors medical care by review proposed treatment plans and medical reports of authorized treating physicians • Coordinates all referrals • Documents in updates Case -Manager action plan after each doctor's office visit • In catastrophic cases. initiates rehabilitation services and assists in the selection of an appropriate rehabilitation provider • Initiates inpatient/outpatient, concurrent/retrospective utilization review as indicated. • Initiates utilization review or dispute resolution as indicated. • Documents all medical case management activities • Conducts limited on -going assessment to determine ability of employee to return to pre -injury position. transitional duty. or alternative job with the same employer. • Accountable for adherence to all applicable laws and regulations governing the provision of workers' compensation case management services. • Arranges discounted durable medical equipment when appropriate • Evaluates employee's adjustment to injury and acceptance of medical treatment plan. • Communicates with medical provider to address treatment options, diagnosis prognosis and work capacity when there is documented lack of case progress. • Under limited circumstances. may utilize external Case -Managers for medical management when indicated. Other Duties of Telephonic Case -Manager • Includes the general job duties listed above • Initiates telephone assessment upon First Report of Injury (FROI). The assessment includes contacting the injured employee. the employer. and the treating provider to determine the following: 51 • injured employees understanding of his or her medical diagnosis. prognosis. and medical care needs • Medical treatment plan and estimated costs • Diagnosis -based work restrictions of employee and projected return to work date with conditions as appropriate • Feasibility of returning injured employee to a transitional duty position during recovery • Coordinates medical management services appropriate to the injured employees needs. These include: • Referrals to medical providers and other consultants when appropriate • Communicates with employee to address concerns and answer questions • Provides information to carriers. employers, employees, regulatory agencies, medical care providers. and others involved in the employee's case. • Coordinates return to work activity • Accountable for adherence to all applicable laws and regulations governing the provision of workers' compensation medical case management services • Maintains certifications as needed. 52 Title: Standardized Documentation WC 18a Policy: To ensure that case notes reflect all components of the state and national credentialing bodies' guidelines. Upon opening a case. documenting the progress note activity received after a treating physician's office visit, and the inactivation of a case, the Case -Manager will document all findings in the standardized format which has been approved by the Quality Assurance Committee. Vice President - / Azrz,_ ,1 �' Effective Date 1 / 1 /2005 Most Recent Revision Date 9/06/2011 Review Date 9/23/2016 Approval Date for Calendar year 2017 by Medical Director 10/19/2016 ,� /mot %! �` Procedure: Overview The Case -Manager will use the following format for the opening of a case: PROTOCOL FOR OPENING A NEW FILE • When a new file (or NOI) is received by the Telephonic Case -Manager the following is the procedure to be followed. 1. Document the following: - Activating file to medical management services: - Brief description of injury: - Diagnosis: Treating physician: - Treatment plan: Current work status: - Nursing Care Plan: 2. Ensure 3 point contact is completed 3. Ensure treating provider's information is entered in the telephonic icon section 4. Claim Information Screen to ensure the correct code is listed, (AMC, HNL, EXP) and the correct name is listed for Case -Manager. 5. Verify that the claim is identified as Medical. Indemnity, or Report Only. If not. check the appropriate box. 6. Review the diagnosis code and make sure a valid code is entered. (Not 9599) 7. If needed, enter a post it note. 8. Complete the "Rehab Info'" screen if applicable. 9. Complete the "Return to Work- screen. 10. Open the '`Ancillary Info"" screen. 11. Arrange and/or address any high priority needs. 12. Enter note in "Case Notes" pertaining to any actions or current issues. If applicable complete initial assessment questionnaire and enter "UR" note. 53 13. Enter any appropriate Diary entries in the "Diary" section. Enter diary entry reminding you that Case Management Claims Summary is due in 30 days. Notify adjuster via IDD of any current issues that may affect benefits. (ie: work status change, concerns of pre-existing condition. legal involvement. lack of modified duty. IW not RTW Modified duty when offered. etc.) • The Case -Manager will utilize the following format when documenting activity received after a treating physician's office visit: Dr. LOV: NOV: DX: Work Status: Anticipated MMI: Drs. Eval: Drs. Treatment Plan: Medications: Reference to third party guidelines: Adjuster conference: Yes Nurse Care Plan: Field Case -Manager update/report: N/A 'this format nury be modified to meet the specific needs of the employer • The Case -Manager will utilize the following format when inactivating the file: Standard Note Format RE: Inactivation of File Inactivation of File from CM standpoint REASON: Pharmacy to remain open Satisfaction Survey Sent Notification given to: Dr. LOV: NOV: DX: TX: W/S: MMI: Assigned as of PPI NCP: Inactivation of File from CM standpoint may be re -activated as need Arises, or at Adjusters request. REASON: MMI/PPI assigned as stated above Pharmacy to remain open YES: NO: Satisfaction Survey Sent: Notification given to: Adjuster via diary and/or verbal notification 54 Title: Pre -Authorization / DME / Guidelines WC 18b Policy: Prior to authorizations being issued for items. deemed medically necessary for the accommodation of an injured employee, which surpass a pre -determined, specific amount, approval of such items will be sought and received from the Employer -Risk Management and/or Carrier. Vice President Lc? ,,, / ,�,d1ci ��, 'tit Effective Date 1/1/2005 Most Recent Revision Date Review Date 9/23/2016 Approval Date for Calendar year 2017 by Medical Director 10/19/2016 11 /(1CD„ Procedure: Overview As part of the understanding and agreement with the Employer and Carrier. if they so choose, a pre- determined amount will be established for items deemed medically necessary for the care and treatment of the injured employee that will require an approval prior to the Case -Manager's authorization of the state item. This would be an item/order received from an authorized. treating physician/provider in the course of treatment. It would be appropriate and proven to be medically necessary. The Case -Manager will contact electronically a minimum of three network preferred providers, requesting bids on the item to be given within one business day. once the estimates are received. the Case -Manager will contact the designated party, inform them of the request. the cost of the item and the medically necessity of such item. If approval is granted, the Case -Manager will arrange for the ordered item to be processed and delivery to be set. The Case -Manager will negotiate. if appropriate. to obtain the most cost effective price for the stated item. The Case -Manager will document all the activity related to the purchase of such item in Corrus. 55 Title: Case Conferencing WC 1$c Policy: To bring all parties together to discuss the different aspects of a claim. To jointly formulate a Plan of Action to help facilitate resolution to a claim. Vice President ..7. ,/ Effective Date 1 / 1 /2005 Most Recent Revision Date Review Date 9/23/2016 Approval Date for Calendar year 2017 by Medical Director 10/ 19/201 6 {, !. Overview The Case Management team will represent the medical aspects of the claim. This would include but not be limited to the telephonic Case -Manager. field Case -Manager, their supervisors. and the medical director. The claims staff would include but not be limited to the adjuster on the claim. and their supervisors. Procedure: • The recognition of a claim requiring intervention of a case conference either by the claims staff or the Case -Manager. • The Case -Manager will formulate a brief summary of the claim to be discussed for all in attendance. • The Case -Manager will identify up to five areas of concerns to be addressed during the conference. • During the conference. the Case -Manager will document the joint resolutions agreed upon. • A summary of the case conference will be documented in Corrus. along with the Plan of Action. The Case -Manager's plan to act on the joint resolutions will also be documented and diaried in Corrus. 56 CASE CONFERENCE Claimant: SS#: Date of Injury: Account: Case -Manager Adjuster: In Attendance: Summary of File: Problems Identified 2. 3. 4. 5. Resolutions Agreed Upon: 57 Title: Case Management — Field (External) Case Management WC 19 Polio•: Field Case -Managers will be utilized to facilitate care and return to work. Vice President ,-7,•,t,/� �1.1,.�' ill) Effective Date 1/1/2005 Most Recent Revision Date Review Date 9/23/20I6 Approval Date for Calendar year 2017 by Medical Director 10/19/2016 // /v�t , Procedure: External case management should be considered for assignment in the following situations: All Catastrophic injuries, such as. but not limited to • spinal cord injuries • head injuries • Severe sensory or motor disturbances • Severe communication disturbances • Severe complex integrated disturbances of cerebral function • Severe episodic neurological disorders • Severe brain and closed head injury conditions • Neck injuries (except for minor strains) • Burns of face. hands or greater than 5% of the body and second or third degree burns of 25% or more of the total body surface amputations • Loss of hearing • Electrical shock • fvlultiple fractures • Complex presumption claims Any potential serious back injury: • Failed back syndrome • Multiple fractures in the back • Herniated disc with radiculopathy • Positive neurological findings • Any back injury with any degree of paralysis Chronic Pain Cases Claims with high potential for PT rating including. but not limited to, • Fractures in or near major joints or weight -bearing body parts • Crush injuries • Hand injuries. particularly of the dominant hand Claimants with a previous history of workers" compensation injury or injuries 58 Difficult pre-existing medical or social problems: • Diabetes • Heart disease • Psychiatric problems • Illiteracy • Mental retardation • Alcoholism and/or chemical dependency • Morbid obesity • Total or industrial blindness Cases not fitting an expected recovery time frame: • not responding to provided care time delays in getting appointments • irregular appointment attendance • disagreement with the course of treatment • questionable or experimental treatment recommendations Claimants who are approaching 60 days without returning to work. The need for Re-employment Assessments are decided on a case by case basis. Need for extended home care. Hospital discharging requiring planning for home health and/or significant durable medical goods. Location or communication barriers. Claimants in small rural areas with limited local facilities or claimants with language barriers who know limited or no English. All new claims with an initial reserve established of $50,000 or greater and those where the nature and severity of the injury would qualify the injured worker to receive disability income under Title II or supplemental security income benefits under Title XVI of the Social Security Act that existed on July 1, 1992. The field or external Case -Manager will: • Have person to person contact with the injured worker • Be a qualified rehabilitation provider per state regulatory guidelines • communicate with the internal Case -Manager, the employer and the insurer • Submit reports as required Overview: Medical The manner of delivery is important for establishing rapport with the injured worker and/or family. particularly with high risk or severe injury situations. Medical case management includes but is not limited to. coordinating physical rehabilitation services such as medical, psychiatric or therapeutic treatment for the disabled individual. 59 Activities include: • Providing health training to the injured party and family. • Monitoring the disabled individual's recovery. • Consulting with treating physicians to develop an appropriate individual written rehabilitation plan. • Gathering medical information if needed. • Documentation of findings with recommendations on a monthly basis. • Coordination of referrals and delivery of services. • Horne assessments. • Ergonomic Job Analysis. The purposes of Medical Care Coordination are to minimize the disability and recovery period without jeopardizing medical stability and to assure proper medical treatment. Vocational The purpose of Vocational Case Management is to assess the potential for. develop. and implement plans that assist the injured employee to return -to -work. Services include: • Job Analysis • Reemployment Assessment (REA) • Job Modification • Ergonomic Analysis • Worksite Hazard Evaluation • Vocational Assessment • Transferable Skills Analysis • Job Seeking Skills Training • Job Search & Development • Labor Market Survey • Comprehensive Vocational Evaluation Objectives • Act as an advocate for the injured employee in the medical coordination and return to work process. • Provide assistance and information to the employee regarding medical and vocational issues. • Ensure high quality of medical care in a cost effective manner. • Identify medical or return to work issues to minimize medical and disability costs. • Consult with medical providers to determine appropriate level of medical case management intervention. • Assure efficient and timely service delivery to help the injured employee reach maximum medical recovery and return to work as soon as medically appropriate. Qualifications • Case -Manager must possess one of the following certifications: CRRN. CDMS, CCM, COHN. CRC. CVE • Case -Manager must have a current Qualified Rehabilitation Provider certification. 60 Title: Case Management — Communication WC 20 Policy: The internal Case -Manager will communicate effectively with all parties involved. Vice President ,`7r/' Effective Date 1/1/2005 Most Recent Revision Date Review Date 9/23/2016 Approval Date for Calendar year 2017 by Medical Director 10/19/2016 /1/( Procedure The Case -Manager must facilitate communication between the employee. the employee representative, employer, employer representative. insurer, health care provider, the managed care organization/medical management coordinator and when authorized. any qualified rehabilitation consultant to achieve the goals of the program. Communication can be verbal or electronic. Case notes are used to document all activity and communication. Please reference the following Managed Care Claim Sununcnv, This is completed on lost time claims initially at 30 days and every 60 days following by the telephonic Case -Manager. 61 The leased network will be asked to provide copies of their medical record audit conducted on their providers on an annual basis. Medical Care Claim Summary DATE: 30 Day 90 Day 150 Day 170 Day Days UR CLAIMANT: _ D/A: TYPE OF INJURY/BODY PART: DIAGNOSIS: PRE-EXISTING INJURY: YES NO WAS MAJOR CONTRIBUTING CAUSE ADDRESSED: YES NO PLAINTIFF ATTORNEY: DEFENSE ATTORNEY: CURRENT TREATING PROVIDER MCC/SPECIALTY: 1. PREVIOUS TREATING MEDICAL PROVIDERS: (For UR purposes) CURRENT WORK STATUS: DATE: IF MODIFIED, RESTRICTIONS: SURGERY DATE: THERAPY — PTIOT MEDICATIONS REG FLAGS YES NO BRIEF MEDICAL SUMMARY WITH CURRENT TREATMENT: ONE TIME CHANGE: YES NO NAME/SPECIALTY: FIELD CASE -MANAGER ASSIGNED: YES NO NAME: MEDICAL DIRECTOR INTERVENTION REQUESTED _YES NO MMI DATE: IMPAIRMENT RATE: BY DR: IS THE EMPLOYEE/CLAIMANT MMI BY ALL TREATING PHYSICIANS? YES NO UTILIZATION REVIEW ASSESS AND ADVISE: DATE OF COMPLETION: PEER REVIEW RECO\IIENDED'REQUESTED YES NO AUTHORIZED YES NO TYPE: DATE OF REFERRAI.: DATE OF COMPLETION: GRIEVANCE FILED: YES NO TYPE: DATE FILED: OUTCOME: IME: YES NO TYPE: DATE: DR: CARRIER IME? YES NO CLAIMANTS IME: YES NO REA OR VOCATIONAL EVALUATION COMPLETED: YES NO EVALUATION CONSULTANT: DATE COMPLETE: DATE REPORT RECEVIED: CASE MANAGEMENT ACTION PLAN: DATE COMPLETED: NEXT REVIEW DATE: TELEPHONIC CASE -MANAGER UTILIZATION REVIEW COMMENTS: DATE: UTILIZATION REVIEW NURSE: 62 Title: Communication with Litigated Claim and/or Claimant Attorney WC 20a Policy: To provide knowledge of the extent of verbal and written communication that a Telephonic Nurse Case -Manager may have with a litigated claimant or claimant attorney. Vice President ' Effective Date I /1 /2005 Most Recent Revision Date Review Date 9/23/2016 Approval Date for Calendar year 2017 by Medical Director 10/19/2016 11 4--) _;t, Procedure: • Verbal communication with the litigated claimant should be limited to brief discussion of medical condition/treatment and appointment date and time. • Written communication with the litigated claimant should be limited to notification of appointment date and time. • DO NOT DISCUSS ANY NON -MEDICAL ISSUES SUCH AS TERMS OF MEDIATION, ANY BENEFITS THAT MAY BE DUE. INDEMNITY ISSUES OR TERMS OF SETTLEMENT. These are adjuster functions and should be handled exclusively by an adjuster. • Verbal communication with the claimants attorney aka/ opposing counsel should be limited to brief discussion regarding the scheduling of appointments. The attorney should be encouraged to communicate any requests in writing to the adjuster. • If you are unsure of the direction of conversation with the claimant's attorney promptly redirect them to speak with the claimant's adjuster. • As there are different. policies for each account clarifies with the adjuster as to whether you are allowed to fax or mail network provider lists if requested by the opposing counsel. • Written communication with the claimant's attorney should be limited to notification of appointment date and time, • Any written communication sent to the claimant should also be sent to the claimant's attorney. 63 Title: Case Management — Medical Care Coordination WC 21 Policy: Health care providers must comply with the provider eligibility requirements in accordance with rule 38F-53, Florida Administrative Code and must be authorized by the carrier or their designee before providing routine treatment. Vice President ,�ly ,,./ J, Effective Date 1/1/2005 Most Recent Revision Date Review Date 9/23/2016 Approval Date for Calendar year 2017 by Medical Director 10/ 19/2016 I Procedure • All medical care rendered to an injured worker with the emphasis being on return to work will be under the direction of the Medical Care Coordinator. The Medical Care Coordinator must be a Medical Doctor or Doctor of Osteopathy, Chiropractor or Podiatrist. The Primary Care Physician or Point of Entry Physician may also be the Medical Care Coordinator as per the network contract. • Where the Primary Care Physician does not hold the designation of Medical Care Coordinator the organizations Medical Director will be utilized as the Medical Care Coordinator. • The Medical Care Coordinator is responsible for managing the medical care of an injured worker. including determining other health care providers and health care facilities to which the injured worker will be referred for evaluation or treatment in accordance with practice parameters and protocols of treatment. However, it is understood that the practicality of a physician directly providing those services is doubtful, understanding the efficiency and decreasing the cost of delivering medical care is the objective of the statute. Therefore. the organization operates under '`standing orders"' or procedural format using the acceptable guidelines that includes the internal Case -Managers who are Registered Professional Nurses or Licensed Practical nurses to augment and support the duties of the Medical Care Coordinator. • The Medical Care Coordinator will provide technical direction to the person providing the internal case management. • The Medical Care Coordinator will participate in the quality improvement process and the evaluation of outcomes • Will review grievances when indicated • The Medical Director acting as the Medical Care Coordinator is accessible on a regular and continual basis by telephone or fax and will have regularly scheduled meetings with the internal Case -Manager and or carrier representatives as needed. • Medical Care Coordination is performed at three levels — initial clinical review, peer clinical review and appeals consideration. 64 Title: Case Management Injured Worker/Employee Education WC 21a Policy: To ensure that the injured worker is educated in how to access medical treatment Vice President L,, , t1i.::.2:: +i/ , Effective Date 1/1/2005 Most Recent Revision Date Review Date 9/23/2016 Approval Date for Calendar year 2017 by Medical Director 10/19/2016 /" Procedure: • Those employees will be informed of their rights and responsibilities. • Employee education is a continuing process. • The first step is the education of the employees before an injury occurs. • This is the responsibility of the carrier and employer. This includes: • informing the employee of their right to medically necessary treatment • the requirement to seek care within the provider network • to obtain authorizations prior to obtaining services • consequences of not following the managed care requirements • the right to change primary care providers at least once • how and when to file a compliant or grievance. • The second component of employee education is development of and distribution of educational materials, which are provided to the employee before or at the time of injury. • This is typically done in the form of an employee handbook or pamphlet. This should contain: • The method or requirements for accessing medical care • Use of the network providers • Role of the primary care physician and the Case -Manager • Requesting a referral to a specialist • Any consequences of not using the network providers • Process for changing primary care physicians • Dispute resolution process • The Case -Manager is available to verify and reinforce the managed care process with the injured worker. the employer, the adjuster or the provider. • The Case -Manager should verify that the injured worker could read the information provided and if unable to read make sure that the information is verbally communicated to the injured worker. • Translation services will he provided if necessary 65 Title: Case Management —Medical Care Coordination WC 22 Policy: The organization will assure that the injured worker received initial covered care from a PCP except in cases ot'emervency care. Vice President Effective Date I f 1 /2005 Most Recent Revision Date Review Date 9/23/2016 Approval Date for Calendar year 2017 by Medical Director 10/19/2016 f /. IM t... r Procedure: A primary care provider means, except in the case of emergency treatment. the initial treating physician and when appropriate, the continuing treating physician responsible for the care of the injured worker. • The organization may designate medical doctors. chiropractors. podiatrists, optometrists. dentists, and the following types of physicians licensed under chapter 458 or chapter 459 FS. as a primary care provider: family practitioner. general practitioner and internist. • The organization may designate specialty physicians as primary care providers and medical care coordinators who are in the network. • The medical care coordinator will make the referrals to providers within the network. unless medically necessary treatment care or attendant care not available and accessible to the injured worker through the network. • In addition. for Florida Workers' Compensation. the organization may designate specialty physicians as the primary care provider and medical care coordinator based upon the individual treatment needs of an injured worker. This allows the choice and flexibility of designating and using specialty physicians who play a major role in the treatment and management of medical services as the primary care physician and medical care coordinator. This allows the organization to utilize the most appropriate provider for treatment of the injured workers` medical condition without unnecessary delays in treatment due to restrictive treatment and referral procedures. • The employee may select a primary care physician or medical care coordinator from the provider network directory or call the organization for information. • The employer is provided with a selection of primary care providers in the area to more easily identify the network providers in the specialty and geographic location. • The organization requires that all continuing covered services be received from the same network primary care provider that provided the original covered service except when a specialty physician is authorized by the medical care coordinator. • All specialty or referred physicians must be in the network unless medically necessary treatment or care is not available or accessible to the injured worker in the participating network. • The metrical care coordinator can be designated by specialty in the organizations computerized product. 66 Title: Case Management — Medical Care Coordination WC 22a Policy: The medical care coordinator is responsible for providing technical direction to the Case -Manager and either directly or indirectly managing the medical care of an injured worker including determining other health care providers or facilities to which the injured worker will be referred for evaluation or treatment Vice President -7' / t . 14) Effective Date 1/1/2005 Most Recent Revision Date Review Date 9/23/2016 Approval Date for Calendar year 2017 by Medical Director 10/19/2016 Procedure: Job Function: • Appropriate referral to a primary care physician • Authorizing diagnostics appropriate to diagnosis • Authorizing medications normally used for diagnosis and condition • Referral specialty evaluation based on medical need • Authorizing surgery and admission if in accordance with acceptable criteria • Setting a second opinion or authorizing change in provider • Initial denial of service based on medical necessity or relatedness to the compensable injury or for treatment outside the accepted s or contract. • Activities associated with a grievance • Grievous practice violations • Experimental procedures • Requests for service that are considered to be dangerous or not in compliance with established standards or practice parameters • Request for surgery, diagnostics, or treatment that are unsubstantiated by objective findings • Determination of MMI and PIR ratings Preparation, Training, Education • Hold a current unrestricted license to practice medicine • Have post -residency experience in direct patient care • Be familiar with the principles of utilization management • Be Board Certified and Certified W/C provider in State of Florida 67 Title: Case Management — Change of Provider WC 23 Policy: The organization will allow one change in network provider within the same specialty during the course of treatment for a work -related injury Vice President r,�,, Airizz,' ii/' Effective Date 1/1/2005 Most Recent Revision Date Review Date 9/23/2016 Approval Date for Calendar year 2017 by Medical Director 10/19/2016 /f r Procedure: • The injured worker or their designee either by fax or mail (in writing) contacts the medical care coordinator, the internal Case -Manager or the adjuster requesting a change in provider • The medical care coordinator or internal Case -Manager reviews the request for the change within 24 hours and will initiate the process within 5 days of the request. The medical care coordinator or internal Case -Manager may contact the injured worker or designee for additional information • The internal Case -Manager provides the carrier network access to providers of the same specialty within the network and allows the injured worker a choice of provider. If the injured worker has selected the initial specialist from the network, the subsequent specialist will be chosen by the employer/carrier from the approved provider network. (For WC/MCA only) • The internal Case -Manager chooses a provider of the same specialty and notifies the injured worker of the change. The claims adjuster is consulted with when necessary. The internal Case -Manager assists in facilitating the change in physician. 68 Title: Second Medical Opinion WC 24 Vice President C c1.taa; ,sf/? Effective Date 1/1/2005 Most Recent Revision Date Review Date 9/23/2016 Approval Date for Calendar year 2017 by Medical Director 1 0/19/201 6 Procedure: No longer required by the Florida Statue 69 Title: Independent Medical Exam WC 24a Policy: The organization will allow injured employees to obtain an IME as provided in FS g440.I3(5) Vice President "f 4 .' Effective Date 1/1/2005 Most Recent Revision Date Review Date 9/23/2016 Approval Date for Calendar year 2017 by Medical Director 10/19/2016 # Procedure: There is only one IME allowed per accident. per party The party requesting the IME is responsible for all expenses related to the IME Carrier IME: • Send copies of the medical records • Your authorization letter to the IME doctor may include any pertinent questions • Send appointment letter to the claimant and include their address at the top of the letter • Send appointment letter to the claimant and authorization letter to the IME doctor certified w/return receipt Claimant IME: • Send copies of the medical records. unless otherwise instructed by the adjuster or claimants attorney • Send authorization letter to the attorney only. They will notify the claimant • Do not direct any questions of the IME doctor • Send authorization letters certified w/return receipt 70 Title: EMA WC 24b Policy: To provide an expert medical advisor to resolve disagreement on medical services. Should it be determined by the claims department and /or legal counsel that an expert medical advisor is required, one who is certified by the state and meets statutory guidelines will be provided. Vice President .�� & '" ,L e�ifrl�z'Q' , IL` Effective Date 1/1/2005 Most Recent Revision Date Review Date 9/23/2016 Approval Date for Calendar year 2017 by Medical Director 10/19/2016 A lgil Procedure: • Once the referral is received by the medical management team. the medical advisory panel will be contacted to provide and list of Expert medical advisors for the specialty requested. • The Case -Manager will clearly document any actions that are taken on behalf of the medical management team, • Once the legal status of the claim is determined_ the Case -Manager will follow up with appropriate actions. documenting the actions in Corrus. 71 Title: Physician Choice WC 25 Policy: The organization will allow the injured worker to select a primary care physician or medical care coordinator from the network directory and one who is accessible within the service area Vice President .' f , ,/, Effective Date 1 / 1 /2005 Most Recent Revision Date Review Date 9/23/2016 Approval Date for Calendar year 20I7 by Medical Director 10/19/2016 I 1 I/;41 WC/MCA ACCOUNTS ONLY Procedure: • The injured worker has the right to select a physician from the network directory. • The internal Case -Manager may assist in directing the injured worker into the proper physician for the work related injury. • The internal Case -Manager may assist the injured worker by making the appointment with the selected physician. • The closest MCC/PCP/Acute Care Facility is listed at the employee's place of work. • A complete directory is available at the employers or injured workers request if one is not available. • The internal Case -Manager may direct the injured worker to the proper network WEB site for provider selection. • All attempts will be made to keep the injured employee in the provider network. • Authorization of non -network physicians will be based upon medical needs and only when a physician specialist or service cannot be located within the provider network. 72 Title: Case Management - Physician Selection WC 25 a Policy: The case manager will direct the injured worker to a primary care physician or specialty physician from the network directory and one who appropriate to treat the injury and is accessible within the service area Vice President .� ` Effective Date 1/1/2005 Most Recent Revision Date Review Date 9/23/2016 Approval Date for Calendar year 2017 by Medical Director 10/19/2016 �,� Procedure: • A primary care provider means, except in the case of emergency treatment, the initial treating physician and when appropriate. the continuing treating physician responsible for the care of the injured worker • The organization may designate medical doctors, chiropractors. podiatrists, optometrists, dentists. and the following types of physicians licensed under chapter 458 or chapter 459 FS, as a primary care provider: family practitioner. general practitioner and internist. • In addition. for Florida Workers' Compensation. the organization may designate specialty physicians as the primary care provider and medical care coordinator based upon the individual treatment needs of an injured worker. This allows the choice and flexibility of designating and using specialty physicians who play a major role in the treatment and management of medical services as the primary care physician and medical care coordinator. This allows the organization to utilize the most appropriate provider for treatment of the injured workers' medical condition without unnecessary delays in treatment due to restrictive treatment and referral procedures. • The internal Case -Manager will assist in directing the injured worker into the proper physician for the work related injury. • The internal Case -Manager will assist the injured worker by making the appointment with the selected physician. • The closest MCC/PCP/Acute Care Facility is listed at the employee's place of work. • A complete directory of the geographic area is available at the employer's request. • There is a one-time change in physician allowed of the same specialty for the life of the claim. The prior physician becomes unauthorized at that time. 73 Title: Case Files WC 26 Policy: The collection of medical and demographic information is necessary for the scope and course of case management Vice President ('cla�2�. Effective Date 1/1/2005 Most Recent Revision Date 9/30/2015 Review Date 9/23/2016 Approval Date for Calendar year 2017 by Medical Director 10/19/2016 �� Jfr '�` Procedure: First Report of Injury (FROI) • The First Report of Injury (FROI) is necessary to initiate case management. • The First Report of Injury (FROI) is a tool that describes the nature and cause ofan injury. • The First Report of Injury (FROI) provides demographic information necessary to assist in the assignment of a provider within the travel requirements of the governing body. Provision of medical records • It is the responsibility of a health care provider to submit required documentation to the carrier or their designated representative • A complete DWC-25 should be submitted within 3 business days of the initial visit • A complete report of the patient's symptoms, findings and plan of treatment must be submitted within 15 working days from the initial service and at least every 30 days if requested. • A copy of an operative report must be submitted when a surgical procedure is performed. • A report is necessary when an IME or consultation is provided • A copy of the clinical notes including any testing results for a visit to determine maximum medical improvement and permanent impairment rating. • A specific plan of care for therapy, which identifies the potential degree of restoration and measurable goals. specific therapy needed and frequency and duration of services to be provided. • Reports of psychiatric evaluation and tests • Results of neuromuscular testing procedures • Any report listed as a part of a procedure codes descriptor • A copy of the clinical notes with each medical bill unless the carrier notifies the provider of less frequent intervals such as in chronic cases. Any information needed to substantiate medical necessity and of any service and to verify the relatedness to an injury beyond that contained in the medical record may be requested. The CORRUS system will be utilized to document and act as a tool to ensure case coordination. Each user has a unique "sign on" with a security level for that position. • The adjuster or Case -Manager will enter the First Report of Injury (FROI) into the system. 74 • The Case -Manager and adjuster will document case activity using the case note and case note type designations. • The primary care physician/medical care coordinator will be listed in the claim record • The treatment plan as well as updates will be documented in the case note. • Work status, work restrictions, date of MMI and PIR will be recorded in the case notes as well as on all support screens • The Case -Manager will document all return to work activity and all rehabilitation activity in the case note. Hard Copy Files/Scanned Copy Files • The carrier will keep the hard copy files as per their policy. • Medical information will be kept in the adjuster file and only viewed by those individuals responsible for the medical care. • Medical information will be found on file as well as MMI. PIR, work status, and any vocational work. • Scanned records will be maintained in the CORRUS system as an attached note with the ability to be printed if needed. 75 Title: _,__WC Medical Records — Handling 26a Policy: To obtain the information necessary to substantiate. verify and monitor all medical care rendered to an injured worker. Vice President ,'7' tiv ' Effective Date 1 / 1 /2005 Most Recent Revision Date Review Date 9/23/2016 Approval Date for Calendar year 2017 by Medical Director 10/19/2016 /t y' i1� Procedure: All medical records submitted to the insurer are the property of the insurer. • All medical records will be handled by all staff to protect the confidentiality oldie injured worker. • The initial Case -Manager may receive records directly from the physician. • The internal Case -Manager will make notes in the Corrus computer system in order to track the case and document the progress of the case. • All MMI and PIR information will be recorded in Corrus • All return to work activity and restrictions are noted and recorded • All other pertinent information will be recorded in the electronic system. • Each insurer has a mechanism for storing hard copy files. — See insurer's policy. • Each leased network has the responsibility for training their providers. This organization will assist where necessary to promote and foster their policy. 76 Title: Medical Records — Consent WC 27 Policy: To obtain the information necessary to substantiate, verify and monitor all medical care rendered to an injured worker. Vice President ' Effective Date 1 / 1 /2005 Most Recent Revision Date Review Date 9/23/2016 Approval Date for Calendar year 2017 by Medical Director 10/19/2016 �, �i r Procedure: Under the Workers' Compensation program consent is not need in order to obtain medical information from the provider. The medical information is confidential and is only to be viewed by those individuals performing. claims management. case management and utilization review activities and the information is limited to that information related to the specific injury or accident. Providers are responsible to submit to the insurer the following: • The completed DWC-25 within 3 business days of the initial visit. • A complete report of the injured workers" symptoms, finding. plan to treatment within 15 days of service. • An operative report when a surgical procedure is performed • A narrative report when a consultation to independent medical examination is rendered. • A narrative report when the word report is in the CPT code descriptor. When documentation is necessary to substantiate the information contained in the record. This may include: • The Major Contributing Cause of Injury/Illness • Objective findings that support the need for medical care, as well as continuing treatment • Estimated period of time and number of services required for treatment • Anticipated benefits of the treatment to the patient. • Special consent is needed for certain conditions such as HIV. substance abuse and mental health issues. 77 Title: Confidentiality WC 27a Policy: The employees in the course of their work may have access to confidential information regarding the injured worker or client. A prime responsibility of each employee is not to reveal or divulge any such information and that the information is used only in the performance of duties. Vice President iiry//.. ?i Effective Date 1/1/2005 Most Recent Revision Date Review Date 9/23/2016 Approval Date for Calendar year 2017 by Medical Director 10/19/2016 Procedure: • Uphold the confidentiality of medical and demographic information obtained on an injured worker or member. • Confidential records are determined to be any records that contain identifying characteristics such as name, social security number or address. • Medical records will be protected from loss. alteration and unauthorized use or damage. • All information related to substance abuse, mental health or HIV would be strictly confidential and viewed only by the Case -Manager as it pertains to the case. • Medical record information may be reviewed and requested by the Medical Director. Case -Manager. Claims Analyst and the Carrier Medical Consultant for the performance of their duties. • Personnel not directly involved in the injured workers medical care will not have access to medical records. • Patient specific information obtained during the process of utilization review will be used solely for the purpose of utilization review and quality assurance • Unless otherwise specified. such as in Workers' Compensation. a Release of Medical Information will be obtained and submitted when requesting medical information on patients and injured workers. • The organization will not release any medical information unless a Request for Medical Information is received from the patient or injured worker except in the case of a workers' compensation case. • Medical records obtained by the Carrier. TPA or Employer and used by the organization personnel in performance of their duties will be subject to the above. • The organization will not distribute data identifying a physician or provider, except as allowed or required by state/federal regulations/rules or without obtaining an appropriate release of information. • The Employee Handbook distributed by Brown and Brown has a confidentiality statement. Each employee signs that they have received this handbook. This form is located in the personnel file and kept in personnel at Brown and Brown. 78 Title: Training of All Personnel WC 27b Policy: All persons involved in the medical managment process will be trained in the principles and standards of utilization management Vice President Effective Date 1/1/2005 Most Recent Revision Date Review Date 9/30/2016 Approval Date for Calendar year 2017 by Medical Director 10/19/2016 .711;:-) Procedure: All persons involved in the medical management process will be trained in the Statutory. AHCA. URAC and medical management principles and standards. The persons involved in this process will include: professional staff, claims benefit adjusters. bill review staff, support personnel and intake personnel which includes all persons who answer the telephones. • The bill review staff will process claims for proper payment for workers` compensation claims. • The support staff will provide clerical assistance to the professional staff. The support personnel may collect data and intake screening. The support staff will be directly responsible to the Case - Manager. Telephone calls will be directed to the proper source and will be forwarded to the proper person or department. • The switchboard personnel will receive specific instruction on directing phone calls to the proper department. The switchboard operator will ask the caller the purpose of the call. which may include but is not limited to verification of benefits. reporting work injuries. seeking pre - certification or medical authorization and reporting a compliant or grievance. • All persons involved in utilization activity will review the policies and procedures, which meet the standards of the Utilization Review Accreditation Committee. This will include but is not limited to: • Confidentiality statement • Utilization Management and the Quality Assurance Manual • Grievance procedures and time frames associated with this process • Satisfaction surveys • The policy and procedure manual w ill be reviewed with each person responsible for this activity. 79 Title: Role of non -clinical (administrative staff) personnel in data collection WC 27c Policy: To ensure that all personnel involved in the case management process are trained in the policies and principles of confidentiality managed care Vice President (?u ,i/t) Effective Date I / U2005 Most Recent Revision Date Review Date 9/30/2016 Approval Date for Calendar year 2017 by Medical Director 10/19/2016 Procedure: All persons involved in the managed care process will be trained in the Federal, Statutory and URAC principles and standards for confidentiality. • The persons involved in the process will include: • Professional staff • Bill review staff, • Support personnel • intake personnel, which includes all persons who answer the telephones • Non -clinical support staff may be responsible for data collection in some form. Bill Review Personnel • The bill review staff will process claims for proper payment for workers' compensation claims. • Non -clinical data will be collected as needed • During the course and scope of employment. the bill review staff will be required to review or request medical records for payment determination. • The bill review staff will request only those reports that are related to the billing code submitted. as required by the reimbursement manual or necessary to determine medical necessity or relatedness. Support Staff • A support staff may provide clerical assistance to the professional staff. • Non -clinical data will be collected as needed • The support personnel may collect data and intake screening • The support staff will report and receive direction from the nurse Case-Manager/UR Nurse Specilaist • Telephone calls will be directed to the proper source and will forward to the proper person or department. 80 intake Personnel • The Intake personnel will receive specific instructions on directing phone calls to the proper department. • Non -clinical data will be collected as needed • The switchboard operator will ask the caller the purpose of the call, which may include, but is not limited to verification of benefits. reporting work injuries. seeking pre -certification or medical authorization or reporting a grievance Data Collection • All data collected will be of a confidential nature • Only that data having to do with the current work injury will be requested or reviewed • All other data will be returned to the provider or carrier as not necessary for review. 81 Title: Injured Worker Education WC 27d Policy: To ensure that the injured worker is aware of the managed care plan and how to access the MCA Vice President t ia,f/ 71, ^ ,, , ,' Effective Date 1/1/2005 Most Recent Revision Date 9/12/2012 Review Date 9/30/2016 Approval Date for Calendar year 2017 by Medical Director 10/19/2016 r /t WC/MCA ACCOUNTS ONLY Procedure: • Those employees operating under a WCMCA must be informed of their rights and responsibilities under managed care. • Employee education is a continuing process. • The first step is the education of the employees before an injury occurs. • This is the responsibility of the carrier and employer. This includes • informing the employee of their right to medically necessary treatment • the requirement to seek care within the provider network • to obtain authorizations prior to obtaining services • consequences of not following the managed care requirements • the right to change primary care providers at least once • how and when to file a complaint or grievance. • The second component of employee education is development of and distribution of educational materials. which are provided to the employee before or at the time of injury. • This is typically done in the form of an employee handbook or pamphlet. This should contain: • The method or requirements for accessing medical care. emergent or routine • Use of the network providers • Role of the primary care physician and the Case -Manager • Requesting a referral to a specialist • Any consequences of not using the network providers • Process for changing primary care physicians • Dispute resolution process • The Case -Manager is available to verify and reinforce the managed care process with the injured worker. the employer, the adjuster or the provider. • The Case -Manager should verify that the injured worker could read the information provided and if unable to read make sure that the information is verbally communicated to the injured worker. Translation services will be provided if necessary 82 Title: Medical Record Audit WC28 Policy: The organization currently leases the provider network. The leased network has in place a policy for medical record reviews for their providers. AmedSys will receive a copy of the annual report from the leased network for this service Vice President ,'7;_ d Ili,: L.: Effective Date I / 1 /2005 Most Recent Revision Date Review Date 9/30/2016 Approval Date for Calendar year 2017 by Medical Director 10/ 19/2016 ij,( Procedure: AmeriSys will review medical records on a quarterly basis for QA purposes and report findings to the leased network. The organization does not always receive complete detailed medical records. • Often, the organization will receive office notes only. • This makes a complete record review impossible. • The organization, as part of the quality improvement plan, will review the medical records or office notes submitted by providers for compliance with established standards. • The results of the review will be forwarded to the network for their review. The Supervisor/Team leader or designee may review random files per each WC/MCA for compliance with the AHCA standards. • This will include the number of physicians reviewed by county or specialty • Areas where specific improvement in records keeping are indicated • Results from implementing improvements recommended in prior audits • Recommendations for education and feedback to providers • Extent to which the physicians treatment plan was implemented • Documentation of relatedness • Significant procedures • Past and current diagnoses or problems • Work restrictions, activity and MMI/PIR information The medical record review sheet will be used for the review. The results of the record review per provider still be included in the utilization report submitted to the utilization review committee. Any identified quality issues will be presented to the quality assurance committee. The leased network will be notified of any deficiencies identified. The team leader or the designee will track the results of the review for trends. 83 Title: Case Files System / Corrus System/Coordination of Care WC 29 Policy: The collection of medical and demographic information is necessary in the scope and course of case management Vice President ," Effective Date 1/1/2005 Most Recent Revision Date Review Date 9/30/2016 Approval Date for Calendar year 2017 by Medical Director 10/19/2016 Procedure: The Corrus system is used to electronically track claims. Case notes are written to document all medical activity on managed care cases. This includes but is not limited to: • Medical care coordinator or primary care provider • Reemployment Scheduling of office visits • Referring providers and specialists • Major Contributing Cause • Treatment plan and updates • Work status and restrictions • Return to work activity • Savings achieved by aggressive return to work practices • MMI and PIR determination • Savings achieved by aggressive case management coordination of care • Compliance with treatment • Rehabilitations efforts • Document daily office notes of providers with pertinent medical documentation • Diary activity 84 The leased network will be asked to provide copies of their medical record audit conducted on their providers on an annual basis. Managed Care Claim Summary DATE: 30 Day 90 Day 150 Day 170 Day Days UR CLAIMANT: D/A: TYPE OF INJURY/BODY PART: DIAGNOSIS: PRE-EXISTING INJURY: YES NO WAS MAJOR CONTRIBUTING CAUSE ADDRESSED: YES NO PLAINTIFF ATTORNEY: DEFENSE ATTORNEY: CURRENT TREATING PROVIDER MCC/SPECIALTY: 1. 2. 3. PREVIOUS TREATING MEDICAL PROVIDERS: (For UR purposes) CURRENT WORK STATUS: DATE: IF MODIFIED, RESTRICTIONS: SURGERY DATE: THERAPY — PT/OT MEDICATIONS REG FLAGS YES NO BRIEF MEDICAL SUMMARY WITH CURRENT TREATMENT: ONE TIME CHANGE: YES NO NAME/SPECIALTY: FIELD CASE -MANAGER ASSIGNED: YES NO NAME: MEDICAL DIRECTOR INTERVENTION REQUESTED YES NO MMI DATE: IMPAIRMENT RATE: BY DR: IS THE EMPLOYEE/CLAIMANT MMI BY ALL TREATING PHYSICIANS? YES NO UTILIZATION REVIEW: PRE -CERTIFICATION ASSESS AND ADVISE: DATE OF COMPLETION: PEER REVIEW RECONIMENDED/REQUESTED YES NO AUTHORIZED YES NO TYPE: DATE OF REFERRAL: DATE OF COMPLETION: GRIEVANCE FILED: YES NO TYPE: DATE FILED: OUTCOME: IME: YES NO TYPE: DATE: DR: CARRIER IME? YES NO CLAIMANTS IME: YES NO REA OR VOCATIONAL EVALUATION COMPLETED: YES NO EVALUATION CONSULTANT: DATE COMPLETE: DATE REPORT RECEVIED: CASE MANAGEMENT ACTION PLAN: DATE COMPLETED: NEXT REVIEW DATE: UTILIZATION REVIEW COMMENTS: _ DATE: UTILIZATION REVIEW NURSE: 85 Injured Worker information: es Is• n.." 74. 4.0 §:. ureo•Itet .11..77:* 1 • Claim Information tar 4716-Kok alm •4••••rern "Vow rpr/e �r un}. P.15CM* 1 • NIP 31.1 Zr+7.6§ 1111,111§, Case Notes: .111M.1.1111.1.1 • a*. .••••a a- wity• MCP,* 114•3 11111 111:+• 0 . - ,at., Qat ”14 7se • r f_imel .2111Nifiailf:=1.0111=2...MIEL-,- i ^4 4...•21111=1•11 assm ulartal. ....., , ,...... .1 , 0 oar ir 0.4.1.1 1.0 .i .i L... kallno Allillael D•I.1 .• laa w.• PO. 01.1.,.. 1 "61,-.1d.• Ill . .: I'di• Sim], ...• - • , am Tn.. 1,2, >...a• -, .n.r.6 :I, , . ,..4 ...- •..V.....r.r.{",".4.,..g...•.r .1. la l'aa.N•t• ID. r1 t.,..4,-r Ca.. ‘Saa,„..- 4 :„,, ...e 'fp.. 15'W, low. .... ',. ,a•an td•ert .. k:,..ram.... ...-7..., na, ....al ... ,...,.... • an aqua...4 •aem a I li.../l•a..... .... ......., . .. . . • .. i.„, - 1 .11101 86 Return to Work Dirsr by en efts Et1 Paperis Th. Cke.4 mar, Clan. aff 72:*/13 eith D. of I} vatvu X 20 CON W.A1) Y I Prar*.:1 Rrnos4o-Wark Date : I gager ?canoed %maw La. Ana Rdnin-le-Wink Mier 1— hill &At; — Cram Adecrky 16/441Indd last rah Rev:amend RAWL. to RC Taw 00 60 vC10‘. teem le we* Madded bun Star Athol Rerapsi-te-Weeft sitei )0t, Prowsted Sanaa to Stoddard &nun To Wort Lon Inas not nth Dug% a Rea. Fe W Me:6dd Dun- !Wee I ed le ace Oak Dm Eloped End Days RatINICIMIS L'an.dialie Hegel End Jr, Evi Dui.: 00 90 YX,7 .71 3000 x• 7.e woo •!, I •fyi•-. 30 1,3,X Commas: Reg. Nan LEW. Lest Toe CiondirDiErd -7'7 Med lOury n rosy/ Mod Duty CanularEins Lan Tmd. W.& rloss.(0911.4 I i Mad Dury Wert Dor MSEL11 0001214 Reamarre-Wort Scowl's NOMA MCIV.I1-41'401,..., Sii,crit, Pfej.Nuak LT Cnendor Comp • Canna RTL1; Restno 4 d 7R1t{{ COM, • LT Days 1:1•yi tat. Tomp FO.:04,1•141.A PAT, (1-316-- . r --es--- ) *) • or-TY:1 - .1,-----isTiii ( ".-...- * Th. Mink Clay RAY elm end 1. akUlale ela Corms Rill. Sernip Rehabilitation Information: e. E. dram "m.o. )11.m. AM yobs Era kinged-ann.r.ee• aE. Halo RIP'S Rt% AbrillX It I' C 1- 14.111W p• • :,••••• 0110.4 07.4,A,ree- prrw. Dd. ere Ispey.rl Za.C.nataa 1A-a IlenEr..(1.44.4 Contact Screen: er tam.. M- 6600 1.11n,s .7.,,A^71, 3 * * :are floe enoctedenew 441;141 t•••••• J 87 Title: Case Files Confidentiality and Security WC 30 Policy: To provide secure electronic filing system. Vice President 17,6,,,/ Effective Date 1/1 /2005 Most Recent Revision Date Review Date 9/30/2015 Approval Date for Calendar year 2017 by Medical Director 10/19/2016 f r Procedure: The organization has a process which addresses the security and confidentiality of electronic case files. Electronic case files are password protected. The case files are protected by Verisign Secure. Passwords must be chanced every 30 days Passwords are complex in nature — must contain alpha — numeric combinations. When sending an e-mail containing highly confidential information that may include HIV. substance abuse or mental health issues the information is placed in a document that is marked highly confidential and zipped and password protected. E-mails contain a confidentiality disclosure statement. The storage of medical records that contain information on HIV. substance abuse and mental health issues are secured by the policy of the Third Party Administrator or Insurance Carrier. AmeriSys will abide by their policy. AmeriSys will password protect in the Corms Case Management System any claim that is designated as highly confidential and may contain information on HIV. substance abuse and mental health as directed by the claims policy. 88 Title: Grievance Procedures Overview WC 31 Policy: The organization recognizes that from time to time a member, injured worker, employer or provider may be dissatisfied with any aspect of service provided Vice President ' , Effective Date 1 / 1 /2005 Most Recent Revision Date Review Date 9/30/2016 Approval Date for Calendar year 2017 by Medical Director 10/ 19/2016 ,�� /� r WCJMCA ACCOUNTS ONLY Procedure: The organization will resolve to the best of their ability all complaints and grievances per managed care guidelines. The procedure will include reviewing all: • Request for Service • Complaints • Written Grievances Any dissatisfaction expressed by the insurer, the injured worker, or delegated entity from the injured employee. provider. designated representative concerning the workers' compensation managed care arrangement. • The organization is committed to the resolution of any form of complaint/grievance • A complaint/grievance may be received by written letter. • The internal Case -Manager will investigate all complaints/grievances received from the insurer, the injured worker. or delegated entity from the injured employee, provider, designated representative. the Agency or the Division. Within 10 calendar days of receipt unless the parties and the insurer or designated entity mutually agree to an extension. All urgent grievances will have determinations issued with 72 hours. • If a complaint/grievance remains unresolved a the end of the 10 days. the insurer or designated party will notify the affected parties and the insurer or designated entity in writing of the right to file a grievance. The written denial will include the name, title, and address and telephone number of the grievance coordinator. • If the insurer or designated entity denies a complaint. the injured worker will be notified as to the reason for the denial. The insurer or designated entity will also advise the injured worker of the right to contact the Divisions Employee Assistance Office for additional information on rights and responsibilities and the dispute resolution process. 89 Title: Grievance Procedures Education WC 32 Policy: Educational materials will be distributed by the insurer with the managed care information. Vice President i, •14.24:` Effective Date 1 / 1 /2005 Most Recent Revision Date Review Date 9/30/20 16 Approval Date for Calendar year 2017 by Medical Director 1 0/19/201 6 f It( /i WC/MCA ACCOUNTS ONLY Procedure: It is the current duty of the insurer to distribute educational material on the managed care program. This will include a detailed description of the provider complaint and grievance procedures. The information will be reviewed and updated as needed. 90 Title: Request for Service WC 33 Policy: The organization will address initial requests for service. Vice President F Effective Date 1 / 1 /2005 Most Recent Revision Date 9/06/2011 Review Date 9/30/2016 Approval Date for Calendar year 2017 by Medical Director 10/19/2016 A i il :ir ' Procedure: Initial requests for medical services or changes in providers are not considered complaints or grievances. The Medical Care Coordinator and/or the internal Case -Manager will review initial request for services including medical services or a change in providers. All requests will be evaluated within 5 calendar days for the state of Florida or in compliance with the other state statutory requirements. The internal Case -Manager will contact the injured worker or their designee for information and may need to contact the attending physician. The injured worker will be notified of the decision to grant the request, to deny it or the need for additional information. The injured worker will be notified in writing lithe request is denied. The injured worker will be notified of the right to file a grievance. The AHCA form 3160-0019 will be included with the notification. lithe insurer or designated party does not respond within 7 calendar days of the receipt of request. the injured worker may make a complaint or file a written grievance.. 91 Title: Complaints WC 34 Policy: The organization recognizes that from time to time a member, injured worker. employer or provider may be dissatisfied with any aspect of service provided. Vice President './/de'1.i' 71' '� Effective Date 1 / 1 /2005 Most Recent Revision Date Review Date 9/30/2015 Approval Date for Calendar year 2017 by Medical Director 10/19/2016 I/ ill /t Procedure: Complaint is any dissatisfaction expressed by an injured worker. provider or employer concerning the workers' compensation managed care arrangement. • The organization is committed to the resolution of any form of complaint. • A complaint may be received in person or by telephone. • The Nurse Case -Manager will investigate all complaints received from the insurer, the injured worker, or delegated entity from the injured employee, provider, designated representative. the Agency or the Division. Within 10 calendar days of receipt unless the parties and the insurer or designated entity mutually agree to an extension. • If a complaint remains unresolved at the end of the 10 days, the insurer or designated party will notify the affected parties and the insurer or designated entity in writing of the right to file a grievance. The written denial will include the name. title, and address and telephone number of the grievance coordinator. • 1f the insurer or designated entity denies a complaint, the injured worker will be notified as to the reason for the denial. The insurer or designated entity will also advise the injured worker of the right to contact the Divisions Employee Assistance Office for additional information on rights and responsibilities and the dispute resolution process. 92 Title: Customer Concern WC 34a Policy: The goal is to promptly and appropriately address and/or resolve concerns and complaints expressed by our customers Vice President `' Effective Date 1 / 1 /2005 Most Recent Revision Date Review Date 9/30/2016 Approval Date for Calendar year 2017 by Medical Director I Q/ 19/2016 �` /`t ff r Procedure: RECEIPT OF CONCERN: Customers are encouraged to communicate concerns or complaints related to services provided by AmeriSys. We believe this will allow us to improve our services as well as improve communications with our customers. This communication can be: • Written (email. memo or on the Customer Concern Form) • Verbal (personal meeting or telephone) If the Concern is cotnmunicated in writing (other than the concern form) or verbally, the person receiving the concern is to immediately implement the Customer Concern Procedure and begin with filling the form. If the Customer Concern is reported on the Form. the person receiving the form shall review the form to assure all necessary information is on the form to assure proper resolution. DOCUMENTATION Please assure that there is adequate information identifying the concern as well as the person reporting that concern. PROCESSING THE FORM: 1. All Customer Concern Forms are to be routed to UM Department. 2. Customer Concern Form must be immediately routed to the supervisor of the related service: • Telephonic Case Management & PPO • Bill. Review • Utilization Review (Pre-cert. etc.) • Field Case Management • Billing 3. The appropriate Supervisor is to initiate investigation immediately and provide a telephonic/email update to the customer within one business day. 4. Upon completion of investigation, a resolution or recommendation is to be outlined. 93 5. Upon completion of investigation and a plan or resolution is recommended. this is to be communicated back to the customer by sending (emailing) the first page of the form to the Customer contact generating the concern. A phone call is also generated to discuss the findings and plan. • If the plan is acceptable, implement • If the plan is not acceptable. make immediate contact with the manager of UM Services. 6. After communication with the Customer, documentation of their response will be documented and the Customer Concern Form will be forwarded to the manager of UM Services for administrative analysis and disposition. 7. After the Program Manager for the specific department has completed the analysis and disposition. the form will be forwarded for cataloging and reporting. 94 AmeriSys Concern/Comment Form Customer Name: Date of Concern/Comment: Account Name: Claimant Name: Claim #: AmeriSys Staff Name: Service Concern/Comment: Please assure that this section is complete enough to allow for proper research. review and investigation to be able to properly resolve or recommend a plan for resolution. AmeriSys Staff initial actions: This section should document what was done immediately, including what you communicated to the Customer on what you were going to do and when the customer can expect you to get back with them .for an interim and/or f nal report. AmeriSvs findings and recommended resolution/plan: This sliolllcl section should detail the result of your findings related to the concern and your plan or recommendation Ibr resolution. The resolution/recommendation should be detailed enough to serve as an action plan. If there is no further action recommended or required, please document that also. Customer's Response to findinfus, resolution or recommendation: Either the customer completes this section or the individual reporting will document the customer's response on their behalf. For Office Use Only Provider Response: An achninistrative analysis of the customers response will be documented. Final Outcome: An administrative analysis will be documented 95 Nature of Concern/Comment: (circle one) I . Cost 2. Timeliness of Delivery 3. Quality of Product or Service 4. Inadequate Reporting 5. Staff 6. Referral Process Area of Concern/Complaint: (circle one) I. Telephonic Case Management 2. Field Case Management 3. Utilization Review 4. Bill Review 5. Medical Network Provider 6. Pharmacy Provider 7. Billing 8. Reporting Final Outcome Resolution: (check one) ❑ Very Good ❑ Good ❑ Fair ❑ Poor ❑ Very Poor 96 Title: Grievance Form WC 35 Policy: The form for written grievances will be AHCA form # 3160-0019 Vice President ,-? Effective Date 1 /1 /2005 Most Recent Revision Date Review Date 9/30/2015 Approval Date for Calendar year 2017 by Medical Director 10/19/2016 % Mph Ar /i WC/MCA ACCOUNTS ONLY Procedure: The AHCA term # 3160-0019 will be used for written grievances. It is available on line at the AHCA web site — www.fcihc.state.t1.us/MCHQ/Managed Health Care/WCMC 97 Title: Grievance Form Availability WC 36 Policy: The insurer will develop and implement a policy and procedure governing the ability and distribution of the grievance procedures and the required form. Vice President f.7' < z/A.1 ;1,�. Effective Date 1 / 1 /20 05 Most Recent Revision Date 4/5/2011 Review Date 9/30/2015 Approval Date for Calendar year 2017 by Medical Director 10/19/2016 /Jt �f 00, Procedure: The complaint and grievance policy is sent to the injured worker by the insurer at the time of injury including where to obtain the grievance form. The internal Case -Manager may assist in with this information. When requested. the form and procedure for filing a written grievance will be made available to the provider, the employee or their designated representative within 7 calendar days of request. The form may be posted under the "broken arm" poster if the employer wishes. There is no charge to the employer, employee or provider for administering the grievance process. 98 Title: Written Grievance WC 37 Policy: A grievance is a viTitten dissatisfaction with medical care provided by an insurer. also the insurer's refusal to provide medical care as defined in Section 440.134(1)(d) F.S.. the grievance process will begin with the receipt of AHCA form No.3l 60-00I9. Vice President ���hhiRu.2" ; Effective Date 1/1/2005 _ Most Recent Revision Date 11/28/2008 Review Date 9/30/20 I 5 Approval Date for Calendar a eD e t7 by Medical Director 1 0/ 1 9/2016 WC/MCA ACCOUNTS ONLY Procedure: A grievance may be received from the injured employee. provider. or their designated representative. The insurer or designated entity shall notify the all involved. • A grievance may be filed without first submitting a complaint. • The employer will be notified when a grievance has been filed. • A grievance may be submitted or withdrawn at any time. • The following is not covered under the grievance process: • Initial written requests for medical services • One time change in provider • Grievances do not address the following as these are claims issues and will be handled by claims adjuster. • Indemnity benefits • Vocational benefits • MMI or PIR issues • Mileage reimbursement • Attorney costs and fees • Compensability • Causation • The organization has designated a Grievance Coordinator to coordinate the documentation and investigation of all complaints and grievances. • The Medical Director assists the Grievance Coordinator in the resolution of all complaints and grievances. • Upon receipt of the additional medical information. the Grievance Coordinator and the Medical Care Coordinator/Medical Director will review the medical documentation. If required a physician ofa like specialty will be consulted. • The Grievance Coordinator will inform the provider, claims representative and facility of the recommendation regarding certification of the medical treatment. • The Grievance Coordinator determines if there has been a breakdown in policy or procedure. • The Grievance Coordinator w ill inform the Quality Assurance Committee of any quality issue identified through the grievance process. • The telephone number and address are published to report a grievance. • This information will be part of the employee information packet sent to the injured employee. 99 Title: Grievance process and the grievance committee WC 37a Policy: Upon receiving the grievance form AHCA #3160-0019, the Grievance Coordinator will document the grievance in the grievance log. If the employee is unable to fill out this form the insurer or delegated entity will assist in the form completion Vice President 7 Effective Date 1/1/2005 Most Recent Revision Date Review Date 9/30/2016 Approval Date for Calendar year 2017 by Medical( Director 1 0/ 1 9/2016 WC/MCA ACCOUNTS ONLY Procedure: • It is not necessary for a complaint to be made before a written grievance is submitted. • A written grievance may be submitted or withdrawn at any time. • The employer will be informed of any written grievances. • The Grievance Coordinator investigates and shall gather and review all medical and related information. • The Grievance Coordinator will discuss with the medical director and the Case -Manager. the claims adjuster, provider, network representative or other involved party. • The Grievance Coordinator acknowledges the receipt of the grievance within 24 hours. • Upon receipt of the written grievance, the grievance coordinator shall gather and review the medical and related information. After all appropriate parties are consulted a decision should be rendered within 14 calendar days. • The Grievance Coordinator shall notify the injured employee and employer of a resolution on the grievance within 7 calendar days of the final determination. An expedited grievance will have a decision rendered within 3calendar clays of receipt. • The Grievance Coordinator will inform the provider. claims representative and facility of the recommendation regarding certification of the medical treatment. • if the determination is not in favor of the aggrieved party the grievance coordinator will notify the grievance committee for further consideration unless withdrawn in NAriting by the employee or the provider. 100 • Grievances that cannot be resolved will be sent to the grievance committee for review. • The Grievance Committee will consist of at least three members including the medical director or other peer physician. a representative of the insurer and representative from managed care. • The committee will review all the necessary information pertaining to the issue and render a decision ‘.%ichin 30 calendar days of receipt by the committee unless the grieving party and the committee mutually agree to an extension that is documented in writing. • If additional information is needed from outside the service area in order to make a determination, the entity will have an additional 14 days in which to render a determination. The employee will be notified in writing within 7 days if additional information will be necessary. • If requested by the employee or the provider, a meeting will be arranged at a convenient location with the committee. • The claimant or provider shall be considered to have exhausted all managed care grievance procedures if a determination on a grievance has not been rendered within the required time frame or the specified agreed upon time frame. • Upon completion of the grievance procedure. the insurer or delegated entity shall provide written notice to the employee of the right to file a petition for benefits with the Department of insurance, Division of Workers Compensation pursuant to Section 440.192FS. • The employer and employee will be unformed in writing of the decisions within 7 days of the final determination. • The Grievance Coordinator is responsible for regular and systematic review of all formal grievances for the purpose of identifying trends or patterns and. will upon the identification of any pattern make recommendations for appropriate corrective action to the proper committee. • The Grievance Coordinator or the designee keeps a record of each complaint or grievance. (See grievance log) • The Grievance Coordinator files the annual report of grievances filed by employers and providers to the Agency for Health Care Administration no later than March 31 for grievances filed during the previous calendar year. 101 GRIEVANCE COMMITTEE FORM Claimant SS # Employer: Carrier: Date of Grievance: Date of Committee Session: Committee members in attendance: Grievance issue being addressed: Claims Summary: Managed Care Summary: Medical Director's conclusion: Grievance Coordinator: Please attach a copy of the response letter to claimant or attorney relaying the committee's decision regarding the grievance, also notifying the claimant/attorney of their right to .file cr Petition for Benefits, 102 Title: Grievance Procedure Arbitration WC 38 Policy: The insurer or delegated entity shall develop and implement policies and procedures governing written grievances. which allows but does not require arbitration Vice President 6 4 Effective Date 1 / 1 /2005 Most Recent Revision Date _ Review Date 9/30/2016 Approval. Date for Calendar year 2017 by Medical Director 10/19/2016 /11 7 14-D Procedure: All appeals procedures are aimed at mutual agreement for settlement. Should an injured employee. provider or facility desire arbitration for a difference of opinion the insurer will make available an impartial arbitrator may be available to hear the case and resolve the dispute. This is at the discretion of the Employer/Carrier. A grievance that is arbitrated is permitted an additional time limitation not to exceed 210 calendar days from the date the insurer or delegated entity receives a written request for arbitration from the injured employee. Arbitration does not preclude the employee from tiling a request for assistance with the DWC relating to non -medical issues. 103 Title: Grievance Procedures — Petition for Benefits WC 39 Policy: Upon completion of the grievance procedure. the insurer or delegated entity shall advise the employee of the right to file a petition for benefits with the Department of Insurance, Division of Workers Compensation pursuant to Section 440.192FS. Vice President Lf ' Effective Date 1/1/2005 Most Recent Revision Date Review Date 9/30/2016 Approval Date for Calendar year 2017 by Medical% Director 10/19/2016 Procedure: • Upon completion of the grievance procedure, the insurer or delegated entity shall provide written notice to the employee of the right to the a petition for benefits with the Department of Insurance. Division of Workers Compensation pursuant to Section 440.192FS. • This is a claim handing issue and will be conducted by the insurer. 104 Title: Grievance Coordinator WC 40 Policy: The grievance coordinator will be responsible for the implementation of the Vice President _grievanceprocedure. t1/q;, /: Effective Date 1 / 1 /2005 Most Recent Revision Date 4/5/201 1 Review Date 9/30/2016 Approval Date for Calendar year 2017 by Medical Director 10/19/2016 WC/MCA ACCOUNTS ONLY Procedure: • The grievance coordinator will assist with the implementation of the grievance procedure. • The grievance coordinator will document the nature of the concern and provide the complainant with a description of the grievance process and form if needed. • The grievance coordinator will direct the complaint to the proper problem solving authority. • The grievance coordinator will investigate the situation and compile facts. • The grievance coordinators will conference directly with the medical director or physician advisor to facilitate and complete the grievance process. • The grievance decision will communicated with the employee, the provider and the insurer in a manner that is keeping with the standards set forth by AHCA. • The grievance coordinator will be an internal Case -Manager or Case Management Supervisor with at least 5 years experience in workers' compensation and procedures. 105 Title: Grievances — Phone Number WC41 Policy: There will be a phone number for reporting grievances. Vice President Effective Date 1/1/2005 Most Recent Revision Date Review Date 9/30/2016 Approval Date for Calendar year 2017 by Medical Director 10/19/2016 Procedure: • There will be a toll free phone number for the reporting of grievances. • This number will be published in the employee education materials sent out by the insurer. • This number will be reflected as that of the grievance coordinator. 106 Title: Grievances — Address WC 42 Policy: There will be an address for the reporting grievances. Vice President Effective Date 1/1/2005 Most Recent Revision Date Review Date 9/30/2016 Approval Date for Calendar year 2017 by Medical Director 10/19/2016 r 41 A/' Procedure: • There will be an address listed for the reporting of grievances. • This address will be published in the employee education materials sent out by the insurer. • This address will be reflected as that of the grievance coordinator. 107 Title: Grievances —Physician Review WC 43 Policy: The grievance coordinator will consult with a peer physician. Vice President Effective Date 1/1/2005 Most Recent Revision Date Review Date 9/30/2016 Approval Date for Calendar year 2017 by Medical 10/19/2016 1 11110 ArDirector WC/MCA ACCOUNTS ONLY Procedure: The organization has designated a Grievance Coordinator to coordinate the documentation and investigation of all complaints and grievances. • in medically related grievances, the grievance coordinator will consult with a physician who may be the primary care provider. the medical care coordinator. the medical director or a physician within the same specialty as the requesting provider. • The review shall include at least one other physician than the employees primary care physician. 108 Title: Grievances -- Meeting WC44 Policy: A meeting may be requested between the insurer or delegated entity and the injured employee or provider. Vice President tau 4.. #L&V, , -' Effective Date 1/1/2005 Most Recent Revision Date Review Date 9/30/2016 Approval Date for Calendar year 2017 by Medical ' Director 10/19/2016 /1/(iD Procedure: • A meeting may be requested between the insurer or delegated entity and the injured employee or provider during the written grievance process if requested by the injured employee or provider. • The insurer shall offer to meet the injured employee or provider at a location within the service area convenient to the injured employee or provider. 109 Title: Grievance Files WC 45 Policy: To document each grievance Vice President �? # ,ciz'- Effective Date 1 / 1 /2005 Most Recent Revision Date Review Date 9/30/2016 Approval Date for Calendar year 2017 by Medical1W Director 10/19/2016 9 // ir Procedure: • Each grievance will be recorded on the grievance log, • A copy of the letter sent in response to the grievance will be kept in the grievance book or in the electronic claim tile. • A description of the findings including documentation, findings and final disposition and correspondence will be included. • The current status of a grievance will be noted on the grievance log. • The original grievance form will be sent to the carrier and the carrier will keep in the hard copy fi le. • A summary of all grievances will be reported at the Quarterly QA meeting and tabulated annually. 110 Title: Grievances Log WC 46 Policy: There will be a record of each complaint and/or written grievance. Vice President 1 ? / Y to lift 1 Effective Date 1 / 1 /2005 Most Recent Revision Date Review Date 9/30/2016 Approval Date for Calendar year 2017 by Medical Director 1 0/ 19/2016 iii c7,—) Procedure: The complaint/ grievance log will reflect complaint and grievance activity. The log will contain: • Description of complaint or grievance • Name and address of complaining or grieving injured employee or provider • Any provider relevant to the grievance • Managed care arrangement name and address • A written grievance will also contain: • Description of the findings — including documentation. conclusions and final disposition • Current status of grievance • Sample Form Date Received Tune Name SSN Problem Resolution Date Disposition RFA Urgent Request Complaint Grievance Title: Grievances Analysis WC47 Policy: Grievances will be reviewed as part of QA improvement Vice President 4 ;I `' Effective Date 1 / 1 /2005 Most Recent Revision Date Review Date 9/30/2016 Approval Date for Calendar year 2017 by Medical Director 10/19/2016 (c21;j) WC/MICA ACCOUNTS ONLY Procedure: • All grievances are presented to and reviewed by the grievance coordinator. • All complaints or grievances will be documented. investigated and resolved per policy. • Grievances will be forwarded to the leased network when appropriate. • Grievances reported will be on file in the grievance log book. • All grievances received will be identified and documented on the grievance tracking form. • The grievance tracking form will display the level of the grievance and/or document resolution. • Current grievances will be identified and discussed at the Quarterly Quality QA meeting and action taken when indicated. Previously identified problems will be noted. • Current grievances will be noted. Previous and current grievances will be compared. • Consistent problems will be identified and discussed at the Quarterly Quality QA meeting and action taken when indicated. • Providers will be notified of any grievances filed against them after discussion with the medical care coordinator and Quarterly Quality QA Committee. • All staff members will be notified of trended information and the recommended action taken. 112 Title: Grievances — Annual Report WC 48 Policy: An annual report of grievances will be filed as required by state statute Vice President / dz2,2 it) Effective Date 1/1/2005 Most Recent Revision Date Review Date 9/30/20I6 Approval Date for Calendar year 2017 by Medical Director 10/19/2016 /Yid WC/MCA ACCOUNTS ONLY Procedure: • All grievances will be documented and tracked in the grievance log. • A report will be submitted to the Agency for HealthCare Administration that will contain the number, nature and resolution of all written employee and provider grievances. • The report will not be submitted later than March 31 for grievances filed during the previous calendar year. • The report will be riled even if there were no grievances. 113 Title: Education — Employee Procedure WC 49 Policy: Each insurer will be responsible for the education of their employers and the employees. Vice President {� r,,,f : , it.) Effective Date 1/1/2005 Most Recent Revision Date Review Date 9/30/2016 Approval Date for Calendar year 2017 by Medical Director 10/19/2016 r 1r Procedure: Educational materials will be distributed by the insurer, TPA or medical management team. The material will include: • Rights and responsibilities of the injured employee • Emergency Procedures • Process for accessing medical care, authorized medical providers. medical care coordinators, case management and the request for referral to a specialist. • Failure to use authorized providers • Failure to obtain authorization for specialty care • Process to change a provider • Complaint and grievance process • Toll free numbers to file a complaint or grievance • Telephone number of the Division of Workers' Compensation Employee Assistance toll free hotline. 114 Title: Education — Employee Written Materials WC 50 Policy: Educational materials will be distributed by the insurer with the managed care information. Vice President , . , j Effective Date 1/1/2005 Most Recent Revision Date Review Date 9/30/2016 Approval Date for Calendar year 2017 by Medical Director 10/19/2016 �� Jt 14ip WC/MCA ACCOUNTS ONLY Procedure: • It is the current duty of the insurer to distribute educational material on the managed care program. • The information will be reviewed and updated as needed. 1 1: Title: Education — Employee Disclosure WC 5l Policy: Educational materials will be distributed by the insurer with the pertinent information regarding medical care. Vice President ''Alitzte ilk' Effective Date l/I/2005 Most Recent Revision Date Review Date 9/30/20I6 Approval Date for Calendar year 2017 by Medical Director I0/19/20I6 Procedure: • It is the current duty of the insurer or medical management team to distribute educational material. • The information will be reviewed and updated as needed. • This information will include but not be limited the possible effect on the employee's health and benefits for failure to use network providers or obtaining authorization for specialty care. 116 Title: Education — Provider WC52 Policy: The insurer or delegated entity will have policies and procedures and implement a process for the education of the healthcare providers within the provider network. Vice President Effective Date 1/1/2005 Most Recent Revision Date Review Date 9/30/2016 Approval Date for Calendar year 2017 by Medicali; Director 10/ 19/20 16 Procedure: • The internal Case -Managers are familiar with all aspects of statute 440 and the rules that govern remedial treatment. care and attendance of the injured worker. • Providers shall receive training and education on the provisions of Chapter 440, FS and related administrative rules. • Where a leased network is being utilized, the leased network will educate the network providers. • The organization will have access to the leased networks policies on education. • Where no network is being utilized. AmeriSys Provider Relations will assist in educating providers • The internal Case -Managers will also assist in the education process by reviewing. encouraging and enforcing the policies of managed care when needed with providers, employers or insurers. 117 Title: Education — (Provider) Annual WC 53 Policy: The insurer or delegated entity will provide ongoing provider education at least annually. Vice President iC. '7ftio"Q 2: Effective Date 1 / 1 /2005 Most Recent Revision Date Review Date 9/30/2016 Approval Date for Calendar year 2017 by Medical Director 10/19/2016 �/�//; J�.I WC/MCA ACCOUNTS ONLY Procedure: • Network providers shall receive training and education on the provisions of Chapter 440. FS and related administrative rules. • The organization currently leases the provider network. • It is currently the leased network that educates the network providers on an annual basis. 118 Title: Education — Administrative Staff WC 54 Policy: All administrative staff will be educated in the principles of medical management of a worker's compensation claim. Vice President )7.ji : ; Effective Date 1/1/2005 Most Recent Revision Date 9/12/2012 Review Date 9/30/201 b Approval Date for Calendar year 2017 by Medical Director 10/19/201 b Vim. lit( /f Procedure: The orientation of new employees will be specific to the experience level of the position Administrative staff will include: • Supervisors • Case -Managers • Utilization Review Nurse Specialists • Grievance coordinators • Claims representatives. • Bill Reviewers • Other staff as needed Orientation will include: • Overview ofAmeriSys personnel policies with emphasis on confidentiality • Overview of performance standards • Overview of the AmeriSys system and philosophy • Review ofAmeriSys policies and procedures including URAC standards • Review of ease management goals and objectives • Orientation to the computerized case management software system • Preceptorship with an experienced Case -Manager for a minimum of 2 weeks Training of all personnel: • All persons involved in the utilization review process will be trained in the principles and standards of utilization management • Al] persons involved in the utilization review process will be trained in the requirements of the Florida workers compensation statute including URAC principles and standards. The persons involved in the utilization review process will include: professional staff, claims benefit adjusters, bill review staff._ support personnel and intake personnel which includes all persons who answer the telephones. • The bill review staff will process claims for proper payment for workers' compensation claims. 119 • The support staff will provide clerical assistance to the professional staff. The support personnel may collect data and intake screening, The support staff will be directly responsible to the Case - Manager. Telephone calls will be directed to the proper source and will be forwarded to the proper person or department. • The switchboard personnel will receive specific instruction on directing phone calls to the proper department. The switchboard operator will ask the caller the purpose of the call. which may include but is not limited to verification of benefits. reporting work injuries. seeking pre - certification or medical authorization and reporting a compliant or grievance. • All persons involved in utilization activity will review the policies and procedures, which meet the standards of URAC. This will include but is not limited to: • Confidentiality statement • Utilization Management and the Quality Assurance Manual • Grievance procedures and time frames associated with this process • Satisfaction surveys The policy and procedure manual will be reviewed with each person responsible for this activity. 120 Title: Provider Network WC 55 Policy: The WCMCA shall ensure the availability of and timely access to medical services for the injured employees including ememency care. primary care. specialty care, and inpatient hospital care Vice President if,36.0/ da, , , '" Effective Date 1 / I /2005 Most Recent Revision Date Review Date 9/30/2016 Approval Date for Calendar year 2017 by Medical Director I0/19/2016 ,� yl� r Procedure: AmeriSys leases the provider networks utilized to provide timely access to medical care including emergency' care. primary care, specialty care and inpatient hospital care. In conjunction with the AmeriSys Network Manager and the Quality Assurance committee. the leased networks are continually monitored to ensure the delivery of these services. 121 Title: Credentialing WC 56 Policy: The WCMCA will have a policy and procedure and implement a process for credentialing and re-credentialing network providers at least every two years. Vice President ,G L_ l�z."� �j. Effective Date I / I /2005 Most Recent Revision Date Review Date 9/30/2016 Approval Date for Calendar year 2017 by Medical Director 10/19/2016 •% /1 Procedure: AmeriSys leases the provider networks utilized to credential and re -credential network providers at least every two years. In conjunction with the AmeriSys Network Coordinator and the Quality Assurance committee, the leased networks are continually monitored to ensure the delivery of these services. 122 Title: Telemedicine Protocol WC57 Policy: The telemedicine module will be used for the purposes of health education. This is to be used when the case manager feels it would be beneficial to increase the injured employee's awareness of treatment. medications or procedures by having a face to face meeting. Vice President ;j, / r7bl4::Q_ ,1E' Effective Date 7/16/2014 Most Recent Revision Date _ Review Date 9/30/2016 Approval Date for Calendar year 2017 by Medical Director 10/19/2016 c �,� Procedure: • Injured Employees who are non -litigated and agree to the telemedicine conference will be eligible for participation. • An appointment time during business hours at the injured employee's convenience will be coordinated • The topic of the telemedicine conference will be confirmed with the injured employee prior to the meeting • The topics will remain in the category of "health education" • Conversation as with any phone conversation will remain courteous and professional • All sessions will be recorded for file documentation • The telemedicine conference will last no greater than 30 minutes • Outcomes related to this pilot will be monitored including but not limited to feedback from the injured employee as to the benefit of the session 123 Title: Initial Contact WC 58 Policy: A complete initial contact is performed at the onset of the claim per the requirements of the account being serviced. Vice President '/,e) Effective Date 9/30/2015 Most Recent Revision Date Review Date 9/30/2016 Approval Date for Calendar year 2017 by Medical Director 10/19/2016 (r 1W Procedure: • The initial contract screen will be completed in completion to allow all information to be communicated to all parties. • This information will include but not be injury information and relevant health history to include comorbidities. • Any urgent conditions revealed to the interview must be communicated to the supervisor immediately. • Information obtained during this interview will be used for, but not limited to claims facilitation and data analysis. C4rrt::'.I.ec: Prix.- ; FY. iry: kb IrkTP TP Meta; Dap AvIDMeim VRiWCats*rig� 7mr Clmmt TentT. r Number CJm�mt LT. pier= Et.itt 1 • . -114 . 44, s. zavd..m ease Ann- Sara eu.r - ,a D.c ctY z..� .......w:ara EE !ca.. _ene.... k.:e,.a a¢..,w Ct_ .a:Ps H.r, utt. ';•mac, •v ; Ya 'Sky: Ye • T. Data. ix :: .w 3h4+rrmm ..; t t.,4 .. tir .. tie Ni.var Y :: W. Ione- Bwei ",'ura. .ri .a 'Z6erur Fa -•.'.a eu .ri:•Y•11 0._ Fa • .e .lakmz'• .s. `c. Ilwu' ' .. D .. a. T. • "Co P amntt4T.wu ' ffiw = vn �trsq.y Dr. ki..p... Fri 124 ATTACHMENT 8 Dimension Health, Inc. Providers Dimension Health Workers Compensation Pro►►ider Directory Dimension Health 5881 NW 151St Street Suite 201 Miami Lakes, FL 33014 Tel: (305) 823-7664 1 DIMENSION COMP BROWARD COUNTY Broward Health Medical Center 1600 S. Andrews Avenue Ft. Lauderdale, FL 33316 (954) 355-4400 Broward Health North 201 E. Sample Road Deerfield Beach, FL 33064 (954) 786-6400 Broward Health Coral Springs 3000 Coral Hills Drive Coral Springs, FL 33065 (954) 344-3000 HealthSouth Sunrise Rehabilitation Hospital 4399 Nob Hill Road Sunrise, FL 33351 (954) 749-0300 Broward llcalth Imperial Point 6401 N. Federal Highway Ft. Lauderdale, FL 33308 (954) 776-8500 Joe DiMaggio Children's hospital 3501 Johnson Street Hollywood, FL 3302 1 (954) 987-2000 Memorial Hospital Pembroke 7800 Sheridan Street Pembroke Pines. FL 33024 (954) 962-9650 Memorial Hospital West 703 N. Flamingo Road Pembroke Pines. FL 33028 (954) 436-5000 Memorial Regional Hospital 3501 Johnson Street Hollywood, FL 33021 (954) 987-2000 Memorial Regional Hospital 3600 Washington Street Hollywood, FL 33021 (954) 966-4500 Memorial Hospital Miramar 1901 SW 172nd Avenue Miramar, FL 33029 (954) 538-5500 North Shore Medical Center/FNIC Campus 50041 W_ Oakland Park Boulevard Ft. Lauderdale. FL 33313 (954) 735-6000 Northwest Medical Center 2801 N. State Road 7 Margate, FL 33063 (954) 974-0400 Plantation General Hospital 401 N.W. 42" Avenue Plantation, FL 33317 (954) 587-5010 University Hospital and Medical Center 7201 N. University Drive Tamarac, FL 33321 (954) 721-2200 Westside Regional Medical Center 8201 W. Broward Boulevard Plantation, FL 33324 (954) 473-6600 DADE COUNTY Aventura Hospital and Medical Center 20900 Biscayne Boulevard Aventura, FL 33180 (305) 682-7000 Baptist Hospital 8901) N. Kendall Drive Miami, FL 33176 (305)596-1960 Coral Gables Hospital 3100 Douglas Road Coral Gables. FL 33134 (305)445-8461 Doctors Hospital 5000 University Drive Coral Gables, FL 33146 (305)666-211I HealthSouth Rehabilitation Hospital of Miami 20601 Old Cutler Road Miami, FL 33189 (305) 251-3800 Hialeah Hospital 65! E. 25111Street Hialeah, FL 33013 (305) 693-6100 Homestead Hospital 160 N.W. 1311IStreet Homestead, FL 33030 (305) 248-3232 Kendall Regional Medical Center 11750Bird Road Miami, FL 33175 (305) 223-3000 Plantation General Hospital, L.P. d/b/a Mercy Hospital 3663 S. Miami Avenue \1 ianti, FL 33133 854-4400 Mount Sinai Medical Center 4300 Alton Road Miami Beach, FL 33140 (305) 674-2121 Mount Sinai — Miami Heart 4701 Meridian Avenue Miami Beach, FL 33140 (305)672-1111 North Shore Medical Center 1 100 N.W. 95`1' Street Miami, FL 33150 (305) 835-6000 Palmetto General Hospital 2001 W. 681h Street Hialeah. FL33016 (305) 823-5000 South Miami Hospital 6200 S.W. 73`d Street South Miami, FL 33143 (786) 662-4000 University of Miami Hospital (Pro. Cedars Medical Center) 14010 NW 1211' Avenue Miami. FL 33136 (305)325-5511 West Kendall Baptist Hospital 9555 SW 162 Avenue Miami, FL 33196 (786) 467-2000 MONROE COUNTY Fishermen's Hospital 3301 Overseas Highway Marathon, FL 33050 (305) 743-5533 Mariners Hospital 91500 Overseas Highway Tavernier. FL 33070 (305) 852-4418 10/28/2016 3 PALM BEACH COUNTY Bethesda Hospital, Inc. 2815 S. Seacrest Boulez and Boynton Beach. FL 33435 (561) 737-7733 TIN: 59-2447554 Bethesda Hospital West 9655 Boynton Beach Blvd. Boynton Beach, FL 33472 561-336-7000 TIN: 59-2447554 Columbia Hospital d/b/a West Palm Hospital 2201 45'h Street West Palm Beach. FL 33407 (561)842-6141 Delray Medical Center 5352 Linton Boulevard Delray Beach. FL 33484 (561) 498-4440 Good Samaritan Medical Center 1309 N. Flagler Drive West Palm Beach, FL 33401 (561)655-5511 JFK Medical Center 5301 S. Congress Avenue Atlantis, FL 33462 (561)965-7300 JFK Medical Center North Campus (effect 04/01/16) (prey. Palms West Hospital) 13001 Southern Boulevard Loxahatchee, FL 33470 (561) 798-3300 Jupiter Medical Center 1210 South Dixie Highway Jupiter. FL 33458 (561) 747-2234 Lakeside 111cdical. Center 39200 Hooker Highway Belle Glade, FL 33430 (561) 996-6571 Palm Beach Gardens Medical Center 3360 Bums Road Palm Beach Gardens, FL 33410 (561)622-1411 St. Mary's Hospital 901 456 Street West Palm Beach. FL 33407 (561) 844-6300 Wellington Regional Medical Center 10101 Forest Hill Boulevard West Palm Beach. FL 33414 (561) 798-8500 West Boca Medical Center 21644 State Road 7 Boca Raton, FL 33428 (561) 488-8000 10/28/2016 4 Broward County Broward County Providers SPECIALTY PROVIDER ADDRESS CITY Zip Phone Fax eMail Address Allergy/Immunology _ Andrade, Edith, M.D. 600 N. Hiatus Road, Suite 102 Pembroke Pines 33026 (954) 431-0540 Landman, Zevy, M.D. 600 N. Hiatus Road. Suite 215 Pembroke Pines 33026 (954) 437-3600 (954) 437-8251 pembrokeginestforida-allergy.com 350 N.W. 84th Avenue, Suite 205 Plantation 33324 {954) 472-4848 2699 Stirling Road, Suite 13-305 Ft. Lauderdale 33312 (954) 963-5363 Llanes, Sharlene, M.D. 1801 University Drive. Suite 101 Coral Springs 33071 (954) 344-8100 630 N. Hiatus Road. Suite 215 Pembroke Pines 33026 (954) 437-3600 (954) 437-8251 pembrokepinesaflorlda-allergy.com 350 N.W. 84th Avenue, Suite 205 Plantation 33324 (954) 472-4848 Miller. Maureen. M.D. 400 N. Hiatus Road. Suite 101 Pembroke Pines 33026 (954) 431-0540 2021 E. Commercial Boulevard, Suite 302 Ft. Lauderdale 33308 (954) 492-5525 9681 West Broward Boulevard Plantation 33324 (954) 452-9800 Ryan I11. Walter, D.0, 350 NW 84th Avenue, Suite 205 Plantation 33324 (954) 472-4848 (954) 472-8560 plantationtftonda-allergy.com 1801 University Drive, Suite 101 Coral Gables 33071 (954) 344-8100 Salem. Elias, M.D. _ 1150 N. 35th Avenue. Suite 460 Hollywood 33021 (954) 981-9180 (954) 961-4752 Hollywoodt florida-allergy.com Shamir. Mir, M.D. 600 N. Hiatus Road. Suite 215 Pembroke Pines 33026 (954) 437-3600 2699 Stirling Road, B-305 Ft. Lauderdale 33312 (954) 981-9180 1290 Weston Road. Suite 300 Weston 33327 (954) 389-2599 (954) 961-4752 weston@8orida-allergy,com Cardiac & Vascular Services Aguile, Alien, M.D. 603 N. Flamingo Road, Suite 255 Pembroke Pines 33028 (954) 965-4900 1153 N. 351h Avenue. Suite 605 _ Hollywood 33021 (954) 265-7900 (954) 276-0252 3702 Washington Street, Suite 463 Hollywood 33021 (954) 961-0190 4000 Sheridan Street. Suite A Hollywood 33021 (954) 965-4900 Atanasoski-McCormack. Violeta, M.D. 1600 S. Andrews Avenue. Atrium Building. 1st Floor Flo Lauderdale 33316 (954) 760-7171 Cardiology _ Bender. Kevin, M.D. 7707 N_ University Drive, Suite 106 Tamarac 33321 (954) 722-4206 (954) 722-4226 Buller, Alan, M.D. 333 N.W. 70th Avenue. Suite 116 Plantation 33317 (954) 581-6041 (954) 581-0222 Gioci, Louis. M.D. 6333 N. Federal Highway. Suite 200 Ft. Lauderdale 33308 (954) 772-0711 (954) 229-0711 1 W. Sample Road. Suite 204 Pompano Beach 33064 (954) 785-0300 Cohen. Mitchell. M.D. 2291 N. University Drive Pembroke Pines 33024 (954) 963-2151 (954) 966-6629 epdocaGfbeltsouth,net Flores. Jorge. M.D. 1900 E. Commercial Boulevard, Suite 101 Fort Lauderdale 33308 (954) 351-58388 (954) 351-5836 114 N. Fiagler Avenue Pompano Beech 33060 (954) 786-3691 Gould, Randy, D,O. 601 N. Flamingo Road, Suite 305 Pembroke Pines 33025 (954) 382-1550 2488 N. University Drive Pembroke Pines 33024 (954) 382-1550 _ Gould, Randy, D.D. 2300 N. Commerce Parkway. Suite 108 Weston 33326 (954) 382-1550 700 N. Hiatus Road, Suite 105 Pembroke Pines 33026 (954) 442-0879 6099 Stirling Road, Suite 220 Davie 33314 (954) 382-1550 10650 W. State Road 84, Suite 104 Davie 33324 (954) 382-1550 (954) 382-1250 gouldrbe.yahoo.com Hasan. Mian, M.D. 603 N. Flamingo Road, Suite 150 Pembroke Pines 33028 (954) 436-6660 (954) 436-6655 Kenigsberg, David, M.D. 1841 NE 45th Street Ft. Lauderdale 33308 (954) 678-9531 350 N.W. 84th Avenue. Suite 110 Plantation 33324 (954) 678-9531 (954) 678-9533 2825 N. State Road 7, Suite 303 Margate 33063 (954) 678-9531 I Krichmar. Perry. M.D. 1601 N. Palm Ave. Suite 101 Pembroke Pines 33026 (954) 432-1511 (954) 432-5195 _ Lalude, 0mosalewa. M.D_ 603 N. Flamingo Road, Suite 255 Pembroke Pines 33028 (954) 965-4900 1 1150 N. 35th Avenue, Suite 605 Hollywood 33021 (954) 965-4900 (954) 515-1200 6 Broward County Providers SPECIALTY PROVIDER ADDRESS CITY Zip Phone Fax eMail_Address 4000 Sheridan Street, Suite A Hollywood 33021 (954) 965-4900 3762 Washington Street, Suite 403 Hollywood 33021 (954) 961-0190 Majid, Mezhar, M,D, 7737 N. University Drive, Suite 104 Tamarac 33321 (954) 720-1930 (954) 720-6130 Mascarenhas, Eugene, M.D. 8393 W. Oakland Park Boulevard Sunrise 33351 (954) 741-3335 (954) 764-9475 Osman. Ahmed, M.D. 350 NW 64th Avenue. Suite 110 Plantation 33324 (954) 678-9531 (954} 678-9533 2825 N. State Road 7, Suite 303 Margate 33063 (954) 678-9531 1841 NE 45th Street Ft. Lauderdale 33308 (954) 678-9531 Perloff. David. M.D. 1625 S_E_ 3rd Avenue. Suite 721 FL Lauderdale 33316 (954) 523-3422 (954) 523-3423 Rozanski, John, M.D. 1600 S. Andrews Avenue, 1st Floor Ft, Lauderdale 33316 (954) 760-7171 (954) 764-1722 Sabbota, Mark, D.O. 501 N. Flamingo Road. Suite 305 Pembroke Pines 33928 (954) 382-1550 6099 Stirling Road, Suite 220 Davie 33314 (954) 382-1550 2300 N. Commerce Parkway, Suite 108 Weston 33326 (954) 382-1550 2488 N. University Drive Pembroke Pines 33024 (954) 382-1550 700 N. Hiatus Road. Suite 105 Pembroke Pines 33026 (954) 442-0879 10650 W. State Road 84. Suite 104 Davie 33324 (954) 382-1550 (954) 382-1250 Sareh, Sam, M.D. 2901 Coral Hills Drive, Suite 240 Coral Springs 33065 (954) 227-7787 1 333 N.W. 70th Avenue. Suite 116 Plantation 33317 (954) 581-6041 (954) 581-0222 Schwartz. Alan. M.D. 8393 W. Oakland Park Boulevard Sunrise 33351 (954) 741-3335 (954) 764-9475 Sharma, Ashok, M.D. 260 S.W. 84th Avenue, Suite A Plantation 33324 (954) 382-0700 (954) 382-0400 Shu{man, Joel, M.D. 333 N.W. 70th Avenue. Suite 116 Plantation 33317 (954) 581-6041 (954) 561-0222 Siev. Ethan. M.D. 1150 N. 35th Avenue, Suite 605 Hollywood 33021 (954) 965-4900 (954) 515-1200 credentiakng@cardiology8.com 4000 Sheridan Street. Suite A Hollywood 33021 (954) 965-4900 3702 Washington Street, Suite 403 Hollywood 33021 (954) 961-0190 603 N. Flamingo Road, Suite 255 Pembroke Pines 33028 (954) 965-4900 Singel, Robert, M.D. 2901 Coral Hills Drive. Suite 246 Coral Springs 33065 (954) 227-7787 333 N,W.701t1 Avenue, Suite 116 Plantation 33317 (954) 581-6041 (954) 581-0222 Velasquez, Juan, M.Q. 3001 NW 49th Avenue, Suite 104 Ft. Lauderdale 33313 (954) 714-0686 (954) 731-6017 Cardiovascular and/or Thoracic Surgery Belhea. Brian. M.D. 3001 NW 49th Avenue. Suite 104 FL Lauderdale 33313 (561) 638-9140 Carson. Ted. M.D. 1820 E. Commercial Boulevard Ft. Lauderdale 33308 (954) 776-0191 (954) 776-0430 Cido, William, M.D. 3702 Washington Street, Suite 401 Hollywood 33021 (954) 983-8910 (954) 985-5781 700 N. Hiatus Road, Suite 105 Pembroke Pines 33026 (954) 442-0879 Galindez, Neil, M.D. 3001 NW 49111 Avenue, Suite 104 Lauderdale Lakes 33313 (561) 626-6873 Juslicz. Alexander, M.D. 4725 N. Federal Highway. State 402 FL Lauderdale 33308 (954) 267-6776 (954) 267-6769 Taman, Wael, M.D. 1625 S.E. 3rd Avenue, Suite 723 _ _ Ft. Lauderdale 333)6 (954) 616-1916 (954) 525-0808 Tarrazzi, Francisco, M.D. 1150 N. 351h Avenue, Suite 660 Hollywood 33021 (954) 265-1125 (954) 985-5578 Child/Adolescent Psychiatry Evelson. Jessica, M.D. 7481 W. Oakland Park Boulevard. Suite 100 Lauderhill 33319 (688) 852-6672 (305) 891-4228 Chiropractic Aquino, Anthony, D.C. 1335 South State Road 7 North Lauderdale 33068 (954) 974-3111 (954) 974-6191 kristin@quinochiropractic.com Ashkinazy, Lawrence, D.C. 10778 Wiles Road Coral Springs 33076 (954) 346-5750 (954) 757-2533 dra@prioritymedicalcenters.com Berger, Ted, D.C. 7574 Pembroke Road Miramar 33023 (954) 927-7246 (954) 961-7562 Bronheim. Jeffrey. D.C. 1035 South Federal Highway Hollywood 33020 1954) 922-9355 (954) 922-9366 usichiro a@aol.com Brookner, Manuel, D.C. 8921 W. Atlantic Boulevard, Suite F Cora( Springs _ 33071 (954) 753-6664 (954) 753-7334 drmanuel@aol.com Delesparra, Michael, D.C. 797 S. State Road 7 Plantation 33317 (954) 587-7711 Dinner. Howard. D.C. 261 N. University Drive, Suite 116 Plantation 33324 (954) 370-7246 (954) 370-9535 drdinnerl drdinner.com Douglas. Michael. D,C. 8910 Miramar Parkway, Suite 115 Miramar 33025 (954) 443-8000 4140 N.W. 12th Street Lauderhill 33313 (954) 739-3331 (954) 7924520 Feller. Jeffrey. D.C. 5417 W. Atlantic Boulevard Margate 33063 (954) 970-9355 (954) 979-6714 Fine. Jamie. D.C. 4651 Sheridan Street, Suite 355 Hollywood 33021 (954) 965-0421 7 Broward County Providers SPECtALTY PROVIDER ADDRESS CITY Zip Phone Fax eMall_Address Foster. Scott, D.C. - 2030 Was}ringlon Street Hollywood 33020 (954) 925-7333 (954) 925-7339 drsfaster1aol.com Freedman, Alan, D.C. 190 S. University Drive Pembroke Pines 33025 (954) 433-0300 (954) 433-8298 alanrtreedmandc@aol.com Fruithandler, Clifford, D.C. 5800 Colonial Drive, Suite 400 Margate 33063 (954) 979-3333 (954) 755-9263 drfruithandler@gmail.com Gerhard, Bradley. D.C. 823 E. Oakland Park Boulevard Oakland Park 33334 (954) 565-6333 (954) 565-9913 - brad. erhard ahcomcast.net D.C.r-... r rr DGoldslein Elias, .C. r Drive r- (954)434-8104 D.C.Grays n red. : r r r r (954) 749-5765 fredgolfski@yahoo.com r C. 9532 itSiiiHin Road : 0 r (954) 434-2022 D.C.Hirsch Jonathan • - Boulevard Dania - r 4 + (954) 925-9961 denrachiro@aol.com Legeult, Marcel, D.C. 5745 Hollywood Boulevard Hollywood 33021 (954) 966-2211 (95) 496-62370 Legault, Virginia. Q.C. 5745 Hollywood Boulevard Hollywood 33021 (954) 966-2211 (954) 966-2370 Martinez, Damian, D.C. 18501 Pines 0oulevard, Suite 104 Pembroke Pines 33029 (954) 432.3343 Mathesie. Michael, D.C. 10917 W. Atlantic Boulevard Coral Springs 33071 (954) 755-1434 (954) 755-3652 Pine. David. D.C. 611 E. Atlantic Boulevard Pornpano Beach 33060 (954) 782-7006 (954) 782-0246 - Pine. Ross. D.C. 611 E. Atlantic Boulevard Pompano Beath 33060 (954) 782-7006 (954) 782-0246 info@pinechiropracticcenter.corn Rosenkranz, Bruce, D.C. 9091 Pembroke Road Pembroke Pines 33025 (954) 437-5701 (954)437-8783 Sachs. Scolt D.C. 9633 Broward Boulevard. Suite 3 Plantation 33324 (954) 423-2323 (954) 423-1116 8carolsachst?a aol.com Sasso. Marcia. D.C. 5663 Coral Gate Boulevard Margate 33063 (954) 974-3450 (954) 974-3568 msassodc@aol.com Satmoff, Craig. D.C. _ _ 8994 Taft Street Pembroke Pines 33024 (954) 436-7607 (954) 435-6958 Sobel. Scott, D,C. 10778 Wiles Road Coral Springs 33076 (954) 345-5750 Sussman, Todd. D.C. 4651 Sheridan Street, Suite 355 Hollywood 33021 (954) 965-0421 �daktat@bellsouth.nel Tannenbaum. Russ, D.C. 5800 Colonial Drive, Suite 305 Margate 33063 (954) 979-2333 (954) 968-8468 Tsictoies Tim, D.C. 2030 Washington Street Holly cod 33920 (954) 925-7333 (954) 925-7339 Valcourt, Jacqueline. D.C. 5745 Hollywood Boulevard Hollywood 33021 (954) 966-2211 (954) 966-2370 Weiner, Lawrence. D.C. 14323 Miramar Parkway Miramar 33027 (954) 430-4210 (954) 430-6210 3190 S. Stale Road Seven. Suite 12-8 Miramar 33023 (954) 961-0511 l Weinstein. Brea, D.C. 7195 W. Oakland Park Boulevard Lauderhill 33313 (954) 742-5265 (954) 749-3197 Woelljen. Donald. D.C. 7924 Pines Boulevard Pembroke Pines 33024 (954) 961-6161 (954) 963-8545 ldrwoe1ljenld bellsoulh.net Zecca, Eric, Q.C. 2746 East Commercial Boulevard Ft. Lauderdale 33308 (954) 776-2273 (954) 772-2928 Colon & Rectal Surgery Garcia, Alvaro, M.D. 601 N. Flamingo Road. Suite 309 Pembroke Pines 33028 (954) 369-5511 (954) 323-5554 Snow, Jeffrey, M.D. 1951 SW 172nd Avenue, Suite 408 Miramar 33029 (954) 538-5470 601 N. Flamingo Road, Suite 408 Pembroke Pines 33028 (954) 844-1617 601 N. Flamingo Road, Suite 409 Pembroke Pines 33028 (954) 844-4480 (954) 447-5344 mholsomback@mhs.net 4651 Sheridan Street. Suite 350 Hollywood 33021 (954) 276-8559 Critical/intensive Care Medicine Ali. Syed, M.D. 3501 Johnson Street Hollywood 33021 (954) 265-9976 (954) 965-5396 s1a1292@hotmaiLcom Alterbaum. Robert. M.D. 3501 Johnson Street Hollywood 33021 1954) 265-9976 (954) 965-5396 Alvarez Gonzales, Luis. M_D_ 3501 Johnson Street, 3rd Floor Hollywood 33021 (954}265-9976 '(954) 965-5396 Blake, Dahlia, M.D. 3501 Johnson Street Hollywood 33021 (954) 265-9976 (954) 965-5396 Iphelsdon@mhs.net Bugarin, Elisabeth, M.D. 3501 Johnson Street Hollywood 33021 (954) 265-9976 (954) 965-5396 Carisma, Fsaie, ❑_O- 3501 Johnson Street Hollywood 33021 (954) 265-9976 (954) 965-5396 Chintala, Sreedhar, M.D. 3501 Johnson Street Hollywood 33021 (954) 265.9976 (954) 965-5396 Chuadry, Zatar, M.D. 3501 Johnson Street Hollywood 33021 (954) 265-9976 (954) 965-5396 - - Clark. Cheryl. M.D. 3501 Johnson Street Hollywood 33021 (954) 265-9976 (954) 965-5396 Dyrud, Marttnus, D.O. 3501 Johnston Street. 3rd Floor Hollywood 33021 (954) 265-9976 (954) 965-5396 1phelsdon@mhs.net Eisenkeit., Aron. M.D. 3501 Johnson Street Hollywood 33021 (954) 265-9976 (954) 965-5396 Gittler. Steven, M.D. 3501 Johnson Street Hollywood 33021 (954) 265-9976 (954) 965-5396 7369 Sheridan Street. Suite 302 Hollywood 33024 (954) 981.3700 Gotkin. Brian, M.D. 7369 Sheridan Street, Suite 302 Hollywood 33024 (954) 981-3700 3501 Johnson Street Hollywood 33021 (954) 265-9976 (954) 965-5396 8 Broward County Providers SPECIALTY PROVIDER ADDRESS CITY Zip Phone Fax eMail Address Hidalgo -Cabrera, Renzo. MI/ 3501 Johnson Street Hollywood 33021 (954) 265-9976 (954) 365-5396 Holtzman. Robert, M.D. 3501 Johnson Street Hollywood 33021 (954) 265-9976 (954) 965-5396 Lee. Seong, M.D. 1150 N. 351h Avenue. Suite 60o Hollywood 33021 (954) 265-.5969 (954) 965-3599 Magin, Adam, M.D. 3501 Johnson Street Hollywood 33021 (954) 265-9976 (954) 965-5396 Mayer, Daniel, M.D. 3501 Johnson Street Hollywood 33021 (954) 265-9976 (954) 965-5396 Nader, Samir, M.D. 3501 Johnson Street Hollywood 33021 (954) 265-9976 (954) 965-5396 Neuhaus, Aron, M.D. 3501 Johnson Street Hollywood 33021 (954) 265-9976 (954) 965-5396 Pastewski. Andrew. M.D. 3501 Johnson Street Hollywood 33021 (954) 265-9976 (954) 965-5396 Pesh-Imam, Samir, M.D. 3501 Johnson Street Hollywood 33021 (954) 265-9976 (954) 965-5396 _ Pintado, Raciel. M.D. 3501 Johnsons Street Hollywood 33021 (954) 265-9976 {954) 965-5396 Rondon, ElIseo, M.D. 3501 Johnson Street Hollywood Hollywood 33021 (954) 265-9976 (954) 965-5396 Sareli, Aharon, M.D. 3501 Johnson Street Hollywood 33021 (954) 265-9976 (954) 965-5396 Sheinleld. Geoffrey, M.D. 3501 Johnson Street Hollywood 33021 (954) 987-2020 i Singh, Baldev, M.D. 2400 N. University Drive, Suite 215 Pembroke Pines 33024 (954) 450-5770 (954) 450-5322 2160 Hallandale Beach Boulevard. Suite 307 Hallandale 33009 (954) 450-5770 _ 3501 Johnson Street _ Hollywood 33021 _ (954) 265-9976 Sklaver. Carlos, M.D. 3501 Johnson Street Hollywood 33021 (954) 265-9976 (954) 965-5396 Thompson. Juke -Ann. M.D. 3501 Johnson Street Hollywood 33021 (954) 265-9976 {9541965-5396 Visbal. Alvaro. M.D. 3501 Johnson Street _ _ Hollywood 3302. 1 (954) 26.5-9976 (954) 965-5396 Dermatology Berens, Abram. M.D. 969 North Nob Hill Road Plantation 33324 (954) 916-1100 (954) 916-1104 Styperek, Andrew. M.D. 7301 N. University Drive, Suite 102 Tamarac 33321 (954) 726-2000 (954) 726-3109 Endocrine Surgery Bimston. David. M.D. 601 N. Flamingo Road. Suite 206 Pembroke Pines 33028 (954) 265-0000 _ 1150 N. 35111 Avenue, Suite 200 Hollywood 33021 (954) 265-0000 (954) 893-6347 Endocrinology Jain, Mudit. M.D. 300 N.W. 70th Avenue. Suite 105 Plantation 33317 (954) 585-6292 (954) 585-6290 Family Practice Abdallah, Nadir, D.O. 2700 W Cypress Creek, Suite 100 Ft. Lauderdale 33309 (954) 974-3111 (954) 974.6191 Abrams, West-Ky, D.Q. 1951 S.W. 172nd Avenue, Suite 308 Miramar 33029 {954) 431-1904 (954) 431-1914 drabramsdo@iyahoo.com Anderson -Worts. Paula. D.O. 3200 S. University Drive Davie 33328 (954) 262-4100 (954) 262-2271 rrih154@nova.edu Arcos, Barbara, D.O. 3200 S. University Drive Ft. Lauderdale 33328 (954) 262-4100 (954) 262-2271 vale@nava.edu Barsoum, Natal. M.D. 100 S. Military Trail.. Suite 10 Deerfield Beach 33442 (954) 426-9600 (954) 426-2257 kellianso@live.com Birgani, Behnam. D.O. 4602 N. Federal Highway Ft, Lauderdale 33308 (954) 491-4888 (954) 202-0504 Brat, Karl, M.D. 1402 NE 26th Street Wilton Manors 33305 {954) 565-7789 {954) 563-1784 Camargo, Coralee, M.D. 4750 North Federal Highway, Suite 301 Ft. Lauderdale 33308 (954) 491-8676 (954) 491-5994 _ Case. Wayne. M.D. 17933 N.W. 71h Street. Suite 102 _ Pembroke Pines 33026 (954) 436-1927 Cohen, Peter, D.O. 3200 S. University Drive Davie 33328 (954) 262-4100 (954) 262-2271 eale@nova.edu De La Paz. 'fire. M.D. 12550 Pines Boulevard Pembroke Pines 33027 (9541447-1999 (888) 921-9449 DeGaetano. Joseph, D.O. 3200 S. University Drive Ft, Lauderdale 33328 (954) 262-4100 (954) 262-2271 Imh154sr1eva.edu Dufour, Martin, M.D. 8395 W, Oakland Park Boulevard, Suite E & F Sunrise 33351 (954) 735-1350 (954) 735-1348 Fraser. Wayne, M.D. 2331 N. Stale Road 7, Suite 202 Lauderhill 33313 (954) 581-0088 (954) 581-1924 Gadh. Ruchika. D.O. 600 S. Pine Island Road. Sude 104 Plantation 33324 _ (954) 474-4401 (954) 474-9883 Gaga). Mohamed. M.D. 4966 Pine Island Road Lauderhill 33351 (954) 748-8600 (954) 973-0961 6000 West Atlantic Boulevard Margate 33063 (954) 973-61 1 1 i Garulli-Chidiac, Rita, M.Q. 2100 E. Sample Road, Suite 101 Lighthouse Point 33064 (954) 782-9771 (954) 946-9138 Giraldo, Hernando, M.D i 200 E. Hallandale Boulevard Hallandale 33009 (954) 457-6305 (954) 458-8167 Imdaglraldo.com 9 Broward County Providers SPECIALTY PROVIDER ADDRESS CITY Zip Phone Fax eMail_Address Gupta, Meenu, M.D. 8396 W. Oakland Park Boulevard - - Sunrise 33351 (954) 742-0112 (954) 746-8202 meenuguptared@yahoo.com Hunt. Robert, D.O. 1330 Riverland Road Ft. Lauderdale 33312 (954) 321-9826 (954) 321-9660 Jeannot. Kathleen, M.D. 50 East Sample Road, Suite 201 Pompano Beach 33064 (954) 784-4355 (954) 784-4358 Katz, Stacey, D.O. 4691 S. University Drive Davie 33328 (9541434-7246 (954) 321-9660 afirstchoice)msrtcom 255 SE 14th Street. Suite 1-C Ft. Lauderdale 33316 (954) 321-9826 1330 Rivedand Road Forl. Lauderdale 33312 (9541321-9826 Lee, Noah, D.O. 1421 E. Oakland Park Boulevard Ft, Lauderdale 33334 1954) 565-0875 (954) 565-0876 Moretti, Matthew, D.O. 1777 S. Andrews Avenue, Suite 301 Ft. Lauderdale 33316 (9541 762-9173 (954) 762-9175 Reines. Richard. M.Q. 4614 Hollywood Boulevard Hollywood 33021 (954) 987-7230 (954) 989-0913 Seller, Gerald, D.O. 4431 S.W. 64(h Avenue, Suite 101 Davie 33314 (954) 791-5500 )954) 791-6908 Sandhouse, Mark, D.O. 3200 S. University Drive Fort Lauderdale 33328 (954) 262-4100 (954) 262-2271 Schaffer. Judith. 0,0. 3200 S. University Drive - Davie 33328 (954) 262-4100 I Scott -Holman, Sandi, D.O. 3200 S. University Drive Davie 33328 (954) 262-4100 (954) 262-4100 Shirley. Carmen. M.D. 1625 S.E. 3rd Avenue. Suite 400 Ft. Lauderdale 33316 (954) 832-0055 (954) 832-0063 Siegel, Harold, M.D. 407 SE 24th Street FI. Lauderdale 33316 (954) 468-2140 (954) 524-2146 Silverstein, Scott, D.O. 3000 Coral Hills Drive Coral Springs 33065 (954) 344-3000 I 729 E. Atlantic Boulevard Pompano Beach 33060 (954) 943-5044 (954) 786-8502 201 E. Sample Road Pompano Beach 33064 (954) 786-6406 Silverstein, Stephen, D,O. 201 E. Sample Road Pompano Beach 33064 (954) 786-6400 729 E. Atlantic Boulevard Pompano Beach 33060 (954) 943-5044 (954) - 3000 Coral Hills Drive Coral Springs 33065 (954) 344-3000 Tomchik. Robert. M.D._ 7924 Pines Boulevard Pembroke Pines 33024 (954) 450-3550 '-Gastroenterology 18475 Miramar Parkway Miramar 33029 (954) 450-3550 (954) 450-3557 Gastroenterology _ Shenker, Murali. M.D. 8200 W. Sunrise Boulevard, Suite D6 Plantation 33322 (954) 475-1735 (954) 475-1741 Sharma, Aryama, M.D. 2300 N. Commerce Parkway, Suite 307 Weston 33326 (954) 217-3232 1600 5. Andrews Avenue Ft. Lauderdale 33316 (954) 515-2325 General and/or Vascular Surgery Amko, Cart M.D, 1625 S.E. 3rd Avenue, Suite 723 Ft. Lauderdale 33316 (954) 523-7408 (954) 525-0808 Arison, Ron, M.D. 2438 E. Commercial Boulevard Ft. Lauderdale 33308 (954) 772-6740 (954) 772-6703 iarison@bellsouth.net Bayron, Fernando, M.D. 8395 W. Oakland Parj Boulevard, Suite E & F Sunrise 33351 (954) 472-1322 _ (954) 370-3420 Carrillo. Eddy. M.O. 1150 N. 35th Avenue. Suite 600 Hollywood 33021 (954) 265-5969 (954) 965-3599 Comperatore, Roberto, M.D. 601 N. Flamingo Road. Suite 406 Pembroke Pines 33026 (954) 437-9590 I Gonzalez. Pedro, M.D. 6405 N. Federal Highway. Suite 401 Ft. Lauderdale 33308 (954) 491-0900 (954) 491-1306 Guamen, Ralph. 1508 S.E. 3rd Avenue Ft. Lauderdale _ 33316 1954) 462-8714 (954) 462-8722 Kiffin, Chauniqua, MD _ 1150 N. 35th Avenue, Suite 600 Hollywood 33021 (954) 265-5969 (954) 965-3599 Lee, Seong. M.D. 1150 N. 35th Avenue, Suite 600 Hollywood 33021 (954) 265-5969 (954) 965-3599 _ Matei. Emit D.O. 601 N. Flamingo Road. Sute 408 Pembroke Pines 33028 (954) 844-1617 4651 Sheridan Street, Suite 350 Hollywood 33021 (954) 276-8559 1951 SW 172nd Auerue, Suite 408 Miramar 33029 (954) 538-5470 601 N. Flamingo Road. Suite 409 Pembroke Pines 33028 (954) 844-4480 (954) 447-5344 ematei@yahoo.com Media. Indrek, M.D. 5651 NW 29th Street Margate 33063 (954) 220-8100 (954) 227-8103 gsa983@aol.com O'Rourke. Arden, M.D. 1625 S.E. 3rd Avenue, Suite 723 Ft. Lauderdale 33316 (954) 525-7350 1954) 525-0808 Parra. Michael. M.D. 6405 N. Federal Highway. Suite 401 Ft. Lauderdale 33308 (954) 491-0900 (954) 491-1306 Pidhorecky, Ihor, M,D. 601 N. Flamingo Road, Suite 408 Pembroke Pines 33028 1954) 844-1617 601 N. Flamingo Road, Suite 409 Pembroke Pines 33028 (954) 844-480 (954) 447-5344 mhotsombackfgmhs.net 4651 Sheridan Street, Suite 350 Hollywood 33021 (954) 276-8559 1951 SW 172nd. Suite 408 Miramar 33029 (954) 538-5470 Robinson. David, M.D. 5651 NW 29th Street Margate 33063 (954) 220-8100 (954) 220-8103 Rosenthal. Andrew. M.D. 1150 N. 35th Avenue, Suite 600 Hollywood 33021 (954) 265-5969 (9541 965-3599 Sanchez. Rafael. M.D. -1150 N. 35th Ave.. Suite 600 Hollywood 33021 (954) 265-5969 (954) 965-3599 1RaFsanchez a(ym 1s.net 10 Broward County Providers SPECIALTY PROVIDER ADDRESS CITY Zip Phone Fax eMail Address Tranakas. Nicholas. M.D. 6405 N. Federal Highway. Suite 401 Ft. Lauderdale 33308 1954) 491-0900 (954) 491-1306 General Surgery Bello, Abel, M.D. 210 NW 82nd Avenue, Suite 301 Plantation 33324 (954) 249-3950 Gannon, Christopher. M.D. 601 N. Flamingo Road, Suite 408 Pembroke Pines 33028 (954) 844-1617 1951 SW 172nd Avenue, Suite 408 Miramar 33029 (954) 538-5470 601 N, Flamingo Road, Suite 409 Pembroke Pines 33028 (954) 844-4480 (954) 447-5344 4651 Sheridan Street, Suite 350 Hollywood 33021 (954) 276.8559 Hand Surgery _ Blum. David. M.D. 600 S. Pine IslandRoad, Suite 300 Plantation 33324 (954) 473-6344 Cardozo. Roy. M.D. 350 N. Pine Island Road, Suite 200 Plantation 33324 (954) 476-8800 Cummings, Phillip, M.D. 600 S. Pine Island Road, Suite 300 Plantation 33324 (954) 473-6344 (954) 476-9077 helainefisher(gorthoclrsofl.com Eastlick, Lewis, M.D. 4101 NW 4th Street, Suite 407 Plantation 33317 (954) 797-6789 (954) 797-7484 Finyada, Brian, M.D. 5597 N. Dixie Highway Ft. Lauderdale 33334 (954) 958-4800 (954) 958-4899 Friedman, David, M.D. 2950 Cleveland Clinic Boulevard Weston 33331 ,(954) 659-5000 Gellman, Harris, M.O. 3100 Coral Hills Drive, Suite 305 Coral Springs 33065 (954) 575-8056 (954) 575-2563 hgellmantholmail.com Kinchelow. Tosco. M.D. 4765 SW 1481h Avenue. Suite 401 Davie 33330 (954) 707-5070 350 N. Pine Island. Suite 200 _ Plantation 33324 (954) 476-8800 (954) 476-1362 riggkar@oausa.com Schwartz, Gary, M.D. 3700 Washington Street, Suite 200 Hollywood 33021 (954) 966-6450 (954) 989-4873 Hematology/Oncology Arias, Mayda. M.D. 5700 N. Federal Highway, Suite 5 Ft. Lauderdale 33308 (954) 776-1800 (954) 776-3647 201 E. Sample Road Deerfield Beach 33064 (9541 786-6460 Dennis. David, M.D. 260 S.W. 84th Avenue, Suite C Plantation 33324 (954) 370-8585 (954) 370-1585 Early. William, M.D. 8386 W. Oakland Park Boulevard Sunrise 33351 (954(741-7577 (954) 741-9440 wcearlyo comcast iret Milillo-Nariane. Adriana. M.D. 1150 N. 35th Avenue, Suite 330 Hollywood 33021 (954) 265-4325 801 N. Flamingo Road, Suite 11 Pembroke Pines 33028 (954) 844-6868 Industrial Medicine Weiner, Douglas, M.D. 2929 University Drive. Suite 108 Coral Springs 33065 (954) 340-1992 _ 6610 N. University Drive, Suite 102 Tamarac 33321 (954) 720-6166 (954) 720-3638 Infectious Disease 1 Ak(ilu, Yared, M.D. 4750 N. Federal Highway, Suite 200 Ft. Lauderdale 33308 (954) 489-2260 (954) 489-2261 Buchsteiil, Sara, M.D. 2901 Coral Hills Drive. Suite 220 Coral Springs 33065 (954) 345-0404 (954) 346-8315 Cobian, Ledya, M.D. 4750 N. Federal Highway, Suite 200 Ft. Lauderdale 33308 (954) 489-2260 (954) 489-2261 Gopal, Indulekha, M.D. 2901 Coral Hills Drive, Suite 220 Coral Springs 33065 ;954) 345-0404 (954) 346-8315 Komaiha. Hamed. M.D. 2901 Coral Hills Drive. Suite 220 Coral Springs _ 33065 (954) 345-0404 (954) 346-8315 Dndrusek, Jaroslay. M.D_ 2901 Coral Hills Drive, Suite 220 Coral Springs 33065 1954) 345.0404 (954) 346-8315 Patel, Tetal. MD_ 2901 Coral Springs Hills Drive. Suite 220 Coral Springs 33065 (954) 345-0404 (954) 346-8315 Renee, Stephen, M.D. 4800 NE 20 Terrace, Suite 115 Ft. Lauderdale 33308 (954) 776-9992 (954) 776-9993 Riganolti. Dominic. M.D. 1881 NE 261h Street. Suite G0 Wilton Manors 33305 (754) 206.2031 (754) 206-2032 Villalba. Jose, M.D. 2901 Coral Hills Drive, Suite 220 Coral Springs 33065 (954) 345-0404 (954) 346-8315 Internal Medicine I Akselrud. Mark, M-D. 7421 N. University Drive, Suite 309 Tamarac 33321 (954) 721-9898 (954) 721-9810 Alharnsi. Abed, M.D. 8251 W. Broward Blvd.. Suite 103 Plantation 33324 (954) 255-7310 (954) 255-7311 One West Sample Road, Suite 303 Deerfield Beach 33064 (954) 943-4434 2901 Coral Hills Drive. Suite 360 Coral Springs 33065 (954) 255-7310 _ Beaufort. Jo -Anne, M.D. 1150 N. 351h Avenue. Suite 590 Hollywood 33021 (954) 265-3982 (954) 893-6518 Bender, Kevin, M.D. 7707 N,. University Drive, Suite 106 Tamarac 33321 (954) 722-4206 (954) 722-4226 11 Broward County Providers SPECIALTY PROVIDER ADDRESS CITY Zip Phone Fax eMall Address Blaze. Kenneth. O.O. 1 S.W. 129th Avenue. Suite 109 Pembroke Pines 33027 (954) 433-4200 (954) 433-7710 Garcia. Angel. M.D. 12651 W. sunrise Boulevard. Suite 101 Sunrise 33323 (954) 838-7491 2704 N. University Drive Sunrise 33322 (954) 306-6276 12014 Miramar Parkway Miramar 33025 (954) 438-6228 (954) 438-1596 3705 Garfield Street Hollywood 33021 {954) 265-3406 Littman, Allan. M.D. 3333 N. Federal Highway Pompano Beach 33064 (954) 941-8866 (954) 941-9950 docgil@aol.corn Gupta. Mohan. M.D. 8396 W. Oakland Park Boulevard Sunrise 33351 (954) 742-0112 (954) 746-8202 mohanguplamd@yahoo.com Hodarnau, Diana, M.D. 6333 N. Federal Highway, Suite 225 FL Lauderdale 33308 (954) 958-3300 (954) 958-3303 Le, Phi, M.D. 1900 E. Commercial Boulevard, Suite 101 Ft. Lauderdale 33308 {954) 351-5838 (954) 351-5836 Lieber, Charles, M.D. 2929 University Drive , Suite 108 Coral Springs 33065 (954) 340-1992 1 _ 6610 N. University Drive, Suite 120 _ Tamarac _ 33321 (954) 720-6166 (954) 720-3638 Mann, Ajaib, M.D. 3000 N. University Drive, Suite R Coral Springs 33065 (954) 753-0300 (954) 970-2561 Icathy4675@yahoo caul Mastrole, Richard, M.D. 1900 E. Commercial Boulevard, Suite 101 Ft. Lauderdale 33308 (954) 351-5838 (954) 351-5836 McKenzie, Rana, M.D. 1625 S.E. 3rd Avenue, Suite 400 Ft. Lauderdale 33315 (954) 832-0055 (954) 832-0063 7061 Cypress Road. Suite 400 _ _ - Plantation 33317 (954) 832-0055 McKenzie, Wtlhed, M.D. 1625 S.E. 3rd Avenue, Suite 400 Ft. Lauderdale _ 33316 (954) 832-0055 (954) 832-00.63 7061 Cypress Road, Suite 400 Plantation 33317 (954) 832-0055 I Meiys, Robert, M.D. 1900 E. Commercial Boulevard, Suite 101 Ft. Lauderdale 33308 (954) 351-5838 {954) 351-5836 Oxenhandler, Scott. M.D, 1150 N 35th Avenue. Suite 590 Hollywood 33021 (954) 265-3982 (954) 893-6518 Pandya, Naushira, M.D. 3200 S. University Drive Ft. Lauderdale 33329 (954) 262-4100 (954) 262-2271 vale@nova.edu Pardeli. Herbert, D.Q. 500 Hiatus Road, Suite 105 Pembroke Pines 33024 (954) 432-8872 4486 N. University Drive Lauderhill 33351 (954) 748-7474 (9541 748-7772 Pearlmutter. Nina. M.D. 15814 W. State Road 84 Ft. Lauderdale 33326 (954) 384-7200 (954) 389-9019 Rubio -Gomez, Heysu, M.D. 2901 Coral Hills Drive, Suite 220 Coral Springs 33065 (954) 345-0404 (954) 346-8315 Seth, Usha, M.D. 3850 Coconut Creek Parkway Coconut Creek 33066 (954) 973-9222 (954) 973-7135 Shankar. Murat. M,D. 8200 W, Sunrise Boulevard, Suite 06 Plantation 33322 (954) 475-1735 (954) 475-1741 Singh, Alka. M.D 2001 N. Federal Highway. Suite G301-306 Pompano Beach 33062 (954) 344-3296 Streit, Barry, M.D 6610 N. University Drive, Suite 120 Tamarac 33321 (954) 720-6166 (954) 720-3638 2929 University Drive, Suite 108 Coral Springs 33065 (954) 340-1992 Medical Oncology Lavasani, Sayeh, M.Q. 1150 N. 351h Avenue. Suite 170 Hollywood 33021 (954) 265-6990 (954) 965-6388 Mental Health Professional David, Richard, LMHC 1881 University Drive. Suite 104 Coral Springs 33071 (954) 340-0888 (954) 346-0909 Freels, Mchael, LMHC 3081 E. Commercial Boulevard, Suite 100 Ft. Lauderdale 33308 (954) 776-8544 (954) 776-5573 thefreelsgroup@bellsouth.net Kaplan, Alexander, LCSW 7481 W. Oakland Park. Boulevard. Suite 100 Lauderhill 33319 {888) 852-6672 Nelson, Remy, LMHC 3319 Inverrary Boulevard West. Suite 4088 Lauderhill 33319 (954) 420-9908 {954) 420-9911 Peguero, Delia, LCSW 1601 N. Palm Avenue, Suite 211 Pembroke Pines 33026 (888) 852-6672 (954) 447-0899 Thompson. Gregory, LCSW 150 S.W. 121h Avenue, Suite 207 Pompano Beach 33069 (954) 946-4181 1881 N.E. 261h Street. Suite 221 Ft. Lauderdale 33305 (954) 946-4181 3236 N.E. 51h Street. Suite 201 Pompano Beach 33062 (954) 946-4181 {954) 946-7747 Waits, John. LCSW '7481 Oakland Park Boulevard, Suite 100 Lauderhill 33319 (888) 852-6672 (954) 771-7743 Neurointerventional Radiology Duong. Hoang. MD 4651 Sheridan Street, Suite 150 Hollywood 33021 (954) 265-3500 1150 N. 351h Avenue. Suite 300 Hollywood 33021 (954) 265-1490 (954) 989-0454 12 Broward County Providers SPECIALTY PROVIDER ADDRESS CITY Zip Phone Fax eMail_Address 601 N, Flamingo Raad. Suite 206 Pembroke Pines 33028 (954) 430-6825 Neurology Azaret, Carlos, M.D. 7225 N. University Drive. Suite 102 Tamarac 33321 (954) 755-5900 (954) 718-0233 3540 N. Pines Island Road Sunrise 33351 (954) 484-2270 Ballweg, Gail, M.D. 601 N. Flamingo Road. Suite 406 Pembroke Pines 33028 (954) 438-9112 (954) 433-7402 gpballweg@yahoo.core Barnea, Benjamin,. M.D. 1500 University Drive, Suite 202 Coral Springs 33071 (954) 341-8100 (954) 341-8101 Batayneh. Hassan, M.D. 7225 N. University Drive, Suite 102 Tamarac 33321 (954) 718-9777 (954) 718-0233 9750 NE 33rd Street, Suite 204 Coral Springs 33065 (954) 718-9777 I Cimera, James. M.D. 1625 SE 3rd Avenue, Suite 620 Ft. Lauderdale 33316 (954) 527.9303 (954) 527-3732 Culie, Eduardo. M.D. 4925 Sheridan Street. Suite 200 Hollywood 33021 (954) 981-3850 (954) 981-3889 Dickens, Willis, M.D. 1625 S.E. 3rd Avenue, Suite 620 Ft. Lauderdale 33316 (954) 524-6527 (954) 527-3732 Dokson, Joel. M.D. 12596 Pines Blvd_ Pembroke Pines 33027 (954) 437-4000 (954) 433-5257 jdokson@sntgumc_com wemery@eneuro.med.pro Emery. I11, Waden. M.D. 5340 N. Federal Highway, Suite 205 Lighthouse Point 33064 (954) 771-8300 (954) 771-4002 Gailardo. Joshuae. M.D. 1150 N, 35th Avenue, Suite 300 Hollywood 33021 .(954) 265-1490 (954) 989-0454 Ginsberg, Paul, M.D. 12596 Pines Boulevard Pembroke Pines 33027 (954) 437-4000 (954) 745-0501 4925 Sheridan Street. Suite 200 Hollywood 33021 (954) 981-3850 1 Goldberg. Gerald. M.D. 3540 North Pine Island Road _ Sunrise 33351 (954) 797-7881 (954) 797-7880 Gopalaswamy, Ramesh, M.D. 3540 N. Pine Island Road Sunrise 33021 (954) 321.1776 (954) 321-1885 Grossman, Melvin. M.D. 4700 Sheridan Street, suite u Hollywood 33021 (954) 962-6333 (954) 963-2442 Ismail, Muhammad, M.D. 6000 West Atlantic Boulevard, Suite 1 & 2 Margate 33063 (954) 601-6321 (954) 973-0961 Kishner, Richard. M.D. 2021 E. Commercial Boulevard, Suite 201 Ft. Lauderdale 33308 (954) 928-0611 (866) 854-1906 Liebman, Jill. M.D. 9750 NW 33rd Street. Suite 204 Coral Springs 33065 (954) 341-1171 (954) 341-3328 Padilla, Alvaro, M.D. 12596 Pines Blvd Pembroke Pines 33027 (954) 437-4000 (954) 433-5257 Schwartz, Harvey. M.D. 601 N. Flamingo Drive. Suite 306 Pembroke Pines 33028 (954) 437-4000 I 4925 Sheridan Street. Suite 200 Hollywood 33021 (954) 981-3850 (954) 981-3889 Subramanian, Veena, M.D. 12596 Pines Boulevard Pembroke Pines 33027 (954) 437-4000 (954) 433-5257 Teman, Allen, M.D. 9750 N.W. 33rd Street. Suite 207 Coral Springs 33065 (954) 346-0500 (954) 346-0551 Maker. Harish. M.D. 1625 S.E. 3rd Avenue, Suite 620 Ft. Lauderdale 33316 (954) 524-6527 (954) 527-3732 Vallabheneni, Radha, M.D. 4851 Hillsboro Boulevard, Unit A-8 Coconut Creek 33073 (954) 725-7376 (954) 481-8932 Iradhavall@yahoo.com Ventre, Peter, M.D. 1400 East Oakland Park, Suite 210 Oakland Park _ _ 33334 (954) 561-6222 (954) 990-1659 Zarel. Bruce, M,D._ _ 3540 N. Pine Island Road Sunrise 33351 (954) 321-1776 (954) 321-1885 Neuro-Psychology Arias, Alejandro, M.D. 150 SW 12th Avenue, Suite 330 Pompano 33069 (305) 766-5629 Neurosurgery ___ Aghion. Daniel. M.D. 1150 N. 35th Avenue. Suite 300 Hollywood 33021 (954) 265-1490' (954) 989-0454 Burkett. Clinton. M.D. 7171 N. University Drive, Suile205 Tamarac 33321 (954) 771-4251 I 1930 NE 47th Street. Suite 200 Ft. Lauderdale 33308 (954) 771-4251 (954) 491-4892 Coats. John, M.D. 1930 N.E. 47th Street, Suite 200 Ft. Lauderdale 33368 (954) 771-4251 (954) 491-4892 One West Sample Road, Suite 207 Pompano Beach 33064 (954) 771-4251 7171 N. University Drive, Suite 205 Tamarac 33321 (954) 771-4251 Demassi. Christopher, M.D. 601 N. Flamingo Road, Suite 206 Pembroke Pines 33028 (954) 430-6825 1150 N. 35t1 Avenue, Suite 300 Hollywood 33021 (954) 265-1490 (954) 989-0454 4651 Sheridan Street, Suite 150 Hollywood 33021 (954) 265-3500 Gieseke, Gary, M.D. 7171 N. University Drive. Suite 205 Tamarac 33321 (954) 771-4251 1930 N.E.47th Street. Suite 200 Ft. Lauderdale 33308 (954) 771-4251 f954) 491-4892 One W. Sample Road. Suite 207 Pompano Beach 33064 (954) 771-4251 Hall. Anthony, M.D. 817 S. University Drive, Suite 105 Planation 33324 (305) 461-3116 Laiy, Arnold. M.D. 8251 W. Broward Boulevard, Suite 300 Plantation 33324 (954) 475-9244 -2825 North State Road 7. Suite 304 Margate 33063 (954) 475-9244 (954) 475-0848 Malrner. Lloyd. M.D. 12309 Pembroke Road, 10th Floor Pompano Beach 33062 (954) 862-7099 13 Broward County Providers SPECIALTY PROVIDER ADDRESS CITY Zip Phone Fax eMail_Address 301 N.W. 84th Avenue. Suite 206 Plantation 33324 (954) 862-7099 (954) 862-7296 Moore, Matthew, M.D. 7171 N. University Drive, Suite 205 Tamarac 33321 {954) 771-4251 _ 1 1930 N.E. 47th Street, Suite 200 Ft. Lauderdale 33308 (954) 771-4251 (954) 491-4892 One West Sample Road. Suite 207 Pompano Beach 33064 (954) 771-4251 f Okun, Jessica, D.O. 3540 N. Pine Island Sunrise 33351 {954) 653-3722 (954) 653-3728 Pasarin, Guillermo, M.D. 3540 Pine Island Road Sunrise 33351 (954) 321-1776 (954) 321-1885 Rodriguez, Luis, M.D. 1150 N. 35th Avenue. Suite 300 Hollywood 33021 (954) 985-1490 {954) 989-0454 4651 Sheridan Street, Suite 150 Hollywood 33021 (954) 265-3500 601 N. Flamingo Road, Suite 206 Pembroke Pines 33028 (954) 430-6825 Zorman, Greg. M.D. 4651 Sheridan Street, Suite 150 Hollywood 33021 (954) 265-3500 601 N. Flamingo Road, Suite 206 Pembroke Pines 33028 (954) 430-6825 Zorman, Greg. M.D. 1150 N. 35th Avenue, Suite 300 Hollywood 33021 (954) 985-1490 OCGupational Medicine Feldman, Seth, D.O. 3501 N. Federal Highway Pompano Beach 33064 (954) 785-5411 407 S.E. 24th Street Ft. Lauderdale 33316 (954) 467-2140 (954i 524-2145 Fleigelman, Robert, M.D. 140 S. Federal Highway Dania Beath 33004 (954) 265-3406 12014 Miramar Parkway Miramar 33025 (954) 438-6228 (954) 438-1596 occurned@hellsouth.net 12651 W. Sunrise Boulevard, Suite 101 Sunrise 33323 (954) 838-7491 Ophthalmology Albert, Witham. M.D. 3419 Johnson Street Hollywood 33021 (954) 989-2800 {954) 989-2873 Anagnoste, Scott. M.D. 1776 N. Pine Island Road, Suite 312 Plantation 33322 (954) 452-4500 6333 N, Federal Highway, Suite 300 Ft. Lauderdale 33308 (954) 776-6880 (954) 229-3100 sanagnoste@rgfla.com 4000 Hollywood Boulevard, Suite 190N Hollywood 33021 (954) 894-7020 Berger, Clayton, M.D. 201 S.E. 14th Street FL Lauderdale 33316 (954) 525-1111 (954) 522-5588 1935 E, Hallandale Beach Boulevard Hallandale 33009 (954) 458-2112 Biter, Wayne, D.O. 7800 W. Oakland Park Boulevard, Suite C206 Sunrise 33351 (954) 741-5555 (954) 572-6958 flei7800@bellsouth.net Bosem, Marc, M.D. 1 S.W. 129th Avenue, Suite 209 Pembroke Pines 33027 (954) 437-9300 (954) 437-9377 dcelonrosa@yahoo_com Braverman, Stanley. M.D. 1935 E. Hallandale Beach Boulevard Hallandale 33009 (954) 458-2112 {954) 458-7186 vspdoc@aol.com Bruno, Andrew, M.D. 1609 S.E. 3rd Court Deerfield Beach 33441 (954) 427-6363 (954) 427-6364 Burgess, Stuart, M.D. 7800 W. Oakland Park Boulevard, Suite C206 Sunrise 33351 (954) 741-5555 (954) 572-6958 fler7800@beilsouth.net 6ynoe, Lean, M.D. 1881 N. University Drive, Suite 112 Coral Springs 33071 (954) 755-4633 (954) 755-4637 retinaspring@bellsouthnet Cutler, Seth, M.D. 2500 N. University Dnve, Suite 14 Sunrise 33322 (954) 748-7755 (954) 748-7760 scutler@eyefl.com Ruffner, Lee, M.D. 2740 Hollywood Boulevard Hollywood 33020 (954) 925-2740 (954) 927-1941 spendlebury@eyesurgery.net 603 N. Flamingo Road, Suite 250 Pembroke Pines 33028 (954) 431-2777 Elgut, Noel, M.D. 6333 N. Federal Highway, Suite 401 Ft. Lauderdale 33308 (954) 463-4761 (954) 463-4763 Epstein, Gilbert, M.D. 7800 W. Oakland Park Boulevard, Suite C206 Sunrise 33351 (954) 741-5555 (954) 572-6958 flei7800@bellsouth.net Fess, Lawrence, M.D. 6405 N. Federal Highway, Suite 101 Fort Lauderdale 33308 (954) 776-7327 (954) 776-7307 954776730 Feldman, Mark, M.D. 7800 W. Oakland Park Boulevard, Suite C-206 Sunrise 33351 (954) 741-5555 (954) 572-6958 flei7800@bellsouth.net Fernandez de Castro, Luis, M.D. 850 South Pine Island Road Plantation 33324 (954) 741-5555 (954) 572-6958 Flack, Norma, M.D. 4800 N.E- 20th Terrace, Suite 115 Ft. Lauderdale 33308 (954) 776-0292 (954) 776-1442 njflack@eyetl.com Gechter, Eric, M.D. 2900 West Cypress Creek Road, Suite 1 Fort Lauderdale 33309 (954) 977-0192 Glalzer, Ronald, M.D. 1800 W. Hillsboro Boulevard, Suite 201 Deerfield Beach 33442 (954) 421-8000 (954) 426-4400 jlong419@yaheo.net Glick. Henry. D.O. 3100 Coral Hills Drive, Suite 206 Coral Springs 33065 (954) 575-4711 (954) 575-4722 heglick@yahoe.com Goldberg, Marc, M.D. 8399 West Oakland Park Boulevard, Suite. A Sunrise 33351 (954) 578-2066 (954) 578-2595 ophthalm@bellsouth.net 2334 NE 52rd Street Ft. Lauderdale 33308 (954) 776-2020 Gopalaswamy, Ramesh, M.D, 3540 N, Pine Island Road Sunrise 33021 (954) 321-1776 (954) 321-1885 14 Broward County Providers SPECIALTY PROVIDER ADDRESS CITY Zip Phone Fax eMall_Address Greenberg. Marvin, M.D. 7421 N. University Drive, Suite 109 Tamarac 33321 (954) 726-2080 (954) 726-2105 mervgreenberggataol.coin Guliner. Robert. D.O. 3929 N. Federal Highway Pompano Beach 33064 (954) 425-4565 drguliner@gmeil.com Halperin, Lawrence. M.D. 5601 N. Dixie Highway. Suite 307 FL Lauderdale 33334 (954) 776-6880 (954) 776-6895 Hopen, Gary, M,D. 3419 Johnson Street Hollywood 33021 (954) 989-2800 (954) 989-2873 Iju(ie3ang@yahoo.com Hrdlicka, Zuzana. M.D. 5601 N. Dixie Highway, Suite 115 Ft. Lauderdale 33334 (954) 771-4271 (954) 776-5959 Karp, Kenneth, M.D. 1951 S.W. 172nd Avenue. Suite 304 Miramar 33029 (954) 437-4316 (954) 439-4352 kennethkarpind@hotmaiLcom Katz, Raananah, M.D. 1776 N. Pine Island Road, Suite 214 Plantation 33322 (954) 452-9922 (954) 452-9481 rkalzins2@aoLcom Kline, Norman. M.D. 1801 N. University Drive. Suite 102 Coral Springs 33071 (9541 344-0999 (954) 344-7929 Lane, Alan. M,D. 4000 Hollywood Boulevard. Suile 180-N _ Hollywood 33021 (954) 963-3336 (954) 963-3341 601 N. Flamingo Road, Suite 315 Pembroke Pines 33028 (954) 538-1177 1935 E. Hallandale Beach Boulevard Hallandale 33009 (954) 458-2112 Lara. Tirso. M.D, 7800 W. Oakland Park Boulevard. Suite C206 Sunrise 33351 (954) 741-5555 (954) 572-6958 flei7800@bellsouth.nel Lee -Ghee, Tatiana, D.O. 1828 W. Hillsboro Boulevard, Suite 204 Deerfield Beach 33442 {954) 421-8000 (954) 426-4400 babsgoblue@bellsouth.net Leonard, Elise, M.D. 1732 N. Universtiy Drive Pembroke Pines 33024 (954) 432-7711 8890 W, Oakland Park Bouelvard, Suite 300 Sunrise 33351 (954) 746-7040 (954) 572-0906 Levy, Harris, M.D. 1 SW 129(h Avenue, Suite 209 Pembroke Pines 33027 (954) 437-9300 (954) 437-9377 8051 W. Sunrise Boulevard Plantation 33322 1954) 474-2900 Loeffler. Michael. M.D. 2100 E. Sample Road. Suite 102 Lighthouse Point 33064 (954) 786-5353 (954) 786-5340 oscu(ar@bellsouth. Net Logan. Andrew, M.D. 7401 N. University Drive, Suite 201 Tamarac 33321 (954) 724-5100 (954) 724-5121 Mao. Lisa. M.D. 4800 N.E. 20th Terrance. Suite 305 Ft. Lauderdale 33308 (954) 491-1111 Neely, (ley, M.C. 5601 N. Dixie Highway, Suite 115 Ft, Lauderdale 33334 (954) 771-4271 (954) 776-5959 nrectbeilsouth,net Nolan. Andrew, M.D. 2000 N. Federal Hwy, Suite 100 Pompano Beach 33062 (954) 941-0731 (954) 942-2248 tsn004@aol.com Roche. Sr-. Martin, M.D. 500 S.E. 17th Street. Suite 100 Ft. Lauderdale 33316 (954) 462-7558 _ Rosenberg, Krista, M.D. 5601 N. Dixie Highway, Suite 307 F(. Lauderdale 33334 (954) 776-6880 _ _ (954) 776-6895 Rubin, Tobe, M.D. 1307 Lyons Road _ Coconut Creek 33063 (954) 979-3222 (954) 979-0889 marlirnnellman@aol.com Rubsarnen. Patrick, M.D. 603 N. Flamingo Road, Suite 250 Pembroke Pines 33028 (954) 431-2777 Sandberg, Joel, M.D. 2740 Hollywood Boulevard Hollywood 33020 (954) 925-2740 (954) 923-8379 Scaarnno, John, M.D. 5601 N. Dixie Highway. Suite 115 FI. Lauderdale 33334 (954) 771-4271 (954) 776-5959 Inrecbeltsauth.net Shienbaum, Gary. M.D. 1 SW 129th Avenue. Suite 209 Pembroke Pines 33027 (954) 437-9300 (954) 437-9377 8051 W. Sunrise Boulevard Plantation 33322 (954) 474-2901 I Skolnick, Keith, M.D. 7800 W. Oakland Park Boulevard, Suite C-206 Sunrise 33351 (954) 741-5555 (954) 572-6958 Taber, Rashid, M.D. 2300 N. Commerce Parkway. Suite 201 Weston 33326 (954) 217-6500 (954) 437-9377 ldcolonrosaglyahoo.com Taney. Barry, M.D. 5601 N. Dixie Highway, Suite 307 FL Lauderdale 33334 (954) 776-6880 (954) 776-6895 Tavakkoli, Hassan. D.U. 8051 W. Sunrise Boulevard Plantation 33322 (954) 474-2900 (954) 474-2901 southflondaeye@belisouth.net Teazel. David, M.D. 8395 W. Oakland Park Boulevard, Suite F Sunrise 33351 (954) 578-2066 2334 N.E. 53rd Street Ft. Lauderdale 33308 (954) 578-2066 (954) 578-2595 ophthalm@lbellsouth.net Thompson. William, M.D. 4000 Hollywood Boulevard, Suite 190N Hollywood 33021 (954) 894-7020 6333 N. Federal Highway, Suite 300 FL Lauderdale .33308 (954) 776-6880 (954) 229-3100 1776 N. Pine Island Road, Suite 312 Plantation 33322 (954) 452-4500 Villele, Natalie, M.D. 1930 NE 47th Street. Suite 101 FL Lauderdale 33308 (954) 772-3337 (954) 772-2033 F—I 850 Pine Island Road Plantation 33324 (954) 741-5555 Wise, Jonathan, M.D. 3816 Hollywood Boulevard, Suite 101 Hollywood 33021 (954) 963-4990 (954) 953-1848 1 S.W. 1291h Avenue. Suite 209 Pembroke Pines 33024 (954) 963-1130 Wolfe, Russell, M.D. 3419 Johnson Street Hollywood 33021 (954) 989-2800 (954) 989-2873 lulie3ang@tyahoo.com Oral Surgery Garver. Lanny. D.M.D. 7401 N. University Drive, Suite 102 Tamarac 33321 (954) 721-7990 (954) 720-9484 Stewart, Stanley, D.M.D. 7401 N. University Drive, Suite 102 Tamarac 33321 (954) 721-7990 (954) 720-9484 gandsdrnd@bellsouth.net 333 N.W. 70th Avenue. Suite 207 Plantation 33317 (954) 583-6996 Orthopedic Surgeon! Spine Surgery - 15 Broward County Providers SPECIALTY PROVIDER ADDRESS CITY Zip Phone Fax eMall_Address Brown, Christopher, M.D. 4765 SW 148th Avenue. Suite 401 Davie 33330 (954) 707-5070 350 N. Pine Island Road, Suite 200 Plantation 33324 (954)476-8800 (954) 476-1362 Cameron, Julian. M.D. 7710 NW 71 Court, Suite 205 Tamarac 33321 (954) 747-1221 Jarolem, Kenneth, M.D. 600 5. Pine Island Road, Suite 300 Plantation 33324 (954) 473.6344 (954) 476-9077 helainefishereorlhoctrsofl.corn Matos Ricardo, M.D. 2850 N. Federal Hi. hwa 2nd Floor Lighthouse Paint 33464 (954) 942-0321 (954) 942-0321 Myers. Belmar'''. D.O. 3850 Sheridan Street Hollywood 33021 (954) 983-3888 (954) 983-3999 Rath. Bral lloy D.O. 4440 Sheridan Street Hollywood 33021 (954) 963-3500 (954) 964-2049 Worm, Jamey M.D, 601 N. Flamingo Road. Suite 101 Pembroke Pines 33028 (954) 436-0446 4440 Sheridan Street Hollywood 33021 (954) 963-3500 (954) 989-4873 Orthopedic Surgery Apadcio. Raul, M.D. 499 N.W. 70th Avenue, Suite 210 Plantation 33317 (954) 792-0220 (954) 792-2202 2008orthothetlsouth,net Averbuch, Philip, M.D. 7171 N University Drive, Suite 100 Tamarac 33321 (954) 722-0040 (954) 722-0043 Baker, John, M.D. 1600 S. Federal highway, 5th Floor Pompano Beach 33062 (561) 296-1188 Baylis. Robert, M.D. 350 N. Pine Island Road, Suite 200 Plantation 33324 (954) 476-8800 (954) 476-1362 riggkartiloausa.com Berkowitz. Bruce. M.D. 600 5. Pine Island Road, Suite 300 Plantation 33324 (954) 473-6344 (954) 476-9077 belainefisherrgorthoctrsofl.com Berkowitz. Mario, M.D. 2701 NE 14th Street Causeway, Suite 5 Pompano Beach 33062 (954) 735-3535 1951 S.W. 172nd Avenue, Suite 115 Miramar 33029 (954) 735.3535 4850 W. Oakland Park Boulevard. Suite 201 Lauderdale Lakes 33313 1954) 735-3535 (954) 484-7000 Iocpatgaol.com 10794 Pines Boulevard. Suite 104 Pembroke Pines 33026 (954) 735-3535 Berta'. Alex, M.D. 17842 NW 2nd Street Pembroke Pines 33029 4954) 430-9901 1600 Town Center Boulevard, Suite C Weston 33326 (954) 389-5900 220 SW 84th Avenue, Suite 102 Plantation 33324 (954) 720-1530 (954) 720-6540 Ifruscella)earthlink.net Bivins, Marc. M.D. 1402 NE 26fl1 Street Wilton Manors 33305 (954) 565-7789 (954) 565-6796 Blom, Johannes, M D. 300 S.E. 171h Street, 2nd Floor Ft. Lauderdale 33319 (954) 964-6114 601 N. Flamingo Road, Suite 101 Pembroke Pines 33028 (954) 964-6114 3702 Washington Street, Suite 202 Hollywood 33021 (954j 964-6114 (954) 962-1994 hloinHAcomcast.net Dodder, Jahn, M.D. 440 E. Sample Road, Suite 106 Pompano Beach 33064 (954) 943-3303 (954) 785-3200 Burke, William, M.D. 2307 Broward Boulevard, Suite 200 Ft. Lauderdale 33312 {954) 792-'1010 (954) 792-1199 (,aklwell. Jr., George. M.D. 2307 Broward Boulevard, Suite 200 Ft, Lauderdale 33312 (954) 792-1010 (954) 792-1199 Cardozo, Roy, M.D. 350 N. Pine Island Road, Suite 200 Plantation 33324 (954) 476.8800 Cheyet, Brad, M.D. 600 S. Pine Island Road, Suite 300 Plantation 33324 (954) 473.6344 (954) 476-9077 helainelisher@orlhoctrsofl.com Chin. Kingsley. M.D. 1100 W. Oakland Park Boulevard, Suite 3 Ft. Lauderdale 33311 (954) 640-6010 (877) 647-7874 Colon -Martinez, Mirylsa, M.D. 4701 N, Federal Highway, Suite A39 Ft. Lauderdale 33308 (954) 771-8177 2964 N. Stale Rd 7, Suite 205 Margate 33063 1954) 580-4480 {954) 580-4081 Cope. Lloyd, M.D. 1000 N.E. 56th Street Ft. Lauderdale 33334 (954) 958-0606 5597 N. Dixie Highway Ft. Lauderdale 33334 (954) 958-4800 _ Cross, Brian. 0.0. 1625 S.E. 3rd Avenue, Suite 610 F1. Lauderdale 33316 (954) 355-3490 (954j 355-3498 Cummings. Phillip, M.D. 600 S. Pine Island Road. Suite 300 Plantation 33324 (954) 473-6344 1954) 476-9077 hetainei(sher@arthochsoll.com Delgado -Garcia. Domingo, M.D. 5597 N. Dixie Highway Ft. Lauderdale 33334 (954) 958-0626 _ _ DeSsmone. Alfred, M.D. 17842 S.W. 2nd Street Pembroke Pines 33029 (954) 430-9901 1600 Town Center Boulevard, Suite C Weston 33326 1954) 389-5900 (954) 389-9178 7447 N. University Drive Tamarac 33321 (954) 720-1530 Donshik, Jon. M.D. 301 N.W. 84ttr Avenue, Suite 303 Plantation 33324 (954) 888-1000 (305) 888-1446 Ebersberger, Marc, M.D. 4701 N. Federal Highway. Suite A-39 Ft. Lauderdale 33309 (954) 77 1-8177 (954) 771-3629 2964 N SR 7. Suite 205 Margate 33063 (954) 580-4030 I Eierle, Carl. M.D. 600 South Pine Island Road, Suite 300 Plantation 33324 (954) 473-6344 (954) 476-9077 601 N. Flamingo Road, Suite 213 Pembroke Pines 33028 (954) 473-6344 Feanny, Michael, M.D. 10794 Pines Boulevard, Suite 104 Pembroke Pines 33026 (954) 735-3535 16 Broward County Providers SPECIALTY PROVIDER ADDRESS CITY Zip Phone Fax eMail Address 2701 NE 14th Street Causeway, Suite 5 Pompano Beach 33062 (954) 735-3535 4850 W. Oakland Park Boulevard, Suite 201 Lauderdale Lakes 33313 (954) 735-3535 (954) 735-7000 tocpa@aoi.cem Fingado, Brian, M.D. 5597 N. Dixie Highway FL Lauderdale 33334 (954) 958-4809 (954) 958-4899 Fletcher, Bruce, M.D. 5901 Colonial Drive, Suite 201 Margate 33083 (954) 979-3255 (954) 979-6635 Garcia. Jr.. Rolando. M.D. 230 S. Dixie Highway Hallandale 33009 (954) 458-2166 Gerard. Fredric, M.D. 7225 N University Drive. Suite 202 _ Tamarac 33321 (954) 739-9700 (954) 739-1934 info@orthospecpa.eet 'Gilbert, David, M.D. 5301 North Dixie Highway. Suite 203 Ft. Lauderdale 33334 (954) 771-3334 (954) 771-1069 Glatt, Sergio. M.D. 601 N. Flamingo Road. Suite 101 Pembroke Pines 33028 (954) 473-6344 600 S. Pine Island Road. Suite 300 Plantation 33324 (954) 473-6344 (954) 476-9077 Goldstein, Richard, M.D. 1414 S.E. 3rd Avenue Ft. Lauderdale 33316 (954) 764-8033 (954) 764-5522 2300 N. Commerce Parkway, Suite 307 Weston 33326 (9541 217-7333 Grossman. Warren, M.D. 1 S.W. 129th Avenue. Suite 401 _ Pembroke Pines 33028 (9541 961-3500 4700 Sheridan Street. Suite H Hollywood 33021 (954) 961-3500 (954) 961-1835 Gupta. Manish. M.D. 6280 W. sample Road. Suite 203 Coral Springs 33067 {954} 481-9942 (954) 481-9917 Hapanpour. Mohamed. M.D. 10794 Pines Boulevard. Suite 104 Pembroke Pines 33026 (954} 735-3535 4850 W. Oakland Park Boulevard, Suite 201 Lauderdale Lakes 33313 (954) 735-3535 (954) 484-7000 tocpal aol.cam 2701 NE 14th Street Causeway. Suite 5 Pompano Beach 33062 (954) 735-3535 1951 S.W. 172nd Avenue, Suite 115 Miramar 33029 (954) 735-3535 Hammerman. Marc. M.D. 4310 Sheridan Street Hollywood 33021 (954) 989-3500 (954) 989-4873 601 N. Flamingo Road, Suite 101 Pembroke Pines 33028 (954) 435-9500 Hermida, Verano, M.D. 5597 N. Dixie Highway Ft. Lauderdale 33334 (954) 958-0626 (954) 489-2842 Hinkes, Elliott. M.O. 5901 Colonial Drive. Suite 201 Margate 33063 (954) 979-3255 (954) 979-6635 Horton, Kenneth. M.D. 1150 N. 35th Avenue. Suite 390 Hollywood 33021 (954) 983-6868 1 Horvath, Barney, M.D. 9750 N.W. 33rd Street, Suite 120 Coral Springs 33065 (954) 344-2100 (954) 344-7964 Jacobs, Stephen, M.D. 600 5. Pine Island Road, Suite 300 Plantation 33324 (954) 473-6344 (954) 476-9077 helainefisher@orthocesofl.corn 1414 S.E. 3rd Avenue Ft. Lauderdale 33316 (954) 473-6344 Kanell. Daniel, M,D, 1601 S. Andrews Avenue, 3rd Floor Ft. Lauderdale 33316 (954) 522-3355 (954) 522-9550 Kapila. Deepak, M.D. ' 7050 N.W. 4th Street. Suite 102 Plantation 33317 (954) 584-3001 {954} 584-3013 Kazdan, Scott, D.O. 601 N. Flamingo Road. Suite 209 Pembroke Pines 33028 (954) 349-6550 (954) 385-0460 Kelly. Michael M.D. 5901 Colonial Drive, Suite 201 Margate 33063 (954) 979-3255 (954) 979-6635 Kessler, Kevin, M.D. 4800 N. Federal Highway, 3rd Floor Ft. Lauderdale 33308 (954) 491-7758 Kincheiow, Tosca, M.D. 4765 SW 148th Avenue, Suite 401 Davie 33330 (954) 707-5070 350 N. Pine Island. Suite 200 Plantation 33324 (954) 476-8800 (954) 476-1362 riggkar@oausa.com Kleinhenz, Dominic, M.D. 2850 N. Federal Highway. 2nd Floor Lighthouse Point 33064 (954) 942-0321 (954) 942-7018 Kugler. Jeffrey. M.D. 1600 S. Federal HWY. 5th Floor Pompano Beach 33062 (954) 545-9871 _ _ Kurland. Keith. M.D. 10139 N.W. 31st Street, Suite 202 Coral Springs 33065 (954) 755-6100 (954) 345-3754 orthopedicinsl3@aol.com Landes. Jacob, D.O. 1414 SE 3rd Avenue Ft. Lauderdale 33316 (954) 764-8033 (954) 764-5522 Lazar, Atan. M.D. 7171 N. University Drive Tamarac 33321 (954) 724-9300 350 N, W. 84th Avenue, Suite 206 Plantation 33324 (954) 476-9494 (954) 476-8288 Cindy@dralanlazar.com Leone. William, M.D. 1000 NE 56ih Street Ft. Lauderdale 33334 (954) 489-4575 (954) 489-4584 Lestrange, Nile, M.D. 1600 S. Federal Highway, 10th Floor Pompano Beach 33062 (954) 788-9090 (9541 788-9307 Levy, Jonathan, M.D. 1000 NE 56th Street Ft. lauderdale 33334 (954) 958-0696 5597 N. Dixie Highway Ft. Lauderdale 33334 (954) 958-4800 Linn. Richard, M.D. 7171 North University Drive. Suite 207 Tamarac 33321 (954) 473-6344 600 5. Pine Island Road, Suite 300 Plantation 33324 (954) 473-6344 (954) 476-9077 helainefisher@iorthoclrsoff.com Lipman. Adam. M.D. 4800 N. Federal Highway Ft. Lauderdale 33308 (954) 491-7758 (954) 938-5339 Livingstone, Ayisha, M.D. 4701 N. Federal Highway, Suite A39 Ft. Lauderdale 33308 (954) 771-8177 (954) 771-8421 2964 North State Road 7. Suite 205 Margate 33063 (954) 580-4080 Matuszak, Charles. M.D. 1600 S. Federal HWY, 10th Floor Pompano Beach 33062 (954) 545-9871 McKay, Witham. M.D. 2850 N. Federal Highway, 2nd Floor Lighthouse Point 33064 (954) 942-0321 (954) 946-7018 Meli. Paul. M.D. 2964 North State 7. Suite 205 Margate 33063 _ (954) 580-4080 _ f 17 Broward County Providers SPECIALTY PROVIDER ADDRESS CITY Zip Phone Fax eMail Address 4701 N. Federal Highway, Suite A39 Fi. Lauderdale 33308 (954) 771-8177 (954) 771-8421 Micheiov, Yehuda, D.O. 7225 N University Drive, Suite 201 Tamarac 33321 (954) 724-3400 (954) 724-9721 Mills, Jr., Robert, M.D. 5597 N. Dixie Highway Ft. Lauderdale 33334 (954) 958-4800 Maya. Fernando, M.D. 17842 N.W. 2nd Street Pembroke Pines 33029 (954) 430-9901 (954) 430-0608 220 SW 64th Avenue, Suite 102 Plantation 33324 (954) 720-1530 2101 N. Commerce Parkway Weston '33326 (954) 430-9901 Padden. David, M.D. 2850 N. Federal Highway, 2nd Floor Lighthouse Point 33064 (954) 942-0321 (954) 946-7018 Poovendran. Gayan, M.D. 2964 N SR 7. Suite 205 Margate 33063 (954) 580-4080 4701 N, Federal Highway, Suite A-39 Ft. Lauderdale 33309 (954) 771-8177 (954) 771-3624 Forth, Manuel, M.D. 7225 N. University Drive, Suite 201 Tarnarac 33321 (954) 724-3400 (954) 724-9451 Propper, Michael, M.D. 150 S. Andrews Avenue Pompano Beach 33069 (888) 646-2273 (954) 933-2983 Reich, Alan, M,D. 1150 N. 35th Avenue, Suite 390 Hollywood 33021 (954) 961-3500 (954) 961-1835 1 S.W. 129th Avenue, Suite 401 Pembroke Pines 33021 (954) 961-3500 Reilly. Michael. M.D. 5301 North Dixie Highway. Suite 203 Ft. Lauderdale 33334 (954) 771-3334 (954) 771-1069 Reuter, Merrill. M.D. 150 S. Andrews Avenue Pompano Beath 33069 (888) 646-2273 (954) 933-2983 lisette@browardoutpatient.com Roche. Martin, M,D. 5597 N. Dixie Highway Ft. Lauderdale 33334 (954) 958-4800 1000 NE 56th Street Ft. Lauderdale 33334 (954) 958-0606 Rolnick, Audie, M.D. 600 S. Pine Island Road, Suite 300 Plantation. 33324 (954) 473-6344 (954) 476-9077 helainefisher1 orthoctrsofl.com Ruddy. Michael, M.D. 1625 S.E. 3rd Avenue. Suite 700 II. Lauderdale 33316 ' (954) 463-3200 (954) 463-3292 dr ruddytorthobgh.com Rush, Joel D_O. 1625 S.E. 3rd Avenue, Suite 700 Ft. Lauderdale 33316 (954) 463-3200 (954) 463-3292 Dijrushiurthobgh,com Sanchez. Julio, M.D. 150 S. Andrews Avenue Pompano Beach 33069 (888) 646-2273 (954) 933-2983 Schechter. Neil. M.D. 600 S. Pine Island Road, Suite 300 Plantation 33324 (954) 473-6344 (954) 473-2603 HelainefisheriororlhocUsofl.com Schwartz, Gary, M.D. 3700 Washington Street, Suite 200 Hollywood 33021 (954) 966-8450 (954) 989-4873 Sheikh, Babak, M.D. 2701 NE 14th Street Causeway, Suite 5 Pompano Beach 33062 (954) 735-3535 1951 S.W. 172nd Avenue. Suite 115 Miramar 33029 (305) 735-3535 4850 W. Oakland Park Boulevard, Suite 201 Lauderdale Lakes 33313 (954) 735-3535 (954) 484-7000 tocpa@aol.com 10794 Pines Boulevard, Suite 104 Pembroke Pines 33026 (954) 735-3535 Sheldon, Daniel, M.D. 1855 N. Corporate Lakes Boulevard, Suite #3 Weston 33326 (954) 659-0115 (954) 659-0665 Shrnck, Kevin. M.D. 1414 S.E. 3rd Avenue Ft. Lauderdale 33316 (954) 764-8033 (954) 764-5522 tlosasmbellsaulh.net Simon. Richard, M.D. 600 5. Pine Island Road, Suite 300 Plantation 33324 (954) 473-6344 (954) 476-9077 helainefisherrrorthoctrsofl.com Simon. Rabin, D.O. 2030 Washington Street Hollywood 33020 (954) 925-7333 (954) 925-7339 robin.simon-mark tenethealth.com Steinlaul Steven. M.D. 1150 N. 35th Avenue. Suite 390 Hollywood 33021 (954) 961-3500 (954) 961-1835 1 S.W. 129th Avenue. Suite 401 Pembroke Pines 33028 (954) 961-3500 Strain. Richard, M.D. _ 4700 Sheridan Street, Suite H Hollywood 33021 (954) 961-3500 (954) 961-1835 1855 N. Corporate Lakes Boulevard Weston 33326 (954) 961-3500 Stringham, Douglas. M.D. 600 S. Pine Island Road, Suite 300 Plantation 33324 (954) 473-6344 (954) 476-9077 helainefisher@orthocirsotLcam Taylor, Kenneth, M.D. 4440 Sheridan Street Hollywood 33021 (954) 963-3500 (954) 989-4873 601 N, Flamingo Road Pembroke Pines 33028 (954) 463-3500 Troiano, Christopher. M.D. 7225 N. University Drive, Suite 202 Tamarac 33321 (954) 739-9700 (954) 739-1934 into(gorihospeepa.net Wells, Matthew, M.D. 1414 S.E. 3rd Avenue Ft. Lauderdale 33316 (954) 764-8033 (954) 764-5522 tlosasm@bellsoulh.net 2300 N. Commerce Parkway Weston 33326 (954) 217-7333 Young, Bruce, M,D, 2850 N. Federal Highway, 2nd Floor Lighthouse Point 33064 (954) 942-0321 (954) 946-7018 Zavoyski, Stephen, M.D. 4701 N. Federal Highway, Suite A39 Ft. Lauderdale 33308 (954) 771-8177 2964 N, State Rd 7, Suite 205 Margate 33063 (954) 580-44080 (954) 580-4081 Pain Management Aarons. Jonathan. M.D. 2964 N. State Rd 7, Suite 206 Margate 33063 (954) 580-8838 (954) 580-4081 18 Broward County Providers SPECIALTY PROVIDER ADDRESS CITY Zip Phone Fax eMail_Address 4701 N. Federal Highway, Suite A39 Ft. Lauderdale 33308 (954) 771-8177 Barbeto, Manuel, M.D. 500 Hiatus Road, Stile 105 Pembroke Pines 33024 (954) 432-8872 Barsoum, Nabil, M.D. 160 S. Military Trail. Suite 10 Deerfield Beach 33442 (954) 426-9600 (954) 426-2257 kelliansoca live,com Bislline, Jane, M.D. 1600 S. Federal Highway, 10th Floor Pompano Beach 33062 (954) 545-9939 Daly, Rosemary, D.O. 1951 S.W. 172nd Avenue, Suite 212 Miramar 33029 (954) 447-5206 (954) 447-5259 3000 Bayview Drive Ft. Lauderdale 33306 (954) 447-5206 4925 Sheridan Street, Suite 200 Hollywood 33021 (954) 447-5206 4850 W. Oakland park Bode/yard, Suite 201 Lauderdale Lakes 33313 (954) 447-5206 Davis. Lowell, D.D. 4850 W. Oakland Park Boulevard, Suite 201 Lauderdale Lakes 33313 (954) 447-5206 1951 S.W. 172nd Avenue, Suite 212 Miramar 33029 (954) 447-5206 (954) 447-5259 4925 Sheridan Street. Suite 200 Hollywood 33021 (954) 447-5206 3000 Bayview Drive Ft. Lauderdale 33306 (954) 447-5206 Deziel. Lawrence. M.D. 1613 N. Harrison Parkway, Suite 200 Sunrise 33323 (800) 437-2672 Erickson. Nancy, D,O. 601 N. Flamingo Raod. Suite 411 Pembroke Pines 33028 (954) 433-8711 (954) 433-3646 Escobar, Luis, M.D. 4350 Sheridan Street Hollywood 33021 (954) 322-8586 (954) 322-8581 lescobarpa@hotmal.com Escobar, Luis. M.D. 1 SW 129th Avenue, Suite 102 Pembroke Pines 33027 (954) 322-8586 Fox, Ira, M.O. 4485 N. State Road 7 Lauderdale Lakes 33319 (954) 735-0096 7171 North University Drive. Suite 300 Tamarac 33321 (954) 720-3188 (954) 586-2589 twhiie@fdn.com Frankoski, Edward, D.Q. 8201 W. Broward Boulevard Plantation 33324 (954) 452-2199 2801 N. State Road 7 Margate 33063 (954) 978-4477 Goldberg. Andrew. M.D. 8880 Royal Palm Boulevard. Suite 103 Coral Springs 33065 (954) 975-8233 4399 Nob Hill Road Sunrise 33351 (954) 746-1572 2825 N. State Road 7, Suite 200 Margate 33063 (954) 975-8233 (954) 974-2335 pmpsfml@yahoo.corn Gruskin, Alan, D.O. 7401 N. University Drive, Suite 106 Tamarac 33321 (954) 722-6777 (954) 722-6405 Henley -Seymour, Andrea, M.D. 4399 N. Nob Hill Rd. Sunrise 33351 (954) 315-7978 (954) 746-1438 Hobbs. Andre. M.D. 350 N. Pines Island Road, Suite 200 Plantation 33324 (954) 476-8800 12600 Pembroke Road. Suite 100 Miramar 33027 (786) 514-3290 4765 SW 1481h Avenue, Suite 401 Davie 33330 (954) 707-5070 Kamedink. Jonathan. M.D. 2964 N. State Rd 7. Suite 206 Margate 33063 (954) 580-4060 (954) 450-7081 4701 N. Federal Highway. Suite A39 Ft. Laudeidale 33308 (954) 771-8177 Krost, Stuart. M.D. 7300 NW 51h Street, Suite A Plantation 33317 (561) 296-2220 Leaner-. Jay, M.D. 7171 North University Drive. Suite 300 Tamarac 33321 (954) 720-3188 (954) 722-6996 4485 N. State Road 7 Lauderdale Lakes 33319 (954) 735-0096 _ Lenching, Sergio, M.D. One Sample Road, Suite 303 Deerfield Beach 33064 (954) 493-5048 1930 N.E. 47th Street, Suite 300 Ft. Lauderdale 33308 (954) 493-5048 (954) 493-6224 Mann. Bruce, M.D. 831 Coral Ridge Drive _ Coral Springs 33071 (954) 726-5064 (954) 726-8004 2300 N. Commerce Parkway. Suite 307 Weston 33326 (954) 721-5400 McRoberts, William. M.D. 5601 North Dixie Highway. Suite 209 FI. Lauderdale 33334 (954) 229-7962 (954) 229-7913 Naranjo. Julian, M,D. 1711 E. Hallandale Beach Boulevard Hallandale 33009 (954) 457-0064 (786) 268-4039 Ozaktay, Ahrnet, M.D. 7171 N. University Drive, Suite 300 Tamarac 33321 (954) 720-3188 _ _ _ (954) 722-6996 4485 N. Slate Road 7 Lauderdale Lakes 33319 (954) 735-0096 T Parish. Benjamin, M.D. 600 South Pine Island Road, Suite 300 Plantation 33324 (954) 473-6344 (954) 476-9077 Ramirez. Felix. 0.0. 3501 Johnson Street Hollywood 33021 (954) 838-2452 (305) 279-9330 1951 S.W. 172nd Avenue. Suite 314 _ Miramar 33029 (954) 447-5206 2301 N. University Drive. Suite 204 Pembroke Pines 33024 (954) 967-7245 Relkin, Todd, M.O. 2100 E. Sample Road. Suite 203 Lighthouse Point 33064 (954) 991-5282 (954) 947-5282 Rojas. Sandra, M.O. 1711 E. Hallandale Beach Boulevard Hallandale _ 33009 (954) 457-0064 (954) 457-0601 Saade, Edouard. M.D. 3501 Johnson Street Hollywood 33021 (954) 437-2672 (954) - Saff, Gary, M.D. 301 N.W. 84th Avenue, Suite 206 Plantation 33324 (954) 772-7552 5353 N. Federal Highway, Suite 301 Ft. Lauderdale 33308 (954) 772-7552 (954) 839-6353 ptandcs@eol.com Salamon, Joel, M.O. 350 N. Pine Island Road, Suite 200 Plantation 33324 (954) 476-8800 (954) 475-1362 riggkar@oausa.com 4765 SW 148th Avenue. Suite 401 Davie 33330 (954) 707-5070 Schou, Michael. M.D, 4850 Sheridan Street. Suite 100 Hollywood 33024 (954) 730-2789 19 Broward County Providers SPECIALTY PROVIDER ADDRESS CITY Zip Phone Fax eMail_Addres_s_ Schroeder, Jonathan. M.D. 1613 N. Harrison Parkway, Suite 200 Sunrise 33323 (8001437-2672 Siegel, Alan. M.D. 7447 N. University Drive Tamarac 33321 1954) 722-6200 1951 SW 172nd Avenue. Suite 314 Miramar 33029 (954) 447-5206 Siege( Alan. M.D. 2801 Stale Road 7 Margate 33063 (954)978-4477 8201 W. Broward Boulevard Plantation 33324 (954)452-2199 350 NW 84th Avenue, Suite 311 Plantation 33324 (954) 722-6200 967 University Drive Coral Springs _ 33071 (954) 341-5553 Silverman, Sanford, M.D. 100 E. Sample Road, Suite 200 Pompano Beach 33064 (954) 545-0106 (954) 545-0107 md427@bellsoulh.nel Szelnfeld, Marcos, M.D. 1930 N.E. 47th Street. Suite 300 Ft. Lauderdale 33308 (954) 493-5048 (954) 493-6424 Velasco, Maximllano. M.D. 1711 E. Hallandale Beach Boulevard Hallandale 33009 (954) 457-0064 Vendryes, Christhpher, M.D. 4850 W. Oakland Park Boulevard, Suite 100 Ft. Lauderdale 33313 (305) 694-3775 4925 Sheridan Street Suite 200 Hollywood 33021 (305) 694-3775 4470 Silo idal i Street Hollywood 33021 (305) 694-3775 Victor, Janice, M.D. 3255 NW 9415 Avenue Suite 9161 Coral Springs 33075 (888) 620-7246 (888) 371-1413 Wachsman, Seth. M.D. 2825 N. State Road 7. Stine 200 Margate 33063 (954) 975-8233 (954) 974-2335 pmpsf[albellsouth,net 4399 Nob Hill Road Sunrise 33351 (954)746-1572 8880 Royal Palm Boulevard. Suite 103 Coral Springs 33065 (954) 975-8233 Weidenbaum, Wayne. MD. 1613 N. Harrison Parkway. Suite 200 Sunrise 33323 (954) 851-1758 Wu. Paul. M.D, 5601 North Dixie Highway. Suite 209 Ft, Lauderdale 33334 (954) 229-7962 (954) 229-7913 1900 E. Commercial Boulevard. Suite 201 Ft. Lauderdale 33081 (954) 351-5848 Physical Medicine RehabilitationIPhysiatnst Cairns, Kevin, M.D. 6000 N. Federal Highway Ft. Lauderdale 33308 (954) 771-2551 (954) 771-2772 Deutscher, Matthew. M.D. 831 Coral Ridge Drive Coral Springs 33071 (954) 344-0303 (954) 344-0010 matthewdeulscher@alt.nel Fernando, Nltusha, M.D. 4651 Sheridan Street, Suite 355 Hollywood 33021 (800) 735.1178 350 NW 84th Avenue, Suite 206 Plantation 33324 (800) 735-1178 Fishman, Mark, D.O. 1600 Town Center Boulevard, Suite C Weston 33326 (954) 389-5900 17842 N.W. 2nd Street Pembroke Pines 33029 (954) 430-9901 Gipps. Veronica. M,D. 1211 S.F. 2nd Avenue Ft. Lauderdale 33316 (954) 522-8688 (954) 522-8606 Gruskin, Alan, D.O. 7401 N. University Drive, Suite 106 Tamarac 33321 (954) 722-6777 (954) 722-6405 Jeannot, Francisco, M.D. 8130 Royal Palm Boulevard. Suite 101 Coral Springs 33065 (954) 255-9930 (954) 255-9932 ieannotf@aol,conl Krost. Stuart. M,D, 7300 NW 51h Street, Suite A Plantation 33317 (561) 296-2220 Levy_ Gali), M.D. 4440 Sheridan Street Hollywood 33021 (954) 966-5156 (954) 966-9509 Mendelsohn, Jay. M.D. 3230 Stirling Road. Suite 3 Hollywood 33021 (954) 963-5000 (954) 963-5077 Novick, Alan, M.D. 3600 Washington Street, Suite 2005 Hollywood 33021 (954) 518-2424 (954) 981-3476 Nugent. Ivor. M.D. 3600 Washington Street, Suite 2005 Hollwyood 33021 (954) 518-2424 (954) 981-3476 Patel. Manish, M.D. 3230 Stirling Road, Suite # 3 Hollywood 33021 (954) 963-5000 (954) 963-5077 Perkins. Jeffrey, M.D. 3230 Stirling Road, Suite #3 Hollywood 33021 (954) 963-5000 (954) 963-5077 Sassoon, Eddie, M.D. 9877 Pines Bouelvard, Suite 409 Pembroke Pines 33024 (954) 432-8872 1920 E. Hallandale Boulevard, Suite 809 Hallandale 33009 (954) 458-2202 6100 Hollywood Boulevard. Suite 409 Hollywood 33024 (954) 986-2858 4486 N. University Drive Lauderhill 33351 {954) 748-7474 (954) 748-7772 mr,nica@yahoo.com 500 Hiatus Road, Suite 105 Pembroke Pines 33024 {954) 748-7474 Viable, Allan, M.D. 350 NW 84th Avenue, suite 206 Plantation 33324 (800) 735-1178 Wdliarnson. Stanford. D.O. 2962 SW 26th Terrance. Suite 106 Dania Beach 33312 (9541 791-1600 (888) 684-8452 Plastic Surgery Kaplan. Chance. M.D. 1754 E. Commercial Boulevard Ft_ Lauderdale 33334 1954) 772-1069 (954) 772-9813 Simon. Peter. M.D. 3201 N. Federal Highway, Stale 302 Ft. Lauderdale 33306 (954) 568-1010 (954) 568-0566 Sudarsky. Laura, M.D. 6401 E. Federal Highway, 3rd floor Ft. Lauderdale 33381 (954) 829-1956 6333 N. Federal Highway Ft. Lauderdale 33308 (954( 829-1956 (954) 337-3309 Pediatric Surgery 20 Broward County Providers SPECIALTY PROVIDER ADDRESS CITY Zip Phone Fax eMail Address Caban, Gregorio. D.P.M. 9692 Pines Boulevard Pembroke Pines 33024 (954) 435-8644 Luffy, Cherison, DPM 7301 N. University Drive, Suite 305 Tamarac 33321 (954) 721-4806 Heath, David, D.P.M. 2525 Embassy Drive. Suite 4 Cooper City 33026 (954) 443-4141 (954) 431-7840 2525 Embassy Drive, Suite 6 Cooper City 33026 (954) 443-4141 Herrada. Albedo, D.P.M. 10500 Griffin Road. Suite 107A Cooper City 33328 (954) 434-9877 (954) 434-9881 rayooapertos@aol.corn Metzger. Mark. J.P.M. 150 S. Andrews Avenue Pompano Beach 33069 (888) 646-2273 (954) 933-2983 Radii]. Madelin. DP.M_ 201 N. University Drive, Suite 110 Plantation 33324 (954) 379-2400 (954) 370-2459 (866) 851-5712 Iinfe@myecountabifty.org Slane. Guy. D,P M. 1811 N.W. 123rd Avenue Pembroke Pines 33026 (954) 228-5554 Podiatry Block, Barry, D.P.M. 1001 N_ Federal Highway Hallandale 33009 (954) 454-5221 (954) 458-4232 7800 W. Oakland Park Boulevard, Suite 108 Sunrise 33321 (954) 742-7003 252 5. Flamingo Road Pembroke Pines 33027 (954) 431-8855 Rollo. Augustine, D.P.M. 17779 SW 2nd Street Pembroke Pines 33029 (954) 450-0099 (954) 450-0022 podbilling@belisoulh.nel Brady, Kevin. D.P.M. 10600 Griffin Road. Suite 107A Cooper City 33328 (954) 434-9877 (954) 434-9881 Brandwein. Daniel, DPM. 159 S. Pompano Parkway Pompano Beach 33069 (954) 984-7500 (954) 984-8884 feetdoc@aol.com Brielstein, Richard, D.P.M. 7421 N. University Drive, Suite 304 Tamarac 33327 (954) 722-8080 (954) 722-4093 wounddrBbellsouth.net 8100 Royal Palm Boulevard, Suite 112C Coral Springs 33065 (9541 752-1999 Cantor, Samuel, D.P.M. 601 N. Flamingo Road, Suite 403 Pembroke Pines 33028 (954) 443-5757 (954) 374-8883 Chussid. Fredric, D.P.M. 291 N. University Drive, Suite 110 Plantation 33324 (954) 370-2400 (954) 370-2459 Glendenning, David, D.P,M. 4420 Sheridan Street, Suite C Hollywood 33021 (954) 989-8850 (954) 989-3431 Cohen, Avriel, D.P.M. 2299 N. University Drive Pembroke Pines 33024 (954) 966-7886 (954) 964-8597 Cohen. Bruce. D.P.M. 8100 Royal Palm Boulevard, Suite 112 Tamarac 33065 (954) 752-1999 (954) 752-8756 Dzikowski, Colleen, M.D. 5800 Colonial Drive, Suite 203 Margate 33063 (954) 297-8267 I 4602 N. Federal Highway Ft. Lauderdale 33308 (954) 297-8267 (954) 858-1488 Fits-Aime Jr., Galin, D.P.M, 5500 S. Flamingo Road, Suite 204 Cooper City 33330 (954) 434-3221 (954) 434-2491 Greenman, Paul, D.P.M 4900 W. Oakland Park Boulevard, Suite 107 Lauderdale Lakes 33313 (954) 533-0099 (954) 533-0090 Hall, Michael, D.P.M. 10220 W. Sample Road, Suite C Coral Springs 33095 (954) 341-4306 (954) 340-4431 Idih33065@yahoo.com Heath, David. D.P.M. 2525 Embassy Drive. Suite 4 Cooper City 33026 (954) 443-4141 (954) 431-7840 2525 Embassy Drive. Suite 6 Cooper City 33026 (954) 443-4141 Kim, Ray, D.P.M. 9692 Pines Boulevard Pembroke Pines 33024 (954) 435-8644 (954) 435-8809 pinespodiatry@aol-com MacGli. Alan, DPM 5441 N. University Drive, Suite 102 Coral Springs 33667 (954) 753-3030 (954) 666-9410 Marin, Luis, D.P.M. 1 N.E. 23rd Avenue Pompano Beach 33092 (954) 941-2245 McDonald, Cynthia, D.P.M. 10446 Taft Street Pembroke Pines 33026 (954) 431-6050 6405 N. Federal Highway, Suite 495 Ft. lauderdale 33308 (954) 771-5900 (954) 771-5959 McDonald, Terence, D.P.M. 10446 Taft Street Pembroke Pines 33026 (954) 431-6050 6405 N. Federal Highway, Suite 405 Ft. Lauderdale 33308 (954) 771-5900 (954) 771-5959 Medina, Marisel, D.P.M. 600 5. Pine Island Road, Suite 300 Plantation 33324 (954) 473-6344 (954) 476-9077 helainefisher@arthoctrsofl.com Nieter, Edgar. D.P.M. 1661 E. Atlantic Boulevard Pompano Beach 33060 (954) 941-1200 (954) 942-4005 eneed@msn.com Ringler, Adam, D.P,M. 750 S. Federal Highway Hollywood 33020 (954) 900-6494 Rivera, Michael, D.F.M. 601 N. Flamingo Road. Suite 414 Pembroke Pines 33028 (954) 888-1444 drrivera@flafootendankie.com Schottenstein, Julie, DPM 2699 Stirling Road, Suite A-301 Hollywood 33312 (954) 278-3890 (954) 251-1470 Sheinberg, Robert, D.P.M. 17842 S.W. 2nd Avenue Pembroke Pines 33029 (954) 430-9901 1600 Town Center Boulevard, Suite C Ft. Lauderdale 33326 (954) 389-5900 (954) 389-5751 Sinkoe, Roger, D.P.M. 5500 S. Flamingo Road, Suite 204 Cooper City 33330 (954) 434-3221 (954) 434-2491 Sinkoe, Stephen, DPM. 5500 5. Flamingo Road, Suite 204 Cooper City 33336 (954) 434-3221 (954) 434-2491 Wallach, Gary, D.P.M. 2737 E. Oakland Park Boulevard Ft. Lauderdale 33306 (954) 561-3338 (954) 568-3051 Windram, Warren, D.P_M. 4765 SW 148th Avenue, Suite 401 Davie 33330 (954) 707-5070 I 350 N. Pine Island Road, Suite 200 Plantation 33324 (954) 476-8800 (954) 476-1362 Psychiatry 21 Broward County Providers SPECIALTY PROVIDER ADDRESS CITY Zip Phone Fax eMail Address Barnea. Benjamin. M.Q. 1500 University Drive. Suite 202 Coral Springs 33071 (954) 341-8100 (954) 341-8101 Fernandez, Lino, M.D. 1601 N. Pelnr Avenue, Suite 303 Pembroke Pines 33026 (888) 852-6672 3305) 891-4228 Flaherty, David, M-D. 7481 W. Oakland Park Blvd„ Suite 100 Lauderhill 33319 (954) 771-7743 Hicks, Kristin. M.D. 1490 E. Oakland Park Boulevard, Suite 210 Oakland Park 33334 (954) 561-6222 (954) 990-7650 Kakar, Rishi. M.D. 7481 W. Oakland Park Boulevard, Suite 100 Lauderhill 33319 (888) 852-6672 Olele, Pearly]. D.O. 7481 W. Oakland Park Boulevard. Suite 100 Lauderhill 33319 (888) 852-6672 (954) 771-7748 Pathak, Kama), M.D. 1400 E. Oakland Park Boulevard. Suite 210 Oakland Park 33334 (954) 561-6222 (954). 990-7650 Pushka. Alexander, M,D. 300 5. Pine Island Road, Suite 224 Plantation _ 33324 (954) 667-8285 _ 3911 Hollywood Blvd., Suite 201 Hollywood 33021 (954) 639-7345 (954) 639-7333 AAMBS2@aol.com Segal, Scott, M,D. 7481 W. Oakland Park Boulevard, Suite 100 Lauderhill 33319 (954) 771-7743 Sobhan, Tanveer, M.D. 7481 W. Oakland Park Boulevard, Suite 100 Lauderhill 33319 (888) 852-6672 (305) 891-4228 Psychology Bettica. Gina. Psy.D. 1881 University Drive. Suite 104 Coral Springs 33071 (954) 340-0888 (954) 346-0909 Cantrell. Courtney, Psy.D 1881 Universtiy Drive, Suite 104 Coral Springs 33071 (954) 340-0888 (954) 345-0909 Cohn, Lauren, Ph.D. 7500 N.W. 5th Street, Suite 111 Plantation 33317 (954) 584-6478 (954) 797-4911 LKCohnPhDQaol.com Davies. Anne, Psy.D. 1881 University Drive, Suite 104 Coral Springs _ 33071 (954) 340-0888 (954) 346-0909 Gibson, Douglas, Psy.D. 3990 Sheridan Street. Suile 104 Hollywood 33021 (954) 966-3223 12251 Taft Street. Suite 301 Pembroke Pines 33026 (9541 966-3223 Gotthelf, Cheryl, Ph.D 5700 Hollywood Boulevard Hollywood 33021 (954) 983-7457 (954) 983-2963 browardpsych oeaoLcom Gray, Marlene, Psy.D. 8890 W. Oakland Park Boulevard, Suite 103 Sunrise 33351 (954) 742-7032 (954) 742-7868 _ Gregg. Alan. Ph.D. 1601 N. Palm Avenue Pembroke Pines 33026 (888) 852-6672 (954) 447-0899 Harrison. Melissa. Psy.D. 1881 University Drive. Suite 104 Coral Springs 33071 (954) 340-0888 (954) 346-0909 Karbonik, Elaine. Psy.D. 5337 Orange Drive Davie 33314 (954) 562-3640 (954) 252-4037 Killian, Grant. Ph.D. 2871 N.E. 30th Street Lighthouse Point 33064 (954) 786-9000 (954) 782-9000 lkillianphdp4laaol.com Kravitz. Frederick. Ph.D. 1881 University Drive, Suite 104 Coral Springs 33071 (954) 340-0888 (954) 346-0909 Kushner, Tammy, Psy.D. 5700 Hollywood Boulevard Hollywood 33021 (954) 983-7457 (954) 983-2963 Nelson-Wernick. Eleanor, Ph.D. 1681 University Drive. Suite 104 Coral Springs 33071 (954) 340-0888 (954) 346-0909 lbhinsfitule@aofcom Pedemonte, Monica, Psy.D. _ 1881 University Drive. Suite 104 Coral Springs 33071 (954) 340-0888 (954) 346-0909 Roth, Alec, Ph.D. 8890 W. Oakland Park Boulevard. Suite 103 Sunrise 33351 (954) 742-7032 (954) 742-7868 Sperry, Faith. Psy.D. 2787 E. Oakland Park Boulevard, Suite 201 Ft. Lauderdale 33306 (954) 327-8999 (954) 565-6178 Drsperry(bellsouth,nel Stirlen, Amber. Psy.d. 700 N. Hiatus Road, Suite 213 Pembroke Pines 33026 (954) 431-0411 Thompson. Tara, Psy.D, 1881 University Drive, Suite 104 Coral Springs 33071 (954) 340-0888 (954) 346-0909 Traub, Gary. Ph.D. 6000 N. Federal Highway Fort Lauderdale 33069 (954) 202-6200 (954) 202-6207 behmcd1232ayahoo,com Wernick, Robert. Ph.D. 1881 University Drive. Suite 104 Coral Springs 33071 (954) 340-0888 (954) 346-0909 bhinstilute r(�Paol.com Pulmonary Medicine Gitt)er, Steven, M.D. 3501 Johnson Street Hollywood 33021 (954) 265-9976 (954) 965-5396 7369 Sheridan Street. Suite 302 Hollywood 33024 (954) 081-3700 Catkin. Brian. M.D. 7369 Sheridan Street. Suite 302 Hollywood 33024 (954) 981-3700 3501 Johnson Street Hollywood 33021 (954) 265-9976 (954) 965-5396 Jain, Sandeep, M,D. 7420 N.W. 51h Street. Suite 103 Plantation 33317 (954) 792-8304 (954) 587-8686 Radiation Oncology Phillips, Bruce. M,D, 4848 Coconut Creek Parkway, Suite 100 Coconut Creek 33063 (954) 379-4848 22 Broward County Providers SPECIALTY PROVIDER ADDRESS CITY Zip Phone Fax eMafl_Address 1600 5. Andrews Avenue Ft. Lauderdale 33316 (954) 355-5365 _ 201 E. Sample Road Pompano Beach 33064 (954) 786-6836 (954) 786-6522 ddonelan@bellsouth.net 6030 Hollywood Blvd., Suite 100 Hollywood 33024 (954) 322-7200 Sperry, Janet, M.D. 1625 S.E. 3rd Avenue., Suite 100 Ft. Lauderdale 33316 (954) 355-5365 2101 Riverside Drive, Suite 101 Coral Springs 33071 (954) 341-6200 201 E. Sampler Rd Pompano Beach 33064 (954) 786-6522 Sports Medicine Faaekas, Matthew, M.D. 5830 Coral Ridge Drive, Suite 207 Coral Springs 33076 (954) 265-6300 1951 SW 172nd Avenue, Suite 207 Miramar 33021 {954) 265-6300 1150 N. 35th Avenue, Suite 345 Hollywood 33021 (954) 265-6300 (954) 961-3600 1865 N. Corporate Lakes Blvd„ Suite 1 Weston 33326 (954) 265-6300 Surgical Oncology Neimark, Phyllis, M.D. 1150 N. 35th Avenue. Suite 170 Hollywood 33021 {954) 985-5846 (954) 985-2451 Pidhorecky, Ihor, M.D. 1951 SW 172nd, Suite 406 Miramar 33029 {954) 538-5470 4651 Sheridan Street, Suite 350 Hollywood 33021 (954) 276-8559 601 N. Flamingo Road, Suite 408 Pembroke Pines 33028 (954) 844-1617 601 N, Flamingo Road, Suite 409 Pembroke Pines 33028 (954) 844-480 (954) 447-5344 mholsombackgmhs.net Urology Bloom, Norman, M.D. 1 S.W. 129th Avenue, Suite 109 Pembroke Pines 33026 (305) 931-5663 Martin. Joel. M.D. 3939 Hollywood Boulevard. Suite 3-A Hollywood 33021 (954) 961-7700 (954) 961-0092 )martin@dstx.net 9692 Pines Boulevard Pembroke Pines 33024 (954) 431-6099 23 Dade County 24 Dade County Providers SPECIALTY PROVIDER ADDRESS CITY Zip Phone Fax eMail Address Aliergy/Immunology Andrade, Edith. M.D. 3100 SW 62nd Avenue Miami 33155 (305) 662-8272 (305) 663-6868 Bonansea-Frances, Adriana, M.D. 9035 Sunset Drive, Suite 202 Miami 33173 (305) 279-3366 100 N.E. 15th Street, Suite 104 _ Homestead 33033 (305) 245-1100 (305) 245-0852 homestead@florida-allergy.com Landman, Jaime, M.D. 14411 S. Dixie Highway, Suite 223 Palmetto Bay 33176 (305) 255-4868 21150 Biscayne Boulevard, Suite 408 Aventura 33180 (305) 932-3252 1(305) 932-2798 aventura@florida-allergy.com Landman, Zevy, M.D. 14411 S. Dixie Highway, Suite 223 Palmetto Bay _ 33176 (305) 255-4868 Martell, Jr., Frank, M.D. 9035 Sunset Drive, Suite 202 Miami 33173 (305) 279-3366 475 Bittmore Way, Suite 311 Coral Gables 33134 (305) 445-9422 (305) 444-4651 coralgables@tlorida-allergy. cam Miller, Maureen. M.D. 475 Bittmore Way, Suite 204 Coral Gables 33134 (305) 444-9177 7413 Miami Lakes Drive Miami Lakes 33014 (305) 823-1369 7800 S.W 87th Avenue, Suite 340-C Miami 33173 (305) 595-0109 1(305) 595-7092 2925 Aventura Boulevard, Suite 308 Aventura 33180 (305) 932-5662 Mirmelli, Philip, M.D. 400 Arthur Godfrey Road, Suite 504 Miami Beach 33140 (305) 538-8339 (305) 538-4907 miamibeach@ftorida-allergy.com Pacin, Michael. M.D. 14411 S. Dixie Highway, Suite 223 Miami 33176 (305) 255-4668 16401 NW 2nd Avenue. Suite 204 Miami 33169 (305) 945-4131 9035 Sunsset Drive, Suite 202 Miami 33173 (305) 279-3366 (305) 271-3355 kendall@tlorida-allergy.corr Cardiac & Vascular Services Aguila, Alien, M.D. 20803 Biscayne Blvd., Suite 204 Aventura 33180 (305) 933-8465 Cardiac Electrophysiology Martel, Jose. M.D. 7000 SW 97th Avenue. Suite 102 Miami 33173 {305) 484-8231 {651) 490-7797 Cardiology Chua, Henry, M.D. 100 N.W. 170th Street. Suite 411 North Miami Beach 33169 (305) 249-5666 (305) 249-5669 drhenryohua@aol.com 1295 NW 14th Street. Suite N Miami 33125 (305) 545-5465 _ Escotar, Esteban. M.D. 2150 W. 68th Street Hialeah 33016 (305) 674-2964 4300 Alton Road. Dehirsh Meyer Tower, Suite ;Miami Beach 33140 (305) 674-2690 (305) 674-2693 Heimowilz, Todd, D.O. 4300 Alton Road, Suite 2070 Miami Beach 33140 {305) 674-2690 (305) 674-2693 Ing, Albers, M.D. 7150 W. 20th Avenue, Suite 318 Hialeah 33016 (305) 702-9222 (305) 702-9275 Korn, David, M.D. 2845 Aventura Boulevard, Suite 249 Aventura 33180 (305) 932-6061 (305) 932-6717 aventuraheart@aol.com Latude, Omosalewa, M.D. 20803 Biscayne Blvd„ Suite 204 Aventura 33180 (305) 933-8465 Lamas, Gervasio, M.D. 2150 W. 68th Street Hialeah 33016 (305) 574-2964 4300 Alton Road. Suite 2070 Miami Beach 33140 (305) 674-2162 (305) 574-2169 Lopez, Leonardo, M.D. 2601 S.W. 37th Avenue. Suite 701 Miami 33133 (305) 446-7472 (305) 446-6818 Ilopez1282@aol.com Lora. Julio, M.D. 777 E. 25th Street, Suite 112 Hialeah 33013 (305) 693-8887 (305) 693-8808 Martens, J. Nicolaus, M.D. 9200 Sunset Drive Miami 33173 (305) 412-6315 (305) 412-8936 Rasken, Robert, M.D. 2845 Aventura Boulevard, Suite 249 Aventura 33180 (305) 932-6061 (305) 932-6717 menrigLiez006@hotmail.com Rosado, Antonio. M.D. 4302 Alton Road, Suite 470 Miami Beach 33140 (786) 709-5865 (305) 397-8889 arosadomd@hotmail.com Sanchez, Jaime, M.D. 2140 W. 68th Street, Suite 403 Hialeah 33016 (305) 821-6167 (305) 824-9012 Schnur, Steven, M.D. 4302 Alton Road, Suite 300 Miami Beach 33140 (305) 672-9989 (305) 672-8711 Siev. Ethan, M.D. 20803 Biscayne Blvd., Suite 204 Aventura 33180 (305) 933-8465 1 25 Dade County Providers SPECIALTY PROVIDER ADDRESS CITY Zip Phone Fax eMaif_Address Tolentino, Alfonso, M.D. 4300 Alton Road, De Hirsch Meyer Tower. Suit. Miami Beach 33140 (305) 674-2690 (305) 674-2693 atotentino@miamicardiologydoctors.com Weinberg, Denis, M.D. 2845 Aventura Boulevard, Suite 250 Aventura 33180 (305) 931-4404 400 W. 41st Street, Suite 103 Miami Beach 33140 (305) 695-0644 (305) 695-0662 deinberg@mlamicardiologydoctors.com Wells, David, M.D. 9075 SW 87th Avenue, Suite 402 Miaml 33176 ;305) 596-3400 (305) 271-1706 Cardiovascular and/or Thoracic Surgery Garami. Agnes, M.D. 400 W. 41st Street. Suite 103 Miami Beach 33140 (305) 695-0644 (305) 695-0662 agarami@miamicardiologydectors.com 2845 Aventura Boulevard, Suite 250 Aventura 33140 (305) 931-4404 Lamelas, Joseph, M.D. 4304 Afton Road, Suite 21(0 Miami Beach _ 33140 {305) 674-2121 (305) 674-2865 Masroor, Saquib, M.D. 8251 W. Broward Boulevard. Suite 300 Plantation 33175 (786) 428-1059 21097 NE 27th Court Aventura 33180 (786)428-1059 (786) 428-1062 11760 SW 40th Street, Suite 352 Miami 33175 (305) 552-1005 Reis, Robert. M.D. 90 Leucadendra Drive Coral Gables 33156 (305) 545-5006 (305) - ChildlAdoiescent Psychiatry Davis, Asha, M.D. 11440 N. Kendall Drive, Suite 208 Miami 33176 (888) 852-6672 (305) 503-7363 Chiropractic I Chase, Stephen, D.C. 660 N.W. 119th Street Miami 33168 (305) 681-0778 (305) 688-6503 Cohen, Eric, D.C. 7000 S.W. 97th Avenue. Suite 107 Miami 33173 (305) 274-2888 (305) 274-9889 Iecohendc@aol.com Fine, Jamie, D.C. 6910 N. Kendall Drive, Suite 200 Miami 33156 (305) 661-2910 (954) 965-0423 Friedman, Eric. D.C. 100 N.E. 84th Street, Suite 100 Miami 33138 (305) 757-5950 (305) 751-0955 Gentile, John, D.C. 8056 S.W. 81st Drive Miami 33143 (305) 271-1652 (305) 271-1855 Goetz. Christopher D.C. 7000 SW 97th Avenue, Suite 120 Miami 33173 (305) 670-0055 (305) 670-0054 cgoets7276@aol.com Goodrich, Aixa, D.C. 9570 S.W. 107th Avenue, Suite 201 Miami 33176 (305) 271.7447 (305) 271-7448 ,Agooddc@hotmail.com Greaux, Alexander, D.C. 2440 N.E. Miarni Gardens Drive, Suite 101 Aventura 33180 (305) 705-0777 (305) 705-9978 Kern, Brad, D.C. 18205 Biscayne Boulevard, Suite 2214 Aventura 33160 (305) 899-0777 (305) 899-0816 bak111@aot.com Lopata, Jason, D.C, 33550 S. Dixie Highway, Suite 132 Florida City 33034 (305) 242-6665 (305) 242-6919 drjason@aoLcom Maguire, Thomas, D.C. 8056 S.W. 81 Drive Miami 33143 (305) 693-0033 2825 E. 41h Avenue Hialeah 33013 (305) 693-0033 (305) 693-8362 chirc17@be8south.net Martinez, Damian, D.C. 12595 SW 137 Avenue. Suite 108 Miami 33186 (305) 388-7577 (305) 388-7851 Moss, Ruben, D,C. 9526 N.E. 2nd Avenue, Suite 203 Miami Shores 33138 (305) 756-7246 (305) 754-1172 infotaimspainretief.com Osborn, Kenneth, D.C. 18441 NW 2nd Avenue, Suite 220 Miami Gardens 33169 (305) 652-8401 (305) 652-8413 Reynolds, Henry. D.C. 5801 Bird Road, Suite E Miami 33155 (305) 662-2071 (305) 662-9587 Reynoldshenrymdc@betlsouth.net Richmond. Michael, D.C. 100 N.E. 84th Street. Suite 100 Miami 33138 (305) 757-5950 (305) 751-0955 Rosenkranz, Bruce, D.C. 1741 Allan Road Miami Beach 33139 (305) 531-6299 Schroer, Andrew. D.C. 1991 W. 60th Street Hialeah 33012 (305) 823-1808 (305) 821-7186 ibkilty@aol.com 12440 N.E. Miami Gardens Drive Miami 33180 ;305) 705-0777 Scott, Ronald. D.C. 9245 S.W. 158 Lane. Suite 302 Miami 33157 (305) 253-2161 (305) 235-7123 Sussman, Todd, D.C. 8501 SW 124th Avenue, Suite 108 Miami 33183 (305) 270-3137 (305) 270-3139 toddjs@aol rem Weinstein, Brett, D.C. 1900 Coral Way. Suite 101 Miami 33145 (305) 854-4499_ Colon & Rectal Surgery Pons, Roger, M.D. 777 E. 25th Street. Suite 420 Hialeah 33013 (305) 696-0001 (305) 696,0007 Snow, Jeffrey, M.D. 20801 Biscayne Blvd., Suite 203 Aventura 33180 (305) 682-2560 7150 W. 2oth Aveneu, Suite 313 Hialeah 33016 (305) 702-9313 26 Dade County Providers SPECIALTY PROVIDER ADDRESS CITY Zip Phone Fax eMail_Address Critical/Intensive Care Medicine een)amin. Robert. M.D. 21110 Biscayne Boulevard, Suite 400 Aventura 33180 (305) 918-7050 (305) 918-7051 Boneva, Dessisiava, M.D. 21110 Biscayne Blvd, Suite 400 Aventura 33180 (305) 918-7050 (305) 918-7051 Cockburn, Mark, M.D. 21110 Biscayne Boulevard, Suite 400 Aventura 33180 (305) 918-7050 (305) 918-7051 Diagnostic Radiology Baquero, Julio, MD 6200 S.W. 73rd Street Miami 33143 (305) 661-4511 Gordon, Robert, M.D. 6200 S.W. 73rd Street Miami 33143 (305) 662-6171 Endocrinology Acosta, Brenda, M.Q. 3901 NW 79th Avenue, Suite 222 Doral 33166 (786) 845-8989 (786) 845-8615 Cohen, Martin, M.D. 7800 S.W. 87th Avenue, Suite 130 Miami 33173 (305) 270-1571 (305) 270-0326 Family Practice Anderson -Worts, Paula, D.O. 1750 NE 167th Street North Miami Beach 33162 (954) 262-4100 Arcos. Barbara. D.O. 1750 NE 167th Street North Miami Beach 33162 (954) 262-4100 Case, Wayne, M.D. 3410 West 84th Street. Suite 110 Hialeah 33018 (305) 558-3571 1(305) 558-3682 Cohen. Peter, D.O. 1750 N.E. 167th Street North Miami Beach 33162 (305} 949-6202 DeGaetano, Joseph. D.O. 1750 NE 167th Street North Miami Beach 33162 (954) 262-4100 Donley. William, M.D. 1190 N.W. 95th Street, Suite 310 Miami 33150 (305) 835-9844 I(305) 835 7270 mdpawl@bellsouth.net Flores, Lucky. M.D. 6450 W, 21st Court. Suite 200 Hialeah 33015 (305) 698-0806 (305) 698-2325 8774 S W. 8th Street Miami 33174 (305) 559-7445 Gutteber, John. M.D. 139 NE 15 Street Homestead 33030 (305) 247-1213 (305) 247-5701 Igtesias. Nayvis. M.D. 3650 N.W. 82nd Avenue, Suite 502 Doral 33166 (305) 594-9333 (305) 594-0440 1040 Caribbean Way Miami 33132 (786) 398-4000 Jimenez-Barredo, Jesus. M.D. 3650 N.W. 82nd Avenue. Suite 502 Doral 33166 (305) 594-9333 (305) 594-0440 Kramer. David, M.D. 870 Fisherman Street Opa Locka 33054 (305) 688-2519 (305) 688-2785 Idkmedical181@yahoo.com Krestow, Victor, M.D. 7 N.W. 183rd Street Miami 33169 (305) 652-3614 (305) 652-3616 Monet, Harris, D.O. 2645 S. Douglas Road, Suite 502 Coral Gables 33133 (305) 448-8134 (305) 445-2691 drmones@drmanes.cam Pena, Heriberto, M.D_ 950 N. Krome Avenue, Suite 202 Homestead 33030 (305) 245.5933 (305) 245-1020 herpena@bellsouth.net Sanjur, Alma, D.O. 975 41 St Street, Suite 501 Miami 33140 (305) 531-8643 (305) 531-7221 jmetcalf@att.net Sarnow, Melvyn, D.O. 11120 N. Kendall Drive, Suite 100 Miami 33176 (305) 279-0808 (305) 271-4916 Schaffer, Judith, D.O. 1750 N.E. 167th Street North Miami Beach 33162 (954) 262-4101 (954) 262-2271 Imh154inova.edu Somodevilla, Guillermo, M.D. 7805 Coral Way, Suite 126 Miami 33155 (305) 663-9330 (305) 269-0386 Gastroenterology Connolly, Hugh, M.D. 941 North Krome Ave Homestead 33033 (305) 251-3434 15053 South Dixie Highway Miami 33176 (305) 251-3434 (305) 971-6393 Price. Steven, M.D. 1321 N.W. 14th Street. Suite 101 Miami 33125 (305) 325-4888 (305) 547-1508 Price, Steven, M.D. 7400 N. Kendall Drive, Suite 502 Miami 33156 (305) 325-4888 General and/or Vascular Surgery Adam, Marie. M.D. 1190 N.W. 95th Street, Suite 302 Miami 33150 (305) 835-0312 (305) 691-9224 unimed54@aol.c0m 9000 S.W. 87th Court, Suite 105 Miami 33175 (305) 835-0344 Alvarez -Moreno. Jorge, M.D. 5558 SW 8 Street Coral Gables 33012 (305) 444-0664 (305) 444-0668 Comperatare, Roberto M.D. 7150 W. 20th Avenue, Suite 215 Hialeah 33016 (305) 558-4428 (305) 364-1295 Donkor, Charan. M.D. 7800 SW 87th Avenue, Suite B2t0 Miami 33173 (305) 271-9777 (305) 595-9590 975 Baptist Way, Suite 201 Homestead 33033 (786) 243-8701 15955 SW 96 Street. Suite 407 Miami 33196 (786) 467-3435 27 Dade County Providers SPECIALTY PROVIDER ADDRESS CITY Zip Phone Fax eMail Address Edelman, David, M.D. 6401 SW 87th Avenue, Suite 105 Miami 33173 (305) 271-4080 (305) 271-7663 ewilbum@femwell.corr Glucksman, Donald, M.D. 4701 Meridian Avenue. Suite 500 Mtami Beach 33140 (305) 535-7555 (305) 614-3352 Gomez, Enrique. M.D. 3661 5. Miami. Avenue. Suite 402 Miami 33133 (305) 858-6971 (305) 858-6950 Gonzalez, Anthony, M.D. 7800 S.W. 871h Avenue. Style B210 Miami 33173 (3(35) 271-9777 (305) 595-9590 Ivrgrndpa@bellsouth.net Kanter. Steven, M-D. 8755 S.W. 94th Street. Suite 200 Miami 33176 (305) 279-9522 (305) 279-3218 Mangione. Todd, D.O. 975 Baptist Way, Suite 201 Homestead 33033 (786) 243-8701 (786) 243-8700 Matei, Emil, D.O. 20801 Biscayne Blvd„ Suite 203 Aventura 33180 (305) 682-2560 7150 W. 20th Avenue, Suite 313 Hialeah 33016 (305) 702-9313 McKenney, Mark, M.D. 11760 Bird Road, Suite 722 Miami 33175 (305) 559-1883 1(305) 559-1887 Pidhorecky. Thor, M.D. 20801 Biscayne Blvd., Suite 203 Aventura 33180 (305) 682-2560 7150 W 20th Avenue. Suite 313 Hialeah 33016 (305) 702-9313 Pujals, Santiago, M.D. 3659 S. Miami Avenue, Suite 5003 _ Miami 33133 (305) 854.1942 (305) 854-3563 Pujalsmd@bellscuth.net Rabaza, Jorge. M.D. 7800 S.W. 87th Avenue, Suite B210 Miami 33173 (305) 271-9777 (305) 595-9590 Rodriguez. Magaty, M.D. 11760 SW 40th Street, Suite 448 Miami 33175 (305) 220-6010 (305) 220-6115 fsurgerymiami@msn,com Rua. Ignacio, M.D. 8950 N. Kendall Drive. Suite 504-W Miami 33176 (305) 274-2030 (305) 545-9562 8770 SW 144th Street Palmetto Bay 33176 (305) 252-9408 i Sendzischew. Harry, M.D, 4302 Alton Road, Suite 630 Miami Beach 33140 (305) 673-2794 (305) 534-7806 1029 Kane Concourse Bay Harbor 33154 (305) 868-5323 General Practice Moire, Rudolph, D.0. 371 N.W. 119th Street North Miami 33168 (305) 688-0811 (305) 722-1066 General Surgery 1 Bello, Abel, M.Q. 315 Palermo Avenue Coral Springs 33134 (305) 569-9502 (786) 250-1970 Cardoso, Eufemiano, M.D. 2750 SW 37th Avenue Miami 33134 (305) 642-4263 (305) 426-3329 Gannon, Christopher. M.D. 20801 Biscayne Blvd.. Suite 203 Aventura 33180 {305) 682-2560 7150 WI. 20th Avenue. Suite 313 Hialeah 33016 {305) 702-9313 Martindale, Stacey, M.D. 21110 Biscayne Boulevard, Suite 400 Aventura 33180 {305) 918-7050 (305) 918-7051 Ramirez. Marceta, M.D. 11760 Bird Road, Suite 722 Miami 33175 (305) 559-1883 (305) 559-1887 Vasudevan, Vanitha, M.D. 7150 West 20th Avenue, Suite 615 Hialeah 33016 (305) 820-6657 (305) 820-6658 Hand Surgery Alfonso, Daniel. M.D. 2750 SW 37th Avenue Miami 33134 (305) 642-4263 (305) 426-3329 _ Badia, Alejandro, M.D. 3650 N.W. 82 Avenue, Suite 103 Miami 33166 (305) 227-4263 (305) 537-7222 alex@surgical.net Cabrera. Jorge. M.D. 3661 S. Miami Avenue, Suite 309 Miami 33133 (305) 667-2242 6341 Sunset Drive. 1st Floor South Miami 33143 (305) 667-2242 Cardozo, Roy. M.D. 2750 SW 37th Avenue Miami 33134 (305) 642-4263 1(305) 426-3329 15600 NW 67th Avenue. Suite 306 Miami Lakes 33014 (954) 476-8800 Eastlick, Lewis, M.D. 11760 SW 40th Street, Suite 606 _ Miami 33175 (954) 797-6789 Kadiyala, Rajendra. M.D. 4302 Alton Road. Suite 710 Miami Beach 33140 (305) 695-1290 (305) 674-2764 Ivega@msmc.com Khouri, Roger, M.D. 2750 SW 37th Avenue Miami 33134 (305) 642-4263 (305) 426-3329 Kinchelow, Tosco. M.D. 15500 N.W. 67th Avenue, Suite 306 Miami Lakes 33014 (954) 476-8800 Miller, Stephen, M.D. 6280 Sunset Drive. Suite 505 Miami 33143 (305) 668-5636 (305) 668-5621 stephenmdpa@bellsouth.net Redondo. Jacqueline, M.Q. 7130 S.W. 87th Court. Suite 100 Miami 33173 (305) 412-2800 (305) 412-6045 jacquelineredondc@bellsouth_net Reyes, Franklin, M.D. 7100 W. 20th Avenue, Suite 616 Hialeah 33016 (305) 556-426.3 (305) 556-4095 Hematology/Oncology Milillo-Nariane, Adrian. M_D_ 20801 Biscayne Blvd., Suite 200 Aventura 33180 (305) 682-2550 Hernia Surgery 28 Dade County Providers SPECIALTY PROVIDER ADDRESS CITY Zip Phone Fax eMail_Address Graham. Michael, M.D. 6200 Sunset Drive, Suite 501 Miami 33143 (305) 667-7878 Young, Jerrold M.D. 6200 Sunset Drive, Suite 501 Miami 33143 (305) 667-7878 (305) 667-7459 Internal Medicine Bengoa, Milton. M.D. 925 N.E. 30th Terrace Homestead 33033 (305) 248-9488 (305) 248-9557 Cabrera. Francesco, M.D. 3701 S.W.87th Avenue Miami 33165 (305)229-3848 (305)220-4578 Diaz. Miguel. M.D. 2601 SW 37th Avenue. Suite 701 Miami 33133 (305) 446-7472 1 2140 W. 68th Street, Suite 308 Hialeah 33016 (305) 817-1344 (305) 817-1355 Diaz-Secades, Luis, M.D. 11880 Bird Road. Suite 210 Miami 33175 (305) 559-0211 (305) 559-0966 Esnard, Jose. M.D. 11880 Bird Road. Suite 411 Miami 33176 (305) 223-1959 (305) 220-7102 Garami, Agnes. M.D. 400 W. 41st Street, Suite 103 Miami Beach 33140 (305) 695-0644 (305) 695-0662 agararni@miamicardialogydoctors.com 2845 Aventura Boulevard. Suite 250 Aventura 33140 (305) 931-4404 Gutierrez. Robert. M,D. 8020 SW 24th Street Miami 33155 (305) 266-6644 (305) 269-0022 rgutierrezmd(obellsauth.net Halpern. Scol1, M.D. 7100 W. 20th Avenue. Suite 213 Hialeah 33016 (305) 821-5261 (305) 821-5094 Lazo, Angel, M.D. 8080 West Hagler Street, Suite 2B Miami 33144 (305) 266-6400 (305) 266-6401 Laredo, Jorge, D.O. 4304 Alton Road, Lowerstein Bldg Miami Beach 33140 (305) 674-2430 (305) 674-2413 Mantilla, Juan, M.D. 11050 N, Kendall Drive, Suite 104 Miami 33176 (305) 279-4222 (305) 279-0252 Martinez, Luis, M.D. 3650 NW 82 Avenue, Suite 503 Miami 33166 (305) 433-2005 (305) 591-8020 luismartinezmd@hotmail.com Merlino. Gary. D.O. 4701 Meridian Avenue, Nichols Building, Level Miami Beach 33140 (305) 604-2888 200 Crandon Boulevard, Suite 300 Key Biscayne 33149 (305) 674-2599 Morgan. Jose. M.D. 3650 NW 82nd Avenue, Suite 502 Dora! 33166 (305) 594-9333 1(305) 594-0440 Pandya, Naushira, M.D. 1750 NE 167th street North Miami Beach 33162 (954) 262-4100_ Petteway. Anita. M.D. 909 N. Miami Beach Boulevard, Suite 503 North Miami Beach 33162 (305) 944-8887 (305) 944-8440 drpette@hotmait.com Reyes, Ciro, M.D. 7200 N.W. 7th Street, Suite 207 Miami 33126 (305) 261-7299 (305) 261-7296 Riveros, Carlos. M.D. 6705 Red Road, Suite 522 Coral Gables 33143 (305) 444-1213 (305) 444-1216 Shaffer, Robert, M.D. 200 Crandon Boulevard, Suite 300 Key Biscayne 33149 (305) 674-2599 4701 Meridian Avenue, Nichol Building. Level E Miami Beach 33140 (305) 604-2858 Thevenin, Joseph, M.D. 9635 S.W. 181 Terrace Miami 33157 (305) 238-8561 (305) 238-4089 Vitiello, Marco, M.D. 7775 S.W. 87th Avenue, Suite 100 Miami 33173 (305) 661-0181 (305) 661-0407 snoriega@truecarefl_com Wells, David, M.D. 9075 SW 87th Avenue, Suite 402 Miami 33176 (305) 596-3400 _(305) 271-1706 Wong, Tzewan, M.D. 363 S. Homestead Boulevard Homestead 33030 (305) 668-4484 10420 S.W. 77 Avenue, Suite 100 Pinecrest 33156 (305) 668-4484 (305) 668-4994 pinecrestcenter@bellsouth.com Mental Health Professional Camejo. Maria, LMHC 13550 SW 88th Street. Suite 112 Miami 33186 (305) 383-6565 (305) 383-7767 Castillo, Edmundo, LCSW 11440 N. Kendall Drive. Suite 208 Miami 33176 (888) 852-6672 (305) 279-2742 Kaplan, Alexander, LCSW 1065 NE 125th Street Suite 206 North Miami 33161 (888) 852-6672 (305) 503-7363 Stillman, Melissa, LMHC 11440 N. Kendall Drive, Suite 208 Miami 33176 (888) 852-6672 (305) 279-2742 Vazquez. Carmene, LMHC 1065 NE 125th Street. Suite 206 North Miami 33161 (888) 852-6672 (305) 503-7363 Nephrology 1 Glasser_ Cliff. D.O. 16401 N.W. 2nd Avenue, Suite 203 North Miami Beach 33169 (305) 999-0009 (305) 945-7136 21110 Biscayne Boulevard. Suite 400 Aventura 33180 (305) 999-0009 Neurology 29 Dade County Providers SPECIALTY PROVIDER ADDRESS CITY Zip Phone Fax eMail_Address Ballweg, Gail. M.D. 7100 West 20th Avenue, Suite G-176 'lateen 33016 (305) 823-6777 Conn. Morton, M.Q. 7100 W. 20th Avenue. Suite 512 Hia}eah 33016 (305) 821-5220 (305) 821-9825 dreorin@bellsouth.net Damski, Paul, M.D. 9090 SW 87th Court. Suite 200 Miami 33176 (305) 596-2060 (305) 351-7905 Faradji. Victor. M.D. 8940 N. Kendall Drive. Suite 802E Miami 33176 (305) 595-4041 (305) 595-6638 Gran. Bernard, M.D. 9090 S.W. 87th Court, Suite 200 Miami 33176 (305) 596-2080 (305) 351-7905 Herskowitz. Brad, M.D. 9090 S.W. 87th Court, Suite 200 Miami 33176 (305) 596-2080 (305) 545-9696 lbotoxcenter@aol.com Kenniff, Sean, M.D. _ 3661 S. Miami Avenue, Suite 209 Miami 33133 (305) 856-8942 (305) 856-0432 Kobetz, Steven, M.Q. 5940 N. Kendall Drive, Suite 802E Miami 33176 (305) 595-4041 (305) 595-6638 Logo, Lourdes, M.D, 7100 W. 20th Avenue, Suite 504 Hialeah 33016 (305) 823-8510 (305) 823-8530 Martinez, Guillermo, M.D. 5975 Sunset Drive, Suite 405 Miami 33143 (305) 661-8040 1 Mesa, Antonio, D.O. 9090 SW 87 Court, Suite 201 Miami 33176 (305) 670-7650 (786) 219-0158 Resnick Steven, D.Q. 1111 Kane Concourse, Suite 504 Bay Harbor lsland 33154 (305) 865-1995 (305) 866-1844 Smart, Shaun. M.D. 7100 W 20th Street, Suite 504 _ Hialeah _ 33016 (305) 823-8510 (305) 823-8530 Neuro-Psychology Arias, Alejandro. M.Q. 1991 West 60th Street Hialeah 33012 (305) 766-5629 (954) 704-0320 dr.alex@mindspring.com 2440 N.E. Miami Gardens Drive, Suite 101 Miami 33180 (305) 766-5629 9360 Sunset Drive, Suite 234 Miami 33173 (305) 766-5629 Neurosurgery Albanes, Pedro, M.D, 590 E. 25th Street, Suite 601 Hialeah 33013 (305) 836-1940 (305) 693-0098 Gonzalez -Arias, Sergio, M.D. 15955 SW 96 Street, Suite407 Miami 33196 (305) 271-6159 8950 N. Kendall Drive, Suite 407-W Miami 33176 (305) 271-6159 (305) 271-6851 mariajmg@baptisthealth.net Hall, Anthony. M.D 2750 Coral Way, Suite 200 Miami 33145 (305) 461-3116 (954) 765-3206 Lasner, Todd, M.D. 4302 Alton Road, Suite 830 Miami Beach 33140 (305) 674-2950 (305) 674-2749 Pagan, Luis. M.D, 7150 W. 20th Avenue, Suite 614 Hialeah 33016 (305) 826-3366 (305) 826-7973 9085 SW 87th Avevue, Suite 210 Miami 33176 (305) 626-7973 1 Yates, Basil, M.D. _ 590 E. 25th Street. Suite 601 Hialeah 33014 (305) 836-1940 (305) 693-0098 Occupational Medicine Grinberg, Monica, M.D. 1025 E 251h Street Hialeah 33013 (305) 696-0842 (305) 696-2150 Kane, David, M.D. 3270 N.W. 36th Street Miami 33142 (305) 635-1445 (305) 634-9042 occmedctr@aol.com Krestow Victor, M.D. 7 N.W. 183rd Street Miami 33169 (305) 652-3614 (305) 652-3616 Schwartz. Robert. M.D. 8301 N.W. 12th Street Miami 33126 (786) 596-3860 Ophthalmology Ballen, Ann, M.D. 925 NE 30th Terr, Suite 216 Homestead 33033 (305) 661-8588 5950 Sunset Drive Miami 33143 (305) 661-8588 1(305) 661-4906 9299 S.W. 152 Street, Suite 101 Miami 33157 (305) 233-8043 Belalcazar-Ardila, Rodrigo, M.D. 1840 West 49th Street. Suite 601 Hialeah 33012 (305) 828-0317 (305) 823-5862 Dzetzkalns, Janis. M.D. 5950 Sunset Drive Miami 33143 (305) 661-8588 (305) 661-6493 naty@medeyeassociates.com 9299 SW 152 Street, Suite 101 Miami 33157 (305) 233-8043 Gabay, Jack, M.D. 8940 N. Kendall Drive. Suite 400E Miami 33176 (305) 598-2020 (305) 270-6430 Gechter, Eric, M.D. 7150 W. 20th Avenue Hialeah 33016 (305) 702-9460 21150 Biscayne Boulevard. Suite 202 Aventura 33180 (305) 682-9600 1295 N.W. 14th Street. Suite C Miami 33125 (305) 545-0800 (305) 545-8817 Hamburger, Harry, M.D. 8501 S.W. 124th Avenue. Suite 109 Miami 33183 (305) 271-4544 (305) 274-9668 30 Dade County Providers SPECIALTY PROVIDER ADDRESS CITY Zip Phone Fax eMai1_Address Hernandez, Rafael, M.D. 1385 Coral Way, Suite 304 Miami 33145 (305) 854-3307 (305) 854-3130 Howitt, David, M.D. 1460 N.E. 123rd Street North Miami 33161 (305) 891-0331 (305) 893-5200 Levy, Jay, M.D, 1313 S.W. 27th Avenue Miami 33145 (305) 858-2228 184 N.E. 168th Street North Miami Beach 33162 (305) 655-0411 (305) 655-0499 6705 Red Road. Suite 514 Coral Gables 33143 (305) 666-8850 Pelletier. Jesse, M.D. 1400 N.E. Miami Gardens Drive, Suite 203 North Miami Beach 33179 (305) 864-1500 jessepelletier@yehoo.com Perez, Jorge, M.D. 1385 Coral Way, 3rd Floor Miami 33145 (305) 854-3307 (305) 854-3130 Rosenberg, Stanley, M.D. 8940 N. Kendall Drive, Suite 703E Miami 33176 (305) 279-3400 (305) 279-3988 rosenbergeyecenter@yahoo.com Segal, Alan, M.D. 151 N,W, 11111 Street. 4th Floor Homestead 33030 (786) 242-3561 9299 S.W. 152nd Street, Suite 101 Miami 33157 (305) 233-8043 5950 Sunset Drive Miami 33143 (305) 661-8588 (305) 661-6493 naty@medeyeassociates.com Stewart, Kevin, M.D. 1400 N.E. Miami Gardens Drive, Suite 203 North Miami Beach 33179 (305) 864-1500 doctorstewart@yahoo.com Swift. John. M.D. 6161 Sunset Drive. Suite B Miami 33143 (305) 665-2023 1(305) 665-2363 Taker, Rashid, M.D. 184 NE 168th Street North Miami Beach 33162 (305) 655-0411 6705 Red Road, Suite 5.14 Miami 33162 (305) 666-8850 1385 Coral Way _ Miami 33145 (305) 655.0411 Trattler, William. M.D. 8940 N. Kendall Drive. Suite 400E Miami 33176 (305) 598-2020 (305) 243-8470 Oral Surgery McCain, Joseph. D.M.D. 8940 N. Kendall Drive. Suite 604E Miami 33176 (305) 595-1905 (305) 595-2219 jpmccain@att.net Orthopedic Surgeon/ Spine Surgery Brown, Christopher, M.D. 15600 N.W. 67th Avenue, Suite 306 Miami Lakes 33014 (305) 828-6260 Henrys, Richard, M.D. 1190 N.W. 95th Street, Suite 305 Miami 33150 (305) 694-9400 1(305) 693-6942 richardhenrys@yahoo.com Jarolem, Kenneth, M.D. 1025 E. 25th Streel Hialeah 33013 (954) 473-6344 Monderson, Thesselon. M.D. 1190 N.W. 951h Street, Suite 404 Miami 33150 (305) 696-2100 7(305) 696-0025 Pell, Richard, M.D. 9165 SW 87 Avenue Miami 33176 (305) 233-0011 925 NE 30th Terrace, Unit 102 Homestead 33033 (305) 247-1701 (305) 247-1799 Raposo, Juan, M.D. - 3650 N.W. 82nd Avenue, Suite 201 Dora! 33166 (305) 716-8348 (305) 716-8359 Wender, Stephen, M.D. 2050 N.E. 163rd Street North Miami Beach 33162 (305) 949-4348 Orthopedic Surgery Ash, Sam, M.D. 8940 S.W. 88th Street, Suite 101-E Miami 33176 (305) 275-5677 (305) 275-6560 mercy©phy-med.com 6701 SW 72nd Streeet, Suite 201 Miami 33143 (305) 661-7601 Barry, Patrick, M-D. 7100 W. 20th Avenue. Suite 513 Hialeah 33016 (3057 822-6000 (305) 557-7904 patbarry@bellsouth.net Beauperthuy, Gilbert, D.O. 351 N.W. 42nd Avenue, Suite 205 Miami 33126 (305) 649-2133 (305) 642-7184 Bermann. Pedro. M.D. 2140 W. 681h Street, Suite 201 Hialeah 33016 (305) 557-0212 (305) 935-4711 Blinn. Randall. M.D. 9165 SW 87 Avenue Miami 33176 (305) 233-0011 11440 S.W. 88th Street. Suite 111 Miami 33176 (305) 279-2840 1(305) 279-2644 blinnrandall@yahoo.com 925 NE 30th Terrace, Suite 102 Homestead 33030 (305) 247-1701 Cabrera. Jorge, M_D, 3661 S. Miami Avenue. Suite 309 Miami 33133 (305) 667-2242 6341 Sunset Drive, 1st Floor South Miami 33143 (305) 667-2242 Calvo, Ignacio. M.D. 1790 W 491h Street, Suite 401 Hialeah 33012 (305) 826-4567 1800 S.W- 271h Avenue, Suite 400 .Miami 33145 (305) 856-7411 1(305) 529-2803 Cardozo, Roy, M.D. 15600 NW 67th Avenue, Suite 306 Miami Lakes 33014 (954) 476-8800 2750 SW 37th Avenue Miami 33134 (305) 642-4263 1(305) 426-3329 31 Dade County Providers SPECIALTY PROVIDER ADDRESS CITY Zip Phone Fax eMail Address Gebellos Cesar. M_D. 7800 SW 87th Avenue. Suite A-110 Miami 33173 (305) 596-2828 (305) 596-6446 ksm@orlhomiami.com Chaplin, Paul. M.D. 21000 N.E. 281h Avenue, Suite 104 Aventura 33180 (305) 937-1999 (305) 931-9741 Clarke. Matthew, M.D, 11760 SW 40th Street, Suite 722 Miami 33175 (305) 559-1883 (305) 559-1887 Clifford, Stephen, M.D. 12996 W. Dixie Highway North Miami 33161 (305) 891-6060 (305) 891-6589 scmd6589@bellsouth.net Cohen, Brad. M,D, 20601 E,DixieHighway, Suite 330 Miami Beach 33180 (305) 674-5956 2260 NE 123rd Street North Miami 33181 (786) 923-3000 4701 N. Meridian Avenue, Suite C601 Miami Beach 33140 (305) 674-5956 1(305) 923-3002 bradcohenmd@yahoo.com Corces, Arturo. M.D. 9299 SW 152 Street. Suite 103 Miami 33157 (877) 427-8876 11801 S.W. 90th Street, Suite 201 Miami 33186 (305) 595-1317 1(305) 595-0157 office @miamijoints.com 747 Ponce De Leon. Suite 505 Miami 33134 (305) 442-8777 Dennis, Michael, M.D. 21000 N.E. 28th Avenue Aventura 33180 (305) 937-1999 1(305) 931-9741 Donshik, Jon, M.D. 2925 Aventura Boulevard. Suite 102 Aventura 33180 (305) 937-2160 Drucker, Melvyn, M.D. 20601 E. Dixie Highway, Suite 330 Aventura 33180 (305) 932-2310 (305) 932-2583 Dunn, Allan, M.D. 1790 Sans Souci Boulevard North Miami 33181 (305) 865-6534 (305) 892-6534 Evans, Theodore, M.D, 925 NE 301h Terrace, Unit 102 Homestead 33033 (305) 247-1701 _ (305) 247-1799 9165 SW 87 Avenue Miami 33176 (305) 233-0011 Fernandez. Joseph, M.D. 8940 S.W. 88th Street, Suite 101E Miami 33176 (305) 275-5677 1(305) 275-6560 mercy@phy-med.com Fernandez. Rafael. M.D. 1797 Coral Way Miami 33145 (305) 856-3592 1(305) 854-5887 orthodocl@bellsouth.net Font -Rodriguez. David. M.D. 760 Ponce de Lean Boulevard, Suite 505 Coral Gables 33134 {305) 442-8777 9299 SW 152 Street. Suite 103 Miami 33157 {877) 427-8876 Font -Rodriguez. David. M.D. 11801 S.W. 90th Street. Suite 201 Miami 33186 {305) 595-0157 (305) 595-0157 dfr21@aol.com Friedman, Justin. M.D. 11760 SW 40th Street. Suite 352 Miami 33175 (305) 226-2020 (305) 226-2018 Garcia, Jr., Rolando, M.D. 21000 N.E. 28th Avenue, Suite 104 Aventura 33180 (305) 937-1999 (305) 931-9741 Herrera, Mauricio, M.D. 11801 SW 90th Street, Suite 201 Miami 33186 (305) 595-1274 (305) 595-0157 rnfh15columbia@yahoo.com 9299 SW 152 Street, Suite 103 Miami 33157 (877) 427-8876 760 Ponce de Leon Boulevard Coral Gables 33134 (305) 595-1274 Hodor, Kenneth, M.Q. 20296 N.E. 29th Place. Suite 300 Aventura 33180 (305) 932-7366 (305) 932-1271 dr.ken@hodor.com Jennings. John. M.D. 1150 Campo Sano Avenue, Suite 301 Coral Gables 33146 (786) 308-3350 (786) 308-3379 denisepar@bastisthealth.net Kalbac, Daniel, M,D, 6701 Sunset Drive, Suite 201 Miami 33143 (305) 661-7601 (305) 661-0154 miamisportsolocos@aot.com Keyes, David, M.D. 8940 S.W. 88th Street, Suite 1003E Miami 33176 (305) 595-2550 (305) 595-2555 sandkey1@bellsouth.net Klnchelow, Tosca, M.D. 15500 N.W. 67th Avenue. Suite 306 Miami Lakes 33014 (954) 476-8800 Koonin, Michael, M.D. 21000 N.E. 28th Avenue, Suite 104 Aventura 33180 (305) 937-1999 (305) 931-9741 Lang, Elliot, M.D. 3399 NW 72 Avenue Miami 33122 (786) 342-5127 14201 5. Dixie Highway Miami 33176 (786) 342-8082 1(800) 404-0732 Lewis, Dominic, M.D. 21000 N.E. 28th Avenue Aventura 33180 (305) 937-1999 (305) 931-9741 Lozman, Phi€ip. M.D. 825 Arthur Godfrey Road, Suite 100 Miami Beach 33140 (305) 674-5956 1 20601 E. Dixie Highway. Suite 330 Aventura 33180 (305) 674-5956 1(305) 674-5958 7000 SW 62 Avenue, Suite 600 5. Miami 33143 (305) 674-5956 Posada, Alejandro, M.D. 2601 S, W. 37th Avenue. Suite 602 Miami 33133 (305) 774-9400 (305) 774-9800 la.posada@tenetheatth.com Ramirez, Salvador, M.D. 1797 Coral Way Miami 33145 (305) 856-3592 (305) 854-5887 Rich, Jeffrey. D.C. 6141 Sunset Drive Suite 403 South Miami 33143 (305) 663-8877 (305) 663-1262 Rivera, Venus. M,D. 3150 SW 38th Avenue. Suite 800 Miami 33146 (786) 953-8337 (305) 596-6446 Roble. Julio. M.D. 9134 S.W. 87th Avenue Miami 33176 (305) 279-2322 1 8940 S.W. 88th Street, Suite 101-E Miami 33176 (305) 275-6770 (305) 275-6440 Silverman, Edward, M.D. 21097 NE 27th Court, Suite 320 Aventura 33180 (305) 933-9440 1 3659 S. Miami Avenue, Suite 4008 Miami 33133 (305) 285-5025 (305) 285-5026 Turoff, Norman, M.D. 4500 Alton Road, 2250 Miami Beach 33140 (305) 535-8099 {305) 535-8097 Witte's, Michael, M.D. 1085 Kane Concourse Bay Harbor Island 33154 (305) 8664664 {305) 861-5558 32 Dade County Providers SPECIALTY PROVIDER ADDRESS CITY Zip Phone Fax eMail_Address Pain Management 6arbeito, Manuel, M.D. 9370 Sunset Drive, Suite A-150 Miami 33173 (305) 231-7040 (954) 741-4427 mr.ntca@yahoo.com LChao. Raul, M.D, 6285 Sunset Drive Miami 33143 (305) 662-2925 (305) 662-7840 southmiamipainct@aol.com 2387 W. 68 Street. Suite 401 Hialeah 83016 (305) 456-5508 DeMeo, Ronald, M.D. 555 Washington Avenue Miami Beach 33139 (305) 448-6166 6 Aragon Avenue Coral Gables 33134 (305) 448-6166 I(305) 448-6150 Demeo@meridianspine.com Escobar. Luis. M.D. 2925 Aventura Blvd.. Suite 102 Aventura 33180 (954) 322-8586 Frankoski. Edward, D.0_ 21097 N.E. 27th Court. Suite 340 Aventura 33180 (305) 932-1660 I(305) 932-1649 bfranco@shcrcoin 120 N.E. 167th Street North Miami Beach 33162 (305) 940-5100 Gonzalez, Ruben, M.D. 8396 S.W. 8th Street, 2nd Floor Miami 33144 (305) 260-9803 (305) 260-9298 Flpaintreatment@gmail.com Hassun. Armando, D.D. 555 Biltmore Way. Suite 201 Coral Gables 33134 (305) 442-1001 (305) 442-1003 docamnesia@aol.com _ Hobbs, Andre, M.D. 15600 NW 67th Avenue, Suite 306 Miami Lakes 33014 (305) 828-8260 100 NW 170th Street, Suite 405 North Miami 33169 (786) 514-3290 Hobbs, Andre, M.D. 6705 Red Road_ Suite 516 Coral Gables 33143 (786) 514-3290 1(786) 522-9015 Lustgarten. Moises, M.D. 8950 N. kendall Drive. Suite 608W Miami 33176 (305) 279-3223 8755 SW 94th Street Miami 33176 (305) 279-3223 (786) 596-2993 Mesa. Antonio. D.O. 9090 SW 87 Court, Suite 201 Miami 33176 (305) 670-7650 (786) 219-0158 Murciano. Enrique, M.D. 2387 W. 68 Street, Suite 401 Hialeah 33016 (305) 456-5508 6285 Sunset Drive Miami 33143 (305) 662-2925 (305(662-7840 southmismipainct@aol.com Muresan. Carmen, M.D. 848 Brickell Avenue, Suite 210 Miami 33131 (3051 377-0017 (305) 377-8001 Naranjo. Julian, M.D. 7000 S.W. 62nd Avenue, Suite 535 South Miami 33143 (786) 268-0610 Ojea. Juan. M.D. 7990 Coral Way Miami 33155 (305) 220-0224 1(305) 220-4050 )cojea@aol.com Ramirez. Felix, D.O. 160 N.W. 170th Street North Miami Beach 33169 (305) 654-6855 8755 S,W, 94th Street, Suite 300 Miami 33176 (305) 279-3223 120 N.E. 167th Street North Miami Beach 33162 (305) 940-5100 Rodriguez. Ignacio, M.D. 1991 W. 60th Street Hialeah 33012 (305) 823-1808 I(305) 823-7186 MPM2014@bellsouth.net Saade, Edouard, M.D. 20900 Biscayne Boulevard Aventura 33180 (305) 937-6948 Salamon. Joel, M.D. 15600 NW 67th Avenue, Suite 306 & 308 Miami Lakes 33014 (305) 828-8260 Sanchez. Julia, M.D. 7100 W 20th Avenue, Suite 210 Hialeah 33016 (786) 332-2089 (786) 332-3953 Schou, Michael, M.D. 1100 N.W. 95th Street, 2nd Floor Miami 33150 (305) 694-3775 (305) 694-3678 Sultan, Hashem, M.D. 11760 S.W. 40th Street, Suite 411 Miami 33175 (305) 559-5554 (305) 559-5315 Ibillonel@bellsouth.nel Velasco, Maximliano, M.D. 7000 SW 62nd Avenue, Suite 535 Miami 33143 (786) 268-4044 (786) 268-4039 Vendryes. Christopher, M.D. 1100 N.W. 95th Street, 2nd Floor Miami 33150 (305) 694-3775 (305) 694-3678 Vilasuso. Javier, M.D. 2601 SW 37th Avenue, Suite 506 Miami 33133 (305) 448-8455 (305) 448-5882 Physical Medicine Rehabilitalion/Ph'siatrist Epstein, Bryce. M_D. 21000 N.E. 281h Avenue Aventura 33180 (305) 937-1999 (305) 931-9741 Fetiz, Miriam, M.D. 6447 Miami Lakes Drive, Suite 200-A Miami Lakes 33014 (305) 935-3536 (305) 362-2141 drtelizrcm@aol.com Fernando Ndusha, M.D. 8501 SW 12th Avenue. Suite 108 Miami 33183 (800) 735-1178 Knmshtein Sulim. M.D. 7400 N. Kendall Drive, Suite 208 Miami 33156 (305) 670-0606 (305) 670-7859 krimshteinmd@beltsouth.net Peppard. Terence. M.D. 3663 S. Miami Avenue Miami 33133 (305) 285-2977 (305) 651-6595 Sassoon. Eddie, M.D. 9370 Sunset Drive, Suite A-150 Miami 33173 (954) 474-7474 100 NW 170th Street. Suite 302 North Miami Beach 33169 (954) 432-8872 Plastic Surgery 1 Kaptan, Chance. M.D. 4308 Alton Road. Suite 830 Miami 33140 (305) 401-5357 Zaydon, Jr., Thomas, M.D. 9060 S.W. 73 Court Miami 33156 (305) 856-3030 3661 S. Miami Avenue, Suite 509 Miami 33133 (305) 856-3030 I(305) 285-9423 tzaydon@pol.net 20800 Biscayne Boulevard Aventura 33181 (305) 856-3030 33 Dade County Providers SPECIALTY PROVIDER ADDRESS CITY Zip Phone Fax eMail_Address 925 N.E. 30 Terrace Homestead 33033 (305) 856-3030 Podiatric Surgery Abrebaya. Alberto. DP.M. 4300 W. Flagler Street. Suite 101 Miami 33134 (305) 266-9100 (305) 648-0525 askthepadiatrist@gmail.com Buslamante Edward, D.P.M. 9035 Sunset Drive, Suite 201 Miami 33173 (305) 596-9999 (305) 398-5067 Callan, Gregorio. D.P.M. 3650 NW 82nd Avenue, Suite 201 Dotal 33166 (305) 537-7272 (305) 577-7222 kphz26@gmail.com Cuffy, Cherison, DPM 16800 NW 2nd Avenue, Suite 202 North Miami Beath 33169 (305) 693-7287 {305) 694-9616 Francois, Jon, D.P.M. 301 NE 167th Street North Miami Beach 33162 {305) 940-0522 {305) 653-1138 Gregoline, Paul, D.P.M. 17971 Biscayne Boulevard, Suite 109 Aventura 33180 (954) 793-2387 45 NW 4th Street Homestead 33030 {786) 259-3239 (305) 246-8556 toejamu@aol.com Henao, Maribel. DPM 925 NE 30th Terrance, Suite 106 Homestead 33033 {786) 446-0440 (786) 446-0445 6705 SW 57th Avenue, Suite 312 Coral Gables 33143 {305) 670-8411 I Lampert, Elliott. D.P.M. 1437 S.W. 1st Street Miami 33135 (305) 642-0488 (305) 643-1540 Millar, Ann, D.P.M 12516 N. Kendall Drive Miami 33186 (305) 595-3005 (305) 595-3360 Ianree3@aol.com Nguyen. Phu Hoang, D.P.M. 3661 $. Miami Avenue, Suite 309 Miami 33133 (305) 854-6600 (305) 854-9777 Sandler, Dmitry. DPM 999 N. Krome Avenue Homestead 33030 (305) 246-4774 (305) 248-4086 Southerland, Charles, D.P.M. 16800 NW 2nd Avenue, Suite 202 North Miami Beach 33169 (305) 693-7287 (305) 694-9616 csoutherland@mail.barry.edu Podiatry AMommattei-Soda, Lydiann, D.P.M. 1345 Alton Road Miami Beach 33139 (305) 538-2226 (305) 538-2194 Baum, Ira, D.P M. 8940 N. Kendall Drive, Suite 801E Miami 33176 (305) 598-9454 (305) 598-2884 Berkin, Glenn, D.P.M. 9999 N_E, 2nd Avenue, Suite 103 Miami Shores 33138 (305) 751-1531 (305) 754-4589 Boix, Alexander, D.P.M. 11140 SW 88th Street, Suite 100 Miami 33176 (305) 598-6848 (305) 598-6871 Idrboix@bellsouth.net Brill. Jacqueline. D.P.M. 4302 Alton Road, Simon Bldg.. Suite 200 Miami Beach 33140 (305) 893-9366 (305) 859-7444 Buchman, Jacqueline, D.P.M. 4302 Anon Road, Suite 200 Miami Beach 33140 (305) 893-9366 (305) 893-4408 Cala. Mario. M.D. 16800 NW 2nd Avenue. Suite 202 North Miami Beach 33169 (305) 693-7287 (305) 694-9616 3659 S. Miami Avenue, Suite 3008 Miami 33133 (305) 859-7777 Cantor, David. D.P_M_ 8785 S.W. 165 Avenue, Suite 110 Miami - 33193 (305) 385-9494 1(305) 385-1145 475 Bittmore Way. Suite 102 Coral Gables 33134 (305) 442-1780 Carbonell. Jaime, D.P.M 18430 S. Dixie Highway Miami 33157 (305) 251-2552 1(305) 252-7768 drjaim ec@hotmail.com _ 925 NE 30th Terrace, Suite 106 Homestead 33033 (786) 446-0440 6705 S.W. 57th Avenue, Suite 312 Coral Gables 33143 (305) 670-8411 Carmel, Jerald, Q.P.M. 4302 Alton Road. Suite 1005 Miami Beach 33140 (305) 672-2666 (305) 534-1854 Cook. Michael, D.P.M 8955 SW 87th Court, Suite 108 Miami 33176 (305) 412-1218 (305) 412-4151 Cuero, Roy. D.P.M. 4383 West 16 Avenue Hialeah 33012 (305) 512-1033 (305) 512-1034 DeGirolamo, Amy. D.P.M. _ 1321 NW 14th Street, Suite 213 Miami 33125 (305) 324-0903 I 1609 NW 14th Avenue Miami 33125 (305) 324-0903 (305) 324-0057 760 NW 62nd Street Miami 33151 (305) 324-0903 Delage. Miguel. D.P,M, 8900 Coral Way, Suite 206 Miami 33165 (305) 693-5817 777 E. 25th Street, Suite 208 Hialeah 33013 (305) 693-5817 (305) 223-1005 DeTournay Lisa, D.P.M. 12516 N. Kendall Drive Miami 33186 (305) 595-3005 (305) 595-3360 I)md2ltbr aotcom Detweiler, Michele, D.P.M. 4302 Alton Road, Suite 1005 Miami Beach 33140 (305) 673-0033 (305) 534-1854 _ Dorman, Laurence, D.P.M. 9570 S.W 147th Avenue, Suite 103 Miami 33176 (305) 271-1564 (305) 271-5079 Eiber. Luis, D.P.M. 7150 W. 20th Avenue. Suite 110 Hialeah 33016 (305) 558-7437 (305) 558-1881 Era Elbys. D.P.M. 10621 N. Kendall Drive, Suite 213 Miami 33176 (786) 464-0631 (786) 762-2632 Fishman, Tamara, DPM 1100 N.E. 163rd Street. Suite 101 North Miami Beach 33162 (305) 948-8497 (305) 940-7072 Garnet, Robert, D.P.M. 18430 S. Dixie Highway Miami 33157 (305) 251-2552 (305) 252-7768 staff@gametandca bonell_com 925 NE 30th Terrace, Suite 106 Homestead 33033 (786) 446-0440 6705 SW 57th Avenue, Suite 312 Coral Gables 33143 (305) 670-8411 34 Dade County Providers SPECIALTY PROVIDER ADDRESS CITY Zip Phone Fax eMail_Address Gonzalez, Nelson. D.P.M. 764 S.W. 18th Avenue. 2nd Floor Miami 33135 (305) 642-4777 (305) 642-0600 nganzalez@flafootandankle.com Colman, Sandra, D.P.M. 11760 Bird Road. Suite 616 Miami 33175 (305} 229-9595 (305) 22.9-9596 Goykhman, Gary, DPM 9299 SW 152 Street Suite 103 Miami 33157 (877) 427-8876 747 Ponce De Leon. Suite 505 Miami 33134 (305) 595-1317 11801 SW 90 Street, Suite 201 _ Miami 33186 (305) 595-1317 (305) 595-0157 legsurgeon@yahoo,com Hochman. Richard, D.P.M. 8785 S.W. 165 Avenue, Suite 110 Miami 33193 (305) 385-9494 475 Biltmore Way, Suite 102 Coral Gables 33134 (305) 442-4098 (305) 442-9505 Horowitz. Sam, D.P.M. 7000 W. 12th Avenue, Suite 1 Hialeah 33014 (305) 558-0444 (305) 557-3810 poroffice@aol.com Houseworth, Jon, DPM 4302 Alton Road, Suite 200 Miami Beach 33140 (305) 893-9366 (305) 893-4408 Keller, Gary, D.P.M, 777 E. 25th Street. Suite t 12 Hialeah 33013 (305) 696-3444 (305) 693-6656 Kim, Ray, D.P.M. 8600 SW 92nd Street, Suite 201 Miami 33156 (305) 596-5355 1 Leder, Laurence, D.P,M. 8600 S.W. 92nd Street, Suite 201A Miami 33156 (305) 595-3374 (305) 595-6615 Losito, James, M.O. 3659 S. Miaml Avenue, Suite 3008 Miami 33133 (305) 859-7777 (305) 859-7444 Mann, Luis, D.P.M. 3410 W, 84 Street, Suite 100 Hialeah 33018 (305) 826-7774 (305) 826-5505 Marzouka-Losito, Cynthia. M.D. 3659 S. Miami Avenue, Suite 3008 Miami 33133 (305) 859-7777 (305) 859-7444 Mash, Amal D_P_M. 73 NW 167 Street N. Miami Beach 33169 (305) 654-7753 (305) 673-9259 1321 NW 14th Street, Su(Ie 203 Miami 33125 (305) 654-7753 Medina. Marisel, D.P_M. 1479 N.W. 27th Avenue Miami 33125 (954) 473-6344 _ 1025 E. 25th Street Hialeah 33013 (954) 473-6344 Nasr, Jorge. D.P.M. 11760 Bird Road. Suite 529 Miami 33175 (305) 220-3636 (305) 220-3640 Nelson, John, D.P.M. 4302 Alton Road, Simon Bldg. Suite 200 Miam Beach 33140 (305) 893-9366 (305) 893-4408 nrobles@mail.barry.edu Partridge. Carmen, D.P.M. 1380 N.E. Miami Gardens Drive. Suite 209 North Miami Beach 33179 (305) 945-7575 (305) 942-7585 patridge_c@bellsouth.net Perez-Clavi}o, Francisco. D.P.M. 5520 SW 8th Street Coral Gables 33134 (305) 774-1535 (305) 567-9294 Ringler, Adam D P_M_ 777 East 25th Street. Suite 112 Hialeah 33013 (305) 696-3444 (305) 693-6656 hialeandpm@yahoo.com Rodriguez-Anaye, Luis. DPM 3659 S. Miami Avenue, Suite 3008 Miami 33133 (305) 859-7777 (305) 859-7444 Sede. Richard, G.P.M 1345 Alton Road Miami Beach 33139 (305) 538-2226 (305) 538-2194 Shoemaker, Melinda, D.P.M. 1321 N.W. 14th Street, Suite 103 Miami 33125 (305) 326-3338 (305) 326-3339 Snyder, Robert, D.P.M. 16800 NW 2nd Avenue, Suite 202 North Miami Beach 33169 (305) 593-7287 (305) 693-7287 Torregrosa, John, D.P.M. 9380 S. 150th Street, Suite 290-B Miami 33170 (305) 233,0011 925 NE 30th Terrace, Unit 102 Homestead 33033 (305) 247-1701 Williams, Marie, D.P.M. 21000 N.E. 28th Avenue, Suite 201 Aventura 33180 (305) 932-9232 (305) 932-9536 DRMLWILLIAMS@ACL.COM Wlndram, Warren, D.P.M. 15600 N.W. 67th Avenue, Suite 306 Miami Lakes 33014 (305) 828-8260 Zamoreno, Yasmin, D.P.M. 1380 NE Miami Gardens Drive, Suite 209 Miami 33179 (305) 754-8270 (305) 397-1721 Janet@centralbllingbureau.com Zwick, Thomas, D.P.M. 1321 N.W. 14th Street, Suite 103 Miami 33125 (305) 326-3338 (305) 326-3339 szpod�attbelisouth.net Psychiatry Alonso. Leonardo. M.D. 719 N.W. 13th Avenue Miami 33125 (305) 547-2011 (305) 547-2099 Casariego, Jorge, M.D. 8600 S.W. 92nd Street. Suite 203 Miami 33156 (305) 273-0027 (305) 595-8327 Diaz, Angel. M.D. 10661 N. kendall Drive. Suite 218 Miami 33176 (305) 670-4609 (305) 275-1136 copdF@aol.com Fernandez, Lino, M.D. 2103 Coral Way Drive. Suite 601 Coral Gables 33145 (305) 967-8144 Garcia, Manuel. M.D. 7500 S.W. 8th Street. Suite 202 Miami 33144 (305) 261-7800 (305) 261-2728 mgarcia364@aol.com _ Kakar, Rishi. M.D. 1065 N.E. 125th Street, Suite 206 North Miami 33161 (888) 852-6672 (305) 891-4228 Laypeyra, Olga. M.D. 1065 N.E, 125th Street, Suite 206 North Miami 33161 (888) 852-6672 (305) 891-6672 Merayo. Huberto, M.D. 3860 S.W. 8th Street. Suite 300 Carat Gables 33134 (305) 444-6406 (305) 442-0447 mmerayo@aoLcom 11348 Quail Roost Drive Miami 33157 (305) 444-6406 Segal, Scott. M.D. 1065 N.E. 125th Street, Suite 206 North Miami 33161 (888) 852-6672 (305) 891-4228 Psychology I 35 Dade County Providers SPECIALTY PROVIDER ADDRESS CITY Zip Phone Fax eMail_Address Hendrickson. Michael. PhD. 9101 Park Drive Miami Shores 33158 (305) 668-5068 7800 S.W. 57th Avenue. Suite 227 South Miami 33143 (305) 668-5068 (305) 668-5098 Puhn. Henry, Ph.D. 9700 S. Dixie Highway. Suite 1020 Miami 33156 (305) 670-1366 (305) 279-0087 Rosen, Janet, Psy.D. 9700 S. Dixie Highway, Suite 620 Miami 33156 (305) 670-6618 3100 S.W.62nd Avenue Miami 33155 (305) 663-8439 (305)669-6442 Pulmonary Medicine Anjum, Kama!, M.D. 21355 E. Dixie Highway, Suite 102 Aventura 33180 (305) 933-3600 (954) 455-2085 Reed, Barry, M.D. 8353 S.W. 124th Street, Suite 103 Miami 33156 (305) 274-3664 (305) 274-3674 Radiation Oncology Arguelles. Ramon, M.D. 2001 West 681h Street Hialeah 33016 (305) 364-2110 1100 NW 95th Street Miami 33150 (305) 835-6173 78 S.W. 13th Avenue, Suite 100 Miami 33135 (305) 649-2104 (305) 649-2764 Linzer, Debra, M.D 20950 NE 27th Court, Suite 300 & 100 Aventura 33180 (305) 285-5077 (305) 285-5076 Patone, Vincent. M.D. 78 SW 13th Avenue, Suite 100 Miami 33135 (305) 649-2104 2091 West 68th Street Hialeah 33016 (305) 364-2110 1100 N,W. 95th Street Miami 33150 (305) 835-6173 1305) 694-3671 hpatone@gmail.com Surgical Oncology Legaspi, Adrian, M.D. 7150 W. 20th Avenue, Suite 615 Hialeah 33016 (305) 820-6657 4305) 820-6658 Pidhorecky. Thor. M.D. 7150 W. 20th Avenue, Suite 313 Hialeah 33016 (305) 702-9313 20801 Biscayne Blvd.. Suite 203 Aventura 33180 (305) 682-2560 Urology Bloom, Norman, M.D. 2999 N.E. 191st Street, Suite 310 Aventura 33180 (305) 931-6663 (305) 466-5777 Dansky, Alan, M.D. 6910 N. Kendall Drive Miami 33156 (305) 662-9477 4305) 669-0787 Hamady, Ghassan, M.D. 7150 W. 201h Avenue, Suite 406 Hialeah 33016 (305) 820-1050 4305) 820-1559 Suarez, Juan. M.D. 5450 S.W. Bth Street. Suite 204 Coral Gables 33134 (305) 443-1040 4305) 444-2054 lcysto2001@aol.com 36 Monroe County 37 Monroe County Providers SPECIALTY PROVIDER ADDRESS CITY Zip Phone Fax eMaii Address Child/Adolescent Psychology Funk, Michael. Ph.D. 171 Hood Avenue, Suite 10 Tavernier _ 33070 (305) 852-5995 (305) 852-8595 mlkejfunk@ao1.com Chiropractic Felts, Mark, D.C. 5800 Overseas Highway. Suite 7 Marathon 33050 (305) 743-0039 (305) 743-0472 Family Practice Magrane, Brian, M.D. 91550 Overseas Highway, Suite 109 Tavernier 33070 (305) 853-5214 (305) 853-5218 May, Susana, M.D. 103400 Overseas Highway Key Largo 33037 (305) 852-8670 (305) 743-5383 Isusanamay@bel)south.nel Turbessi, Eileen M.D. 91550 Overseas Highway. Suite 109 Tavernier 33070 (305) 853-5214 (305) 853-5218 General andlor Vascular Surgery Donkor, Charon, M.D. 91550 Overseas Highway, Suite 215 Tavemier 33070 (305) 852-2089 Mang ione, Todd, D.O. 91550 Overseas Highway, Suite 215 Tavernier 33070 (305) 852-2089 Ne1zman, Alan, D.O. 97671 Overseas Highway Key Largo 33037 (305) 852-9001 (305) 853-7060 tsambiled@yahoo.com _ Smith, Steven, M.D. 5701 Overseas Highway, Suite 8 Marathon _ 33050 (305) 743-3511 (305) 743-2765 88555 Overseas Highway, Suite 1 Tavernier 33070 (305) 852-2310 Infernal Medicine 9adano, Sara. M.D. 91550 Overseas Highway. Suite 105 Tavernier 33070 (305) 852-8670 (305) 852-8672 sarabadanomd@bellsouth_net Ophthalmology Rosenberg, Stanley, M.D. 92410 Overseas Highway, Suite 1 Tavenier 33070 (305) 852-3686 _ Plastic Surgery Lansden, Frank, M_D- 91550 Overseas Highway. Suite 205 Tavernier 33070 (305) 853-0002 (305) 853-0032 flansden@comcast.net Podiatric Surgery Sander. Dmitry, DPM 91461 Overseas Highway Tavemier 33070 {305) 852-1878 Podiatry Smith, Sngette, D.P.M. 92410 Overseas Highway, Suite 1 Tavemier 33070 (305) 852-8395 (305) 444-7807 Torregrosa. John. D.P.M. 8151 Overseas Highway. Suite 5 Marathon 33050 (305) 853-5151 li 91550 Overseas Highway, Suite 107 Taverner 33070 )305) 853-5151 {305) 853-5788 Psychology f Watts, Patricia, Psy.D. 5701 Overseas Highway, Suite 17 Marathon 33050 (305) 743-4748 (305) 743-3819 38 Palm Beach County 39 Palm Beach County Providers SPECIALTY PROVIDER ADDRESS CITY Zip Phone Fax eMail_Address Allergy/Immunology Miller, Maureen. M.D. 30 S.F. 7th Street, Suite C Boca Raton 33432 (561) 368-2915 Roberson, Clive, M.D. 10115 W. Forest Hill Boulevard, Suite 403 West Palm Beach 33416 (561) 792-5436 210 Jupiter Lakes Boulevard, Bldg. 5000, Suit€rJupiter 33458 (561) 747-5057 1411 N_ Flagler Drive, Suite 6100 West Palm Beach 33401 (561) 655-4450 1(561) 655-4469 Ryan III, Walter, D.O. 7301 W. Palmetto Park Road, Suite 105C Boca Raton 33433 (561) 392-8832 Cardiac Electrophysiology Weisman, David. M.D. 5035 Via Delray Delray Beach 33484 (561) 804-9295 3575 Burns Road, Suite 101 Palm Beach Gardens 33410 (561) 804-9295 1411 N. Flagler Drive, Suite 4900 West Palm. Beach 33401 (561) 804-9295 (561) 802-9951 Cardiology Baine, Stuart, M.D. 5258 Linton Boulevard, Suite 106 Defray Beach 33484 (561) 495-0990 (561) 495-8276 8756 Boynton Beach Boulevard: Suite 2300 i Boynton Beach 33472 (561) 737-0030 Baker, Jay, M.D. 9980 Central Park Boulevard N., Suite 304 Boca Raton 33428 (561) 483-8335 (561) 483-1756 10151 Enterprise Center. Suite 203 Boynton Beach 33437 (561) 483-8335 Chernebelsky, Alexander, M.D. 5401 S. Congress Avenue. Suite 102 Atlantis 33462 (561) 967-5033 1(561) 967-1409 6056 Boynton Beach Boulevard, Suite 145 Boynton Beach 33437 (561) 967-5033 Cioci, Louis, M.D. 9980 Central Park Boulevard, Suite 210 Boca Ratan 33428 (561) 852-9909 Coletti, Steven, M.D. 9980 Central Park Boulevard N., Suite 203 Boca Raton 33428 i (561) 483-8335 (561) 483-1756 10151 Enterprise Center, Suite 203 Boynton Beach 33437 (561) 483-8335 Danchenko, Adrian. M.D. 1411 N. Flagler Drive, Suite 4900 West Palm Beach 33401 (561) 627-3130 500 University Drive, Suite 208 Jupiter 33458 (561) 627-3130 (561) 627-8971 Fields, Constance, M.D. 9980 Central Park Boulevard N., Suite 304 Boynton Beach 33437 (561) 483-8335 (561) 483-1756 10151 Enterprise Center, Suite 203 Boynton Beach 33437 (561) 483-8335 Funt, David, M.D. 10151 Enterprise Center, Suite 203 Boca Raton 33428 (561) 483-8335 9980 Centra Park Boulevard N., Suite 304 Boca Raton 33428 (561) 483-8335 (561) 483-1756 Gabor, Ronald, M.D. 10151 Enterprise Center, Suite 203 Boynton Beach 33437 (561) 483-8335 I 9980 Central Park Boulevard N., Suite 304 Boca Raton 33428 (561) 483-8335 (561) 483-1756 Gare, Meir, M.D. 5401 S. Congress Avenue, Suite 102 Atlantis 33462 (561) 967-5033 (561) 967-1409 6056 Boynton Beach Boulevard, Suite 135 Boynton Beach 33437 (561) 967-5033 Gottsegen, Joshua, M.D. 12957 Palms West Drive, Suite 201 Loxahatchee 33470 (561) 967-5033 (561) 649-1409 Barring, Charles, M.D. 5401 S. Congress Avenue, Suite 102 Atlantis 33462 (561) 967-5033 (561) 967-8974 40 Palm Beach County Providers SPECIALTY PROVIDER ADDRESS CITY Zip Phone Fax eMail Address 6056 Boynton Beach Boulevard, Suite 145 Boynton Beach 33437 (561) 967-5033 12977 Southern Boulevard, Suite 200 Loxahatchee 33470 (561) 967-5033 Janin. Yves. M,D_ 4601 Military Trail, Suite 207 Jupiter 33456 (561) 694-6901 (561) 694-6902 Kahan. Jonathan. M.D. 5035 Via Delray Delray Beach 33484 (561) 637-0050 (561) 637-0055 Kamireddy. Malhkarjuna, M.D. 8200 Jog Road, 5uite204 Boynton Beach 33437 (561) 740-4762 mallikamireddymd@yahoo.com 5405 Dkechobee Boulevard, Suite 100 West Palm Beach 33417 (561) 420-8490 Krasner, Stephen, M.D. 5401 S. Congress Avenue, Suite 102 Atlantis 33462 (561) 967-5033 1{561) 649-1409 6056 Boynton Beach Boulevard, Suite 145 Boynton Beach 33437 (561) 967-5033 Kukreja, Suneet, M.D. 927 45th Street, Suite 201 West Palm Beach 33407 (561) 882-6060 1(561) 882-4622 901 Village Boulevard. Suite 702 West Paim Beach 33409 (561) 882-6214 Lakow. Michael. M.D. 5401 S. Congress Avenue. Suite 102 Atlantis 33462 (561) 967-5033 1(561) 649-1409 6056 Boynton Beach Boulevard, Suite 145 Boynton Beach 33437 (561) 967-5033 Melhado, Mauricio, M.D. 3347 State Road 7, Suite 203 Wellington 33449 (561) 793-6100 1(561) 793-1974 3345 Bums Road, Suite 206 Palm Beach Gardens 33410 {561) 626-1881 Mohanty, Jyoti, M.D. 927 45th Street, Suite 201 West Palm Beach 33407 {561) 882-6060 1(561) 882-4622 3375 Bums Road Palm Beach Gardens 33410 {561) 366-6777 210 Jupiter Lakes Boulevard, Suite 4202 Jupiter 33458 {561) 366-6777 Musarti Albert, M.D. 12977 Southern Blvd.. Suite 200 Loxahatchee 33470 (561) 967-5033 5401 S. Congress Avenue, Suite 102 Atlantis 33462 (561) 967-5033 1(561) 649-1409 6056 Boynton Beach Boulevard, Suite 145 Boynton Beach 33437 (561) 967-5033 Pinedo, Walter, M.D, 12977 Southern Boulevard, Suite 200 Loxahatchee 33470 (561) 967-5033 5401 S. Congress Avenue, Suite 102 Atlantis 33462 (561) 967-5033 1(561) 967-5424 wpinedo@adelphia.nel 6056 Boynton Beach Boulevard, Suite 145 Boynton Beach 33437 (561) 967-5033 Simon, Mark, M.D. 6056 Boynton Beach Boulevard. Suite 145 Boynton Beach 33437 (561) 967-5033 12977 Southern Boulevard, Suite 200 _ Loxahatchee 33470 (581) 798-4900 5401 S. Congress Avenue, Suite 102 Atlantis 33462 (561) 967-5033 (561) 649-1409 Sutton, Jeffrey. M.D. 7280 Boynton Beach Boulevard, Suite 200 Boynton Beach 33467 (561) 734-1110 (561) 369-3303 Vedere, Amarnath, M.D. 3347 State Road 7. Suite 203 Wellington 33445 (561) 793-6100 (561) 422-2001 3345 Burns Road, Suite 105 Palm Beach Gardens 33410 (561) 626-1881 Venugopal, Chandra. M.D. 3347 State Road 7. Suite 203 Wellington 33445 (561) 793-6100 1(561) 793-1974 Von Sohsten, Roberto, M,D. 6056 Boynton Beach Boulevard, Suite 145 Boynton Beach 33437 (561) 967-5033 12977 Southern Boulevard, Suite 200 Loxahatchee 33470 (561) 967-5033 5401 S. Congress Avenue, Suite 102 Atlantis 33462 (561) 967-5033 (561) 967-8974 Cardiovascular and/or Thoracic Surgery Bethea, Brian. M.D. 3375 Burns Road, Suite 101 Palm Beach Gardens 33410 (561) 638-9140 927 45th Street, Suite 301 West Palm Beach 33407 (561) 638-9140 41 Palm Beach County Providers SPECIALTY PROVIDER ADDRESS CITY Zip Phone Fax eMail Address 4205 W. Atlantic Avenue, Bldg B. Suite 201 Defray Beach 33445 (561) 638-9140 (561) 496-0320 Cartledge, Richard, M.D. 801 Meadows Road. Suite 104 Boca Raton 33486 (561) 955-6300 (561) 955-6310 Galindez, Neil. M.D. 3375 Burns Road. Suite 101 Palm Beach Gardens 33410 (561) 622-6550 (561) 622-6331 Scheerer. Rudolph, M.D. 808 N. Olive Avenue _ West Palm Beach 33401 (561) 832-1378 (561) 832-6771 ChildlAdolescent Psychiatry Evelson, Jessica, M.D. 10301 Hagen Ranch Road, Suite B-6 Boynton Beach 33437 (561) 752-9490 Fischer, Diana, M.D. 8200 Jog Road, Suite 100 Boynton Beach 33472 (888) 852-6672 (305) 891-4228 Chiropractic r Aigen, Jordan. D.C. 2309 W. Woolbright Road, Suite 5 Boynton Beach 33426 (561) 739-5393 (561) 369-5960 Ashley, Mark. D.C. 411 7th Street, Suite 4 WeSt Palm Beach 33401 (561) 835-3556 (561) 835-0352 Bartosek. Helen, D.G. 5601 N. Federal Highway, Suite 2 Boca Raton 33487 (561) 997-7660 (561) 997-7661 Brodkin. Ronald, D.C. 7805 NW Beacon Square Boulevard, Bldg 5, &Boca Raton 33487 (561) 620-0174 (561) 988-2125 brodkinchiropractic@7agmail.com Bussie, Delores, D.C. 784 U.S. Highway One, Suite 12 North Palm 33408 (561) 799-0223 (561) 799-0263 sagechropratic@att.nel Caruso, Anthony, D.C. 3003 S. Congress Avenue. Suite 2F Palm Springs 33461 (561) 963-6227 (561) 963-4199 D'Amico, John, D.C. 600 University Boulevard, Suite 105 Jupiter 33458 (561) 822-6111 (561) 622-1176 Figler, Mark, D.C. 525 Northlake Boulevard. Suite 2 North Palm Beach 33408 (561) 844-1133 dfigler@bellsouth.net Giovinco. Vincent, D.C. 2311 10th Avenue. Suite 9 Lake Worth 33461 (954) 379-0300 Goldberg. David. D.C. 9250 Glades Road, Suite 110 Boca Raton 33434 (561) 470-1221 500 N.E. Spanish River Boulevard. Suite 35 Boca Raton 33431 (561) 368-2446 (561) 368-2990 Chiro@bellsouth.net Hackett. Ernest. D.C. 4600 Military Trail, Suite 108 Jupiter 33458 (561) 776-2285 (561) 776-2856 paientfirstfl@yahoo.com Jackson, J. Randall. D.C. 1717 N. Federal Highway Lake Worth 33460 (561) 585-8940 (561) 585-5677 Korum, Gregg, D.C. 9835-14 Lake Worth Road Lake Worth 33467 (561) 642-6400 (561) 642-8198 LaRusso. Salvatore, D.C. 13860 Wellington Trace. Suite 13 Wellington 33414 (561) 793-4700 (561) 793-5504 McClellan, John, D.C. 440 N. State Road 7. Suite 103 _ Royal Palm Beach 33411 (561) 798-6600 T 875 Military Trail, Suite 105 Jupiter 33458 (561) 798-6600 (561) 803-8700 Mitzelfeld, Charles, D.C. 1395 N. Military Trail West Palm Beach 33409 (561) 684-0333 (561) 684-8587 drehuck@foundationchiro.com Moses, Gregg, D.C. 1800 Forest Hall Boulevard, A 8-10 West Patin Beach 33406 (561) 641-9211 {561) 641-2188 chiromoe26@yahoo.cerr Murphy, William, D.C. 2151 Alternate AMA South, Suite 600 Jupiter 33477 (561) 747-5234 (561) 747-6123 Nathanson. Michael. M.D. _ 409 S. Dixie Highway Lake Worth 33460 (561)582-5433 {561) 585-0074 _ _ Smith, Joshua. D.C. 600 University Boulevard, Suite 105 Jupiter 33458 (561) 622-6111 (561) 622-1176 Smith, Seth. D.C. 600 University Boulevard, Suite 105 Jupiter 33458 (561) 622-6111 (561) 622-1176 _ Sobel, Scott, D.C. 2499 Glades Road, Suite 312 Boca Raton 33431 {561) 613-4040 (561) 372-7880 Taylor, Brett, D.C. 1149 Royal Palm Beach Boulevard Royal Palm Beach 33411 {561) 793-5050 (561) 790-6766 brettdc@bellsouth.net Woods. Ronald, D.C. 701 Northlake Boulevard, Suite 101 North Palm Beach 33408 (561) 845-7292 (561) 845-9184 Colon & Rectal Surgery Snow, Jeffrey. M.D. 900 Glades Road. Suite 500 Boca Raton 33431 {954) 265-0000 Zelnick_ Ronald. M.D, 210 Jupiter Lakes Boulevard, Building 3000, Sr Jupiter 33458 (561) 575-7875 (561) 575-5874 surgspec@bellsout .net Dermapathology 42 Palm Beach County Providers SPECIALTY PROVIDER ADDRESS CITY Zp Phone Fax eMail Address Huo. Zhifeng_, M.D. 1830 N. Dixie Highway West Palm Beach 33407 (561) 253-0806 Dermatology Sarro. Robert. M.D. 7280 W. Palmetto Park Road. Suite 207 Boca Raton 33433 (561) 368-1440 (561) 368-3016 3100 S. Federal Highway, Bay 8 Delray Beach 33483 (561) 278-1362 Schillinger, Brent, M.D 3100 S. Federal Highway, Bay 8 Delray Beach 33483 (561) 278-1362 7280 W. Palmetto Park Road, Suite 207-N West Palm Beach 33433 (561) 368-1440 (561) 368-3016 Schorr. M„ M.D. 715 W. Boynton Beach Boulevard, Suite C Boynton Beach 33426 {561) 737-8376 (561) 734-7925 13005 Southern Boulevard, Suite 224 Loxahatchee 33470 (561) 793-2929 3 S.E. Avenue K Belle Glade 33430 (561) 992-0933 Endocrine Surgery Bimston, David, M.D. 900 Glades Road. Suite 500 Boca Raton 33431 (954) 265-0000 Endocrinology Guerrero, Sol, M.D. 9960 Central Park Boulevard N., Suite 150 Boca Raton 33428 (561) 288-5459 (561) 451-0533 Family Practice Abdallah. Nadar, D.O. 4623 Forest Hill Boulevard, Suite 201 West Palm Beach 33415 (954) 829-1956 Dufour. Martin, M.D. 9960 Central Park Boulevard N., Suite 150 Boca Raton 33428 (561) 488-7200 8756 Boynton Beach Boulevard. Suite 2300 Boynton Beach 33472 (561) 737-0030 Gajraj. Mohamed, M.D. 7280 W. Palmetto Park Road, Suite 104 Boca raton 33433 (561) 391-6552 Gherghina, Valentina. M.D. 10151 Enterprise Center Boulevard, Suite 204 Boynton Beach 33437 (561) 737-9796 (561) 737-8583 Goldberg, Jack, D.O. 4801 S. Congress Avenue, Suite 101 Lake Worth 33461 (561) 434-1469 {561) 434-1197 Idrjackgoldberg@gmail.corn Gonzalez, Armando, M.D. 3713 5. Congress Avenue Palm Springs 33461 (561) 649-9296 (561) 649-9382 Goodman, Jeffrey, D.O. 10111 W. Forest Hill Boulevard. Suite 221 Wellington 33414 (561) 790-2661 (561) 790-7021 Grenn, Gordon. D.O. 4002 Rauterson Road Lake Worth 33463 (561) 964-4077 (561) 964-9296 Hauss, Carolyn, D.O. 3345 Burns Road, Suite 102 Palm Beach Gardens 33410 (561) 694-9675 (561) 622-6775 3345 Bums Road, Suite 101 Palm Beach Gardens 33410 (561) 622-2022 Jairam, Anubha, M.D. 6901 Okeechobee Boulevard, Suite E 11 West Palm Beach 33411 (561) 439-6176 (561) 439-8355 Landman, Michael, D.O. 8200 Okeechobee Boulevard West Palm Beach 33411 (561) 964-1111 4623 Forest Hill Boulevard, Suite 105 West Palm Beach 33415 (561) 969-7900 (561) 969-7919 mbennts@medicalcenterofthepal Pentzke, Isidro, M.D. 6309 South Dixie Highway West Palm Beach 33405 (561) 585-0540 (561) 585-0659 drpentzke@betlsouth.nei Presser. Jeffrey, M.D. 13205 U.S. Highway One, Suite 105 Juno Beach 33408 (561) 691-0100 (561) 691-0101 Rogovin, Mark. D.O. 8188 Jog Road, Suite 205 Boynton Beach 33437 (561) 742-4460 (561) 742-4494 Surowitz, Ronald, D.O- 411 W. Indian Town Road Jupiter 33458 (561) 746-7826 (561) 744-1970 lrsurowitzz@aol.com Uribe. Leon. M.D. 5405 Okeechobee Boulevard, Suite 100 West Palm Beach 33417 (561) 420-8492 (561) 420-8491 General and/or Vascular Surgery { 43 Palm Beach County Providers SPECIALTY PROVIDER ADDRESS CITY Zip Phone Fax eMail Address Berman. Robert, M.D. 1004 S. Old Dixie Highway, Suite 203 Jupiter 33458 (561) 748-5760 2141 Alternate A1A South, Suite 450 Jupiter 33477 (561) 743-5112 (561) 743-8567 bermanmd@comcast.nel Chidambaram. Arul, M.D. 1397 Medical Park Boueivard. Suite 100 Wellington 33414 (561) 798-1515 (561) 798-9249 dmoore@mmmtl.com 130 JFK Drive. Suite 134 Atlantis 33462 (561) 964-2211 Corbitt. Jr., John. M.D. 142 JFK Drive Atlantis 33462 (561) 439-1500 (561) 439-9902 Ibarrola, Agustin. M.D. 1397 Medical Park Boulevard, Suite 100 Wellington 33414 (561) 798-1515 (561) 798-9249 dmoore@mmmfl.com 130 JFK Drive, Suite 134 Atlantis 33462 (561) 964-2211 Kleban, Donna, M.D. 1395 State Road 7, Suite 410 Wellington 33414 (561) 791.3301 1(561) 791-7745 dkmdtami@bellsouth.net 1309 N. Flagler Drive, Suite 1027 West Palm Beach 33401 (561) 753.2676 10141 Forest Hill Boulevard Wellington 33414 (561) 753.2676 Matei, Emil, D.O. 900 Glades Road, Suite 500 Boca raton 33431 (954) 265.0400 Pidhorecky, Thor, M.D. 900 Glades Road. Suite 500 Boca Raton 33431 (954) 265-0000 Sayegh. Bassam, M.D. 1004 S. Old Dixie Highway. Suite 301 Jupiter 33458 (561) 743-7766 f(561) 744-6020 1411 N. Flagler Drive. Suite 4100 West Palm Beach 33401 (561) 743-7766 Scott, Thomas, M.D. 1397 Medical Park Boulevard, Suite 180_ Wellington 33414 (561) 753-2680 1(561) 798-9249 diana.sutherland@uhsinc.com Scott, Thomas, M.D. _ 160 JFK Drive, Suite 204 _ Atlantis 33462 (561) 964-2211 Shapiro, Andrew. M.D. 9868 South State Road 7, Suite 335 Boynton Beach 33472 (561) 333-1335 1447 Medical Park Boulevard, Suite 407 Wellington 33414 (561) 333-1335 (561) 333-4252 Zelnick, Ronald, M.D. 210 Jupiter Lakes Boulevard, Building 3000, Si Jupiter 33458 (561) 575-7875 (561) 575-5874 surgspec@bellsouth.net Zeltzer, Jack, M.D. 1397 Medical Park Boulevard, Suite 100 Wellington 33414 (561) 798-1515 130 JFK Drive, Suite 134 Atlantis 33462 (561) 964-2211 (561) 649-3378 dmoore@mmmfl.com General Surgery Coykendall, David. M.D. 1411 N. Flagler Drive, Suite 9700 West Palm Beach 33401 (561) 655-1877 3375 Burns Road, Suite 101 Palm Beach Gardens 33410 (561) 622-6550 (561) 622-6331 Gannon. Christopher, M.D. 900 Glades Road, Suite 500 Boca Raton 33431 (954) 265-0000 I Ricotta. Joseph. M.D. 4205 West Atlantic Avenue, Bldg B Suite 201 Delray Beach 33445 (561) 303-0013 (561) 499-3199 Hand Surgery Blum. David. M.D. 15127 Jog Road. Suite 209 Delray Beach 33446 (954) 473-6344 Eastlick. Lewis, M D. 9980 N. Central Park Blvd.. Suite 118 Boca Raton 33428 (954) 797-6789 Friedman, David. M.D. 525 Okeechobee Boulevard. City Place Tower, West Palm Beach 33401 (561) 804-0200 Kolshak, Laura. M.D. 2150 S. Congress Avenue Palm Springs 33406 (561) 508-7066 (844) 269-7084 Meadows. Steve. M.D. 4800 Linton Boulevard, Suite A-201 Delray Beach 33445 (561) 496-6622 (561) 496-6577 4bonedoc@bellsouth.nel Saylor. Thomas, M.D. 733 U.S. Highway One North Palm Beach 33408 (561) 840.1090 (561) 840-0791 Thebaut. Jr., Ben. M.D. 2580 Metrocentre Boulevard. Suite 1 West Palm Beach 33407 (561) 684-2022 (561) 776-6111 lolsen@pboi.com 1002 South Old Dixie Highway. Suite 105 Jupiter 33458 (561) 743-4263 Hematology/Oncology Mewar, Seetat, M.D. 10151 Enterprise Center Boulevard, Suite 203 Boynton Beach 33437 (561) 740-0545 3918 Via Ponciana, Ste 1 Lake Worth 33467 (561) 439-4682 (561) 968-0483 Tepper, Lawrence. D.O. 2051 45th Street, Suite 107 West Palm Beach 33407 (561) 848-1011 (561) 848-9166 155 Toney Penna Drive, Suite 2 Jupiter 33458 (561) 848-1011 I 44 Palm Beach County Providers SPECIALTY PROVIDER ADDRESS CITY Zip Phone Fax eMail_Address Tomeski. Aurea. M.D. 899 Meadows Road Suite 201 Boca Raton 33486 (561) 392-6226 (561) 391-7632 c.telan@gmail.com Infectious Disease Buchstein. Sara, M.D. 2900 N. Military Trait Suite 210 Boca Raton 33431 (561) 997-7686 Copal, Indulekha. M.D. 2900 North Military Trail. Suite 210 Boca Raton 33431 {561) 997-7686 Komaiha, Harried, M.D. 2900 North Military Trail. Suite 210 Boca Raton 33431 (561) 997-7686 Ondrusek, Jaroslav, M.D. 2900 N. Military Trail, Suite 210 Boca Raton 33431 _ (561) 997-7686 Patel, Tejal. M.D. 2900 N. Military Trail, Suite 220 Boca Raton 33431 {561) 997-7686 Samant, Vijay, M.D. 850 Glades Road, Wound Care Boca Raton 33431 (561) 955-5899 Vkllalba. Jose, M.D. 2900 North Military Trail. Suite 210 Boca Raton 33431 (561) 997-7686 Internal Medicine Ajibade, Adetola, M.D. 1309 N. Flagler Drive West Palm Beach 33401 (561) 882-4541 (561) 650-6093 Campazzi, Earl, M.D_ 340 Royal Poinciana Way, Suite 315 Palm Beach 33480 (561) 832-8300 (561) 832-8050 Egan, Margaret, M.D. 875 Military Trail, Suite 200 & 208 Jupiter 33458 (561) 746-2411 (561) 745-7333 Iintmedaspb@aol.com (561) 650-6093 Gallo-Thys, Teresa, M.D. 1309 N. Flagler Drive West Palm Beach 33401 (561) 882-4541 Gemayel, Gaby, M.D. 4700 N. Congress Avenue, Suite 201 West Palm Beach 33407 (561) 881-2640 (561) 663-2304 Greco, Jennifer. M.D. 2201 45th Street West Palm Beach 33407 (561) 548-1750 Javed. Mohammad. M.D. 11476 Okeechobee Blvd Royal Palm Beach 33411 (561) 204-5111 6447 Lake Worth Road Lake Worth 33463 (561) 433-1700 (561) 642-7587 _ Jean -Charles, Sandra, M.D. 601 N. Congress Avenue, Suite404 Delray Beach 33445 (561) 278-3733 (561) 276-9845 Kacham. Suresh. M.D. 500 University Boulevard. Suite 208 Jupiter 33458 (561) 691-1904 (561) 691-1947 Kalter, Michael. M.D. 601 University Boulevard, Suite 102 Jupiter 33458 (561) 743-2222 (561) 743-3401 Kbarlow@jupiterproder.com Marks, Mitchell, D.O. 3345 Burns Road, Suite 101 Palm Beach Gardens 33410 (305) 622-2022 3345 Burns Road, Suite 102 Palm Beach Gardens 33410 (561) 694-9675 (561) 694-9264 Mendoza, Paul, M.D. 1309 N. Flagler Drive West Palm Beach 33401 (561) 882-4541 (561) 650-6093 Moraes, Brian. D.O. 9325 Glades Road. Suite 107 Boca Raton 33434 (561) 883-7770 (561) 883-7779 moraesoffice@yahoo.com Okeh, Victor, M.D. 2201 45th Street West Palm Beach 33407 (561) 548-1750 5301 S. Congress Avenue Atlantis 33462 (561) 548-1750 (561) 548-1755 Peter -Vazquez, Raul, M.D. 9970 Central Park boulevard, Suite 205 Boca Raton 33428 (561) 487-1203 (561) 487-1251 Sanderson, N.aeieia-Patric, M.D. 1309 N. Flagler Drive West Palm Beach 33401 (561) 882-4541 (561) 650-6093 Singh, Atka, M.D. 1309 N. Flagler Drive West Palm Beach 33401 (561) 882-4541 (561) 650-6093 Swee, Warren, M.D. 2201 45th Street West Palm Beach 33407 (561) 594-1810 (561) 594-1844 Vasuki, Nagavardhan, M.D. 5401 S. Congress Avenue, Suite 102 Atlantis 33462 (561) 967-5033 (561) 967-8974 Zambrano. Martha. M.D. 901 Village Boulevard, Suite 702 West Palm Beach 33409 (561) 882-6214 500 University Boulevard, Suite 208 Jupiter 33458 (581) 625-6177 (561) 625-1834 tvg140230comcast.nel Interventional Radiologist Zemel. Gerald, M.D_ 1309 N. Flagler Drive West Palm Beach 33401 (561) 366-4100 (561) 366-4189 3401 PGA Boulevard, Suite 200 Palm Beach Gardens 33410 (561) 366-4100 Mental Health Professional Beck, Leah, LMHC 10301 Hagen Ranch Road, Suite B-6 Boynton Beach 33437 (561) 752-9490 (561) 752-9491 Odinov-Daniels, Lynn, L.C.S.W 10492 Galleria Street Wellington 33414 (561) 422-1145 {561) 422-3198 aldan20042bellsouth.nel Nephrology 45 Palm Beach County Providers SPECIALTY PROVIDER ADDRESS CITY Zip Phone Fax eMail_Address Agarwala, Rajesh, M.D. 9980 Central Park R4vd N., Suite 312 Boca Raton 33428 (561) 218-4859 (561) 218-4809 Neurology Bezner, Allen, M.D. 116 JFK Drive, Building 110, Suite 116 Atlantis 33462 (561) 439-1234 (561) 439-0506 Dalvi, Arif. M.D. 4920 Loring Drive West Palm Beach 33417 (561) 882-6214 901 Village Boulevard, Suite 702 West palm Beach 33409 (561) 882-6214 (561) 882-6216 Friedman, Robert, M.D. 1015 West lndiantown Road, Suite 202 Jupiter 33458 (561) 748-0528 (561) 748-4718 7625 Lake Worth Road Lake Worth 33467 (561) 641-7100 Malek, Ali, M.D. - 901 Village Boulevard, Suite 702 West Palm Beach 33409 (561) 882-6214 (561) 882-6216 Mate, Laszlo, M.D. 927 45th Street, Suite 105 West Palm Beach 33407 (561) 882-0088 (561) 842-4983 drmate@bellsouth.net Muniz. Juan, M.D. 3375 Burns Road. Suite 101 Palm Beach Gardens 33410 (561) 882-6214 901 Village Boulevard, Suite 702 West Palm Beach 33409 (561) 882-6214 (561) 882-6216 Patel, Paayal, M.D. 901 Village Boulevard, Suite 702 West Palm Beach 33409 (561) 882-6214 (561) 882-6216 Rubin, Jeffrey. M.D, 500 University Boulevard, Suite 208 Jupiter 33458 (561) 802-9966 1411 Flagler Drive, Suite 4900 West Palm Beach 33401 (561) 802-9966 (561) 802-9951 Salvati, Carl. M.D. 13455 Military Trail, Suite A Delray Beach 33484 (561) 495-4644 (561) 495-5191 ICarlsalvati@yahoo.com Yanofsky, Charles, M.D. 3375 Burns Road, Suite 101 _ Palm Beach Gardens 33410 (561) 622-6550 (561) 622-6331 Neuro-Psychology Arias. Alejandro, M.Q. 5700 Lake Worth Road, Suite 205 Lake Worth 33463 (305) 766-5629 Scherdell, Traci, Psy.D. 901 Village Boulevard, Suite 702 West Palm Beach 33409 (561) 882-6214 (561) 882-6216 Neurosurgery Brodner, Robert, M.D. 1411 N. Flagler Drive, Suite 5900 West Palm Beach 33401 (561) 833-6388 (561) 833-6353 Gomez, Jr., Heldo, M.D. 4290 Professional Center Drive, Suite 105 Palm Beach Gardens 33410 (561) 627-7855 (561) 627-5030 Grabel, Jordan, M.D. 1411 N. Flagler Drive, Suite 5900 West Palm Beach 33401 (561) 833-6388 (561) 833-6353 Imd7888@bellsouth.nel Osborn, Brett, D.O. 901 Village Boulevard, Suite 702 West Palm Beach 33409 (561) 882-6214 (561) 882-6216 Obstetrics/Gynecology Bejarano, Eliana, M.D. 5405 Okeechobee Boulevard, Suite 100 West Palm Beach 33417 (561) 420-8492 (561) 420-8491 3375 Burns Road, Suite 101 Palm Beach Gardens 33410 (561) 420-8492 Brown, Dudley, M.D. 3375 Burns Road, Suite 108 Palm Beach Gardens 33410 (561) 458-8955 (561) 459-8956 Sohn, Natalie, M.D. 110 Century Boulevard West Palm Beach 33417 (561) 697-3131 8200 Jog Road, Suite 204 Boynton Beach 33472 (561) 439-6895 3600 Forest Hill Boulevard, Suite 1 Palm Springs 33406 (561) 439-6895 (561) 439-6598 Occupational Medicine Goldberg. Jack, D.O. 4801 S. Congress Avenue, Suite 101 Lake Worth 33461 (561) 434-1469 {561) 434-1197 drjackgoldberg@gmail.com Ophthalmology Barbour, Monique, M.D. 7657 Lake Worth Road _ _ Lake Worth 33467 (561) 432-4141 {561) 432-4166 barbourmonique@aol.com Bellotte, Brent, M.D. 9325 Gtades Road, Suite 201 Boca Raton 33434 (561) 488-1001 (561) 353-1694 info@westbocaeye.com 46 Palm Beach County Providers SPECIALTY PROVIDER ADDRESS CITY Zip Phone Fax eMail Address Benaim, Monroe, M.D. 1001 W. Indiantown Road, Suite 107 Jupiter 33458 (561) 746-6666 (561) 745-8889 Cornell, Floyd, M.D. 2889 16th Avenue North Lake Worth 33461 ' (561) 964-0707 Daubed. Jack, M.D. 1515 N. Flagler Drive. Suite 500 West Palm Beach 33401 (561) 659-9700 J 1050 S.E. Monterey Road. Suite 104 Stuart 34994 (772) 283-2020 1(772) 219-7924 cryfly30@yahoo.com Gechter, Eric, M,D. 9980 Central Park Boulevard N., Suite 126 Boca Raton 33428 (561) 487-6600 Gokno. Andre, M.D. 130 Butler Street West Palm Beach 33407 (561) 832.6113 (561) 833-3003 Habash, Ranya, M.D. 9325 Glades Road, Suite 201 Boca Raton 33434 (561) 488.1001 (561) 353-1694 linfo@westbocaeye.com Haft, Brian, M.D. 11406 Okeechobee Boulevard Royal Palm Beach 33411 (561) 798-2020 (561) 795-0253 Halperin. Lawrence, M.D. 8190 Jog Road, Suite 205 Boynton Beach 33437 (561) 737-1355 950 Glades Road, Suite 1-C Boca Raton 33431 (561) 394-6499 Kelly. Kevin, M.D. 950 Glades Road, Suite 1-C Boca Raton 33431 (561) 394-6499 1(954) 229-3100 8190 Jog Road, Suite 250 Boynton Beach 33472 (561) 737-1355 Khoun. George, M.D. 1411 N. Flagler Drive. Suite 8100 West Palm Beach 33401 (561) 366-8300 (561) 366-8320 Kohn. Alan, M.D. 2505 Metro Centre Boulevard, Suite 300 West Palm Beath 33407 (561) 478-2003 (561) 478-2080 1info14@earthlink.net Kurtzman, Benda, M.D. 120 W. Palmetto Park Road Boca Raton 33432 (561) 395-7616 (561) 395-1399 Leder. Douglas. 0.0. 2055 N. Military Trail, Suite 304 Jupiter 33458 (561) 686-2020 I 500 Northpoint Parkway, Suite 100 West Palm Beach 33407 (561) 686-2020 (561) 686-6204 Mao, Lisa, M.D. 1445 N.W. Boca Raton Boulevard Boca Raton 33432 (561) 997-8100 (561) 338-7785 Ieyemao@aol.com Margolies, Richard, M.D. 3355 Bums Road, Suite 205 Palm Beach Gardens 33410 (561) 626-5600 (561) 626-8524 Melgen, Salomon, M.D. 2521 Metro Center Boulevard West Palm Beach 33407 (561) 687-0007 (561) 688-0431 retina25212@aal.com Merey, John, M.D. 5405 Okeechobee Boulevard, Suite 302B West Palm Beach 33417 (561) 686-8202 ' (561) 686-7202 jhmerey@aol.com Rosecan. Lauren, M.D. 11382 Prosperity Farms Road, Suite 127 Palm Beach Gardens 33410 (561) 627-7311 1050 N.W. 15th Street Suite 116 Boca Raton 33486 (561) 368-7723 618 E. Ocean Boulevard. Suite 3 Stuart 34994 (772) 287-7026 901 N. Flagler Drive West Palm Beach 33401 (561) 832-4411 1(561) 832-1591 Rosenberg, Krista, M.D. 950 Glades Road. Suite 1-C Boca Raton 33431 (561) 394-6499 8190 Jog Road, Suite 250 Boynton Beach 33437 (561) 737-1355 6298 Linton Boulevard. BLDG 2, Suite 104 Delray Beach 33484 (561) 501.5666 Rosenblum, Paul, M.D. 840 U.S, Highway 1, Suite 430 North Palm Beach 33408 (561) 627-6333 1(561) 627-3907 210 Jupiter Lakes Boulevard. Suite 106 Jupiter 33458 (561) 627-6333 Rubsamen. Patrick, M.D. 950 Glades Road. Suite 1-C Boca Raton 33431 (561) 394.6499 (561) 391-6004 8190 Jog Road. Suite 250 Boynton Beach 33437 (561) 737-1355 I Salama, Salomon, M.D. 120 W. Palmetto Park Road Boca Raton 33432 (561) 395-7616 (561) 395-1399 Schnell, Steven, M.D. 210 Jupiter Lakes Boulevard, Suite 3104 Jupiter 33458 (561) 747-4994 (561) 575-9104 Eyestoeyes@bellsouth.nel Sossi, Nunzio, M,D, 130 Butler Street West Palm Beach 33407 (561) 832-6113 (561) 833-3003 Taney, Barry, M.D. 6298 Linton Boulevard, Bldg 2, Suite 104 Delray Beach 33484 (561) 501-5666 8190 Jog Road, Suite 205 Boynton Beach 33437 (561) 737-1355 950 Glades Road, Suite 1-C Boca Raton 33431 (561) 394-6499 Thompson, William, M.D. 950 Glades Road, Suite 1-C Boca Raton 33431 (561) 394-6499 Oral Surgery Westin, John, D.M.D. 250 N. Dixie Boulevard, Suite 100 Delray Beach 33444 (561) 278-3202 (561) 278-7090 47 Palm Beach County Providers SPECIALTY PROVIDER ADDRESS CITY Zip Phone Fax eMail_Address Orthopedic Surgeon/ Spine Surgery Cameron, Julian, M.D. 6080 Boynton Beach Boulevard, Suite 100 Boynton Beach 33437 (561) 790-0031 (561) 790-0032 Desser, Dana, Q.O. 10131 W. Forest Hill Boulevard, Suite 230 Wellington 33414 (561) 798-6600 {561) 753-3328 michele.medore@boneandjoint.c 440 State Road 7, Suite 103 Royal Palm Beach 33411 (561) 798-6600 Jarotem, Kenneth, M.D. 7815 N.W. Beacon Square Boulevard, Suite 1C Boca Raton 33487 (954) 473-6344 15127 Jog Road, Suite 209 Delray Beach 33446 (954) 473-6344 Mates, Ricardo, M.D. 9970 Central Park Boulevard. Suite 400 Boca Raton 33428 (561) 483-1600 Myers, Behnam. D.O. 2499 Glades Road, Suite 113 Boca Raton 33431 (954) 983-3888 Noble, Andrew, M.D. 3401 PGA Boulevard, Suite 500 Palm Beach Gardens 33410 {561) 696-7776 (561) 696-7276 Simpson, David. M.D. 8188 S. Jog Road, Suite 102 Boynton Beach 33472 (561) 798-6600 440 N. State Rd 7, Suite C Royal Palm Beach 33414 {561) 798-6600 (561) 663-4273 michel.medore@boneandjeint.or. Van Houten. John, M.D. 2828 S. Seacrest Boulevard Boynton Beach 33435 (561) 734-5080 (561) 369-1332 1401 N.W. 9th Avenue Boca Raton _ 33486 {561j 395-5733 Zann, Robert. M.D. 2828 S. Seacrust Boulevard Boynton Beach 33435 (561) 734-5080 (561) 369-1332 1401 N.W. 9th Avenue Boca Raton 33486 (561) 395-5733 Orthopedic Surgery Abram, Leon, M.D. 7815 N.W. Beacon Square Boulevard Boca Raton 33487 (561) 962-9600 (561) 962-9601 Acevedo, Jorge, M.D. 440 State Road 7, Suite B Royal Palm Beach 33411 (561) 798-6600 (561) 633-4273 Ackerman, Gary. M.D. 4440 Beacon Circle, Suite 100 West Palm Beach 33407 (561) 845-6000 (561) 881-9019 barbara@pbspm.cam 641 University Boulevard, Suite 214 Jupiter 33458 (561) 845-6000 Adams, Christopher, M.D. 600 University Boulevard, Suite 105 Jupiter 33458 (561) 622-6111 (561) 622-1176 5405 Okechobee Boulevard, Suite 304 West Palm Beach 33417 (561) 255-3131 1 Arlosoroff, Chaim, M.D. 733 U.S. Highway 1 North Palm Beach 33408 (561) 840-1090 1(561) 840-0791 Baker, John, M.D. 1397 Medical Park Boulevard, Suite 400 Wellington 33414 (561) 296-1188 3618 Lantana Road, Suite 100 lakeworth 33462 (561) 296-1188 1(561) 969-6920 6080 Boynton Beach Boulevard, Suite 100 Boynton Beach { 33437 (561) 296-1188 2047 Palm Beach Lakes Boulevard, Suite 100 West Palm Beach 33408 (561) 296-1188 10151 Enterprise Center Boulevard, Suite 204 Boynton Beach 33437 (561) 296-1188 Baynham, Gerald, M.D. 3401 PGA Boulevard, Suite 500 Palm Beach Gardens 33410 (561) 694-7776 _ (561) 694-3099 lolsen@pboi.com 2055 Military Trail, Suite 200 Jupiter 33458 (561) 694-7776 1411 N. Flagler Drive, Suite 9800 West Palm Beach 33401 (561) 694-7776 Beckenbaugh, Jeffrey, D.O. 600 University Drive, Suite 105 Jupiter 33458 (561) 622-6111 1(561) 622-1176 4700 N. Congress Avenue, Suite 103 West Palm Beach 33407 (561) 255-3131 Berkowitz, Ezra, M.D. 6056 Boynton Beach Boulevard, Suite 215 Boynton Beach 33467 (561) 967-6500 180 JFK Drive Atlantic 33462 (561) 967-6500 {561) 433-4175 Buchalter, David, M.D. 4800 Linton Boulevard, Building A, Suite A 201 Delray Beach 33445 (561) 496-6622 (561) 496-6577 4bonedoc@bellsouth.net 48 Palm Beach County Providers SPECIALTY PROVIDER ADDRESS CITY Zip Phone Fax eMail Address Burdett. Arthur. M.D. 1411 N. Flagler Drive. Suite 9800 West Palm Beach 33401 (561) 694-7775 (561) 694-3099 lolsenpboi.com 3401 PGA Boulevard, Suite 500 Palm Beach Gardens 33410 (561) 694-7776 Chalet. Joseph. M.D. 7593 Boynton Beach Boulevard. Suite 280 Boynton Beach 33437 (561) 733-5888 (561) 733-5851 Chang, Steven, M_D. 5511 S. Congress Avenue, Suite 101 Atlantis 33462 (561) 965-0436 (561) 965-0452 1411 N. Flagler Drive, Suite 3900 West Palm Beach 33401 (561) 965-0436 6080 Boynton Beach Boulevard, Suite 100 Boynton Beach 33437 (561) 965-0436 Chayet, Brad, M.D. 15127 Jog Road, Suite 209 Delray Beach 33446 (954) 473-6344 Chin, Kingsley, M.D. 6801 Lake Worth Road, Suite 201 Greenacres 33467 (561) 822-2960 Cohen, Joel. M.D. 641 University Boulevard, Suite 214 Jupiter 33458 (561) 845-6000 4440 Beacon Circle. Suite 100 West Palm Beach 33407 1561) 845-6000 ](561) 881-9019 barbara@pbspm.com Cooney, Michael M.D. 1411 N. Flagler Drive, Suite 9800 West Palm Beach 33401 (561) 694-7776 3401 PGA Boulevard. Suite 500 Palm Beach Gardens 33410 (561) 694-7776 (561) 694-3099 lolsen@pboi.com 1004 S. Old Dixie Highway, Suite 350 Jupiter 33458 (561) 694-7776 6092 S.E. US Highway 1 Stuart 34994 (561) 781-0120 D Ariano, Gerard, M.D. 6056 Boynton Beach Boulevard, Suite 215 Boynton Beach 33437 (561) 967-6500 180 JFK Drive Atlantis 33462 (561) 967-6500 (561) 433-4175 Delucia, Frank, M-D, 1002 S. Old Dixie Highway, Suite 206 Jupiter 33458 (561) 747-6300 (561) 747-6301 Digiulo, Milan, MAD _ 6056 Boynton Beach Boulevard, Suite 215 Boynton Beach 33437 (561) 798-6600 12989 Southern Boulevard. Bldg. 3, Suite 101 Loxahatchee 33470 (561) 798-6600 (561) 633-4273 Eidelson, Stewart. M.D 1401 NW 9th Avenue Boca Raton 33486 (561) 395-5733 2828 S. Seacrest Boulevard Boynton Beach 33435 (561) 734-5080 (561) 369-1332 Fowble, Vincent, M.D. 3401 PGA Boulevard, Suite 500 Palm Beach Gardens 33410 (561) 694-7776 (561) 694-3099 lolsen@pboi,com Fowble, Vincent, M.D. 2055 N. Military Trail, Suite 203 Jupiter 33458 (561) 694-7775 Francisco, Rommel, D.O. 130 JFK Drive, Suite 201 Atlantis 33462 (561) 967-4400 (561) 433-3082 estee,a@atlantisortho.com 5600 PGA Boulevard, Suite 200 Palm Beath Gardens 33418 (561) 627.8500 Gelb, Howard, M.D. 9980 N. Central Park Boulevard, Suite 222 Boca Raton 33428 (561) 558-8898 (954) 755-0916 dianac©drgelb.fdn_com Germain, Arthur, M.D. 9325 Glades Road. Suite 205 Boca Raton 33434 (561) 826-2000 (561) 826-2600 germainarthurlmd@bellsouth.net 1601 Clint Moore Road, Suite 125 Boca Raton 33487 (561) 939-0800 Golden. Marc, D.Q. 9970 Central Park Bouelvard Baca Raton 33428 (561) 488-2200 (561) 488-1064 ;oldenorthol@aoicom 13590 Jog Road Delray Beach 33446 (561) 637-4200 Grandic, Elvis, M.D. 180 JFK Drive Atlantis 33462 (561) 967-6500 1(561) 433-4175 6056 Boynton Beach Boulevard, Suite 215 Boynton Beach 33437 (561) 967-6500 Green, Robert, M.D. 1411 North Flagler Drive, Suite 9800 West Palm Beach 33401 (561) 694-7776 1(561) 694-3099 lolsen@pboi.com Gupta, Manish, M.D. 9325 Glades Road, Suite 205 Boca Raton 33434 {954) 481-9942 Hart. Gavin. M.D. 10131 Forest Hill Boulevard, Suite 206 Wellington 33414 (561) 798-6600 1(561) 753-3328 Jacobs, Stephen, MID _ 10527 Jog Road. Suite 209 Delray Beach 33446 (561) 473-6344 Kessler. Kevin. M.D. 2900 N. Military Trail. Suite 230 Boca Raton 33431 (561) 988-0442 1(954) 958-9227 kesslersurgery@aol.com 49 Palm Beach County Providers SPECIALTY PROVIDER ADDRESS CITY Zip Phone Fax eMail_Address Kirvin, III, James, M.D. 4440 Beacon Circle, Suite 100 West Paim Beach 33407 {561) 845-6000 (561) 881-9019 barbara@pbspm corn 641 University Boulevard. Suite 214 Jupiter 33458 {561) 845-8000 K(einhenz, Dominic, M.D. 9970 N. Central Park Boulevard, Suite 400 Boca Raton 33428 (551) 483-1600 Kohn. Marvin, M.D. 12983 Southern Boulevard. Suite 101 Loxahaichee 33470 (561) 790-4040 180 JFK Drive Atlantis 33462 (561) 967-6500 1(561) 433-4175 16244 5. Military Trail. Suite 710 Delray Beach 33484 (561) 967-6500 6056 Boynton Beach Boulevard. Suite 215 Boynton Beach 33437 (561) 967-6500 Krantzow. Michael,D.O. 9970 Central Park Boulevard, Suite 300 Boca Raton 33428 (561) 488-2200 1(561) 488-1064 13590 Jog Road. Suite 7 Delray peach 33446 (561) 637-4200 Krebsbach, Michael. M.D. 660 Glades Road, Suite 460 Boca Raton 33431 (561) 391-5515 1(561) 347-7470 Kugler, Jeffrey, M.D. 10151 Enterprise Center Boulevard, Suite 204 Boynton Beach 33437 (561) 296-1188 3618 Lantana Road. Suite 100 Lake Worth 33462 (561) 296-1188 1(561) 969-6920 12957 Palms West Drive, Bldg 9, Suite 201 Boynton Beach 33470 (561) 296-1188 2047 Palm Beach Lakes Boulevard, Suite 100 West palm 33401 (561) 697-2444 6080 Boynton Beach Boulevard. Suite 100 Boynton Beach 33437 (561) 296-1188 1397 Medical Park Boulevard, Suite 400 Wellington 33414 (561) 296-1188 Lambe, H. Donald. M.O. 3540 Forest HIII Boulevard, Suite 102 West Palm Beach 33406 (561) 964-1200 (561) 964-1803 Leighton, Michael, M.D. 3401 PGA BLVD. Suite 500 Palm Beach Gardens 33410 (561) 694-7776 (561) 694-3099 lolsen@pboi.com Lenard, Alexander, M.D. 733 US Highway One North Paim Beach 33408 (561) 840-1090 {561) 840-0791 Levin, Larry, M.D. 1601 Clint Moore Road. Suite 125 Boca Raton 33486 (561) 939-0800 (561) 939-0820 Lins. Robert, M.D. __ 440 State Road 7, Suite B Royal Palm Beach 33411 (561) 798-6600 (561) 663-4273 8188 Jog Road, Suite 102 Boynton Beach 33472 (561) 798-6600 f Martin, Gregory, M.D. 7593 Boynton Beach Boulevard, Suite 280 Boynton Beach 33437 (561) 733-5888 (561) 733-5851 Matarazzo, Marc, M.D. 180 JFK Drive Atlantis 33462 (561) 967-6500 (561) 433-4175 marcmatarazzomd@bellsouth.ne 12983 Southern Boulevard. Suite 101 Lake Worth 33461 (561) 967-6500 6056 Boynton Beach Boulevard, Suite 215 Boynton Beach 33437 (561) 967-6500 Matuszak, Charles, M.D. 10151 Enterprise Center Boulevard, Suite 204 Boynton Beach 33439 {561) 296-1188 1397 Medical Park Boulevard, Suite 400 Wellington 33414 (561) 296-1188 3618 Lantana Road, Suite 100 Lake Worth 33462 (561) 296-1188 1(561) 969-6920 2047 Palm Beach Lakes Boulevard, Suite 100 West Palm Beach 33401 (561) 697-2444 6080 Boynton Beach Boulevard. Suite 100 Boynton Beach 33437 (561) 296-1188 McKay, William, M.D. 9970 N. Central Park Boulevard, Suite 400 Boca Raton 33428 (561) 483-1600 Meadows, Steve, M.D. 4800 Linton Boulevard, Suite A-201 Delray Beach 33445 (561) 496-6622 (561) 496-6577 4bonedoc@beltsouth.net _ Mikotajczak. Michael. D.O. 180 JFK Drive Atlantis 33462 (561) 967-6500 (561) 472-0467 Montija, Harvery M_D. 875 Military Trail Jupiter 33458 (561) 798-6600 50 Palm Beach County Providers SPECIALTY PROVIDER ADDRESS CITY Zip Phone Fax eMail_Address 440 State Road 7, Suite 103 _ Royal Palm Beach 33411 (561) 798-6600 (561) 753-3328 Montijo. Harvey. M.Q. 875 Military Trail. Suite 105 Jupiter 33458 (561) 798-6600 440 State Road 7. Suite 103 Royal Palm Beach 33411 (561) 798-6600 (561) 204-2042 Naidoo, Rajendran, M.D. 12989 Southern Boulevard, MOD 3, Suite 202 Loxahatchee 33470 (561) 793-6633 (561) 793-6658 2390 S. Seacrest Boulevard. Suite 300 Boynton Beach 33435 (561) 793-6633 _ Norris, Scott, D.O. 1411 N. Flagler Drive, Suite 9800 West Palm Beach 33401 (561) 694-7776 10111 Forest Hill Boulevard, Suite 231 Wellington 33414 (561) 694-7776 3401 PGA Boulevard, Suite 500 Palm Beach Gardens 33410 (561) 694-7776 2055 Military Trail, Suite 200 Jupiter 33456 (561) 694-7776 (561) 727-1221 _ michellel@pboi.com Null, William, M.D. 2828 S. Seacrest Boulevard Boynton Beach 33435 (561) 734-5080 (561) 369-1332 1401 N.W. 9th Avenue Boca Raton 33486 (561) 395-5733 _ Ortega -Garcia, Jose, M.D. 8188 Jog Road, Suite 102 Boynton Beach 33472 (561) 798-6600 440 State Road 7, Suite E Royal Palm Beach 33411 (561) 798-6600 1(561) 803-8696 Padden. David. M.Q. 9970 Central Park Boulevard South, Suite 400 Boca Raton 33428 (561) 483-1600 Pedro -Alexander, Veronica, M D. 440 State Road 7. Suite C Royal Palm Beach 33411 (561) 798-6600 (561) 633-4273 Penner, Jeffrey, M.D. 130 JFK Drive. Suite 201 Atlantis 33462 (561) 967-4400 (561) 433-3082 estee.a@atlantisortho.cam 5600 PGA Boulevard, Suite 200 Palm Beach Gardens 33418 (561) 627-8500 Pine, Wilbert, M.D. 5700 Lake Worth Road, Suite 103 Lake Worth 33463 (561) 296-2345 1(561) 649-7564 Piza. Pedro. M.D. 9960 Central Park Boulevard N. Suite 150A Boca Raton 33428 (561) 498-4010 5162 Linton Boulevard, Suite 106 Delray Beach 33484 (561) 498-4010 (561) 499-7582 goldenorthol@aol.com Press, Jeffrey, M.D. 7593 Boynton Beach Boulevard, Suite 280 Boynton Beach 33437 (561) 733-5888 (561) 733-5851 Prince. Daniel. M.D. 901 45th Street West Palm Beach 33407 (561) 844-5255 (561) 844-5245 Purita. Joseph. M.D. 660 Glades Road. Suite 460 Boca Raton 33431 (561) 391-5515 (561) 347-7470 6060 Boynton Beach Boulevard, Suite 100 Boynton Beach 33437 (561) 391-5515 Robbins, Craig, M.D. 901 45th Street. Kimmel Building West Palm Beach 33407 (561) 844-5255 (561) 844-5245 Rochman. Robert. M.D. 460 N. State Rd 7. Suite 303 Royal Palm Beach 33414 (561) 798-6600 (561) 753-3328 Rosenfield, Jeffrey, M.D. 180 JFK Drive Atlantis 33462 (561) 967-6500 (561) 433-4175 Routman, Howard. D.O 5600 PGA Boulevard, Suite 200 Palm Beach Gardens 33418 (561) 627-8500 130 JFK Drive. Suite 201 Atlantis 33462 (561) 967-4400 (561) 433-3082 Saker, Anthony, M.D. 1601 Clint Moore Road, Suite 125 Boca Raton 33487 (561) 939-0800 (561) 939-0820 6080 Boynton Beach Boulevard, Suite 100 Boynton Beach 33437 (561) 939-0800 Sama, Nicholas, M.D. 10111 Forest Hill Boulevard. Suite 151 Wellington 33414 (561) 798-6660 1(561) 753-3328 Sandall. Edward, M.D. 2055 Military Trail, Suite 200 Jupiter 33458 (561) 743-4731 3401 PGA Boulevard. Suite 500 Palm Beach Gardens 33410 (561) 694-7776 (561) 694-3099 lolsen@pboi.com 1411 N. Flagler Drive. Suite 9800 West Palm Beach 33401 (561) 694-7776 Schechter, Neil, M.D. 7815 N.W. Beacon Square Boulevard. Suite 1 C Boca Raton 33487 (954) 473-6344 Sehayik, Roni. M.D. 1983 PGA Boulevard. Suite 105 West Palm Beach 33408 (561) 627-3327 1(561) 627-3388 Rsebayik@hotmail.com 51 Palm Beach County Providers SPECIALTY PROVIDER ADDRESS CITY Zip Phone Fax eMail Address Sehayik, Sami, M.D. 1983 PGA Boulevard. Suite 105 Palm Beach Gardens 33408 (561) 627-3327 (561) 627.3388 Ssehayik@hotmail.com Shapiro, Eric, M.D. 2828 S. Seacrust Boulevard Boynton Beach 33435 (561) 734-5080 (561) 369-1332 1401 N.W. 9th Avenue Boca Raton 33486 (561) 734-5080 Simon, Richard, M.D. 15127 Jog Road, Suite 209 _ Delray Beach 33446 (954) 473-6344 Simovitch, Ryan, M.D. 3401 PGA Boulevard, Suite 500 Palm Beach Gardens 33410 (561) 694-7776 (561) 694-3099 lolsen@pboi.com 2055 Military Trail, Suite 200 Jupiter 33458 (561) 694-7776 Starner, James, M.D. 875 Military Trail, Suite 105 _ _ Jupiter 33458 (561) 798-6600 440 N. State Road 7, Suite 103 Royal Palm Beach 33411 (561) 798-6600 (561) 753-3328 Stewart. Charles, M.D. 660 Glades Road, Suite 460 Boca Raton 33431 (561) 391-5515 (561) 347-7470 Stiebel, Matthew, M.D. 4440 Beacon Circle, Suite 100 West Patm Beach 33407 (561) 845-6000 (561) 845-6916 barbara@pbspm.com 641 University Boulevard, Suite B-214 Jupiter 33458 (561) 845-6000 Thebaut, Jr., Ben, M.D. 2580 Metrocentre Boulevard, Suite 1 West Palm Beach 33407 (561) 684-2022 (561) 776-6111 lolsen@pbol.com 1002 South Old Dixie Highway, Suite 105 Jupiter 33458 (561) 743-4263 Taman, Charles. M.D. 7301 A West Palmetto Park Road. Suite 100E Boca Raton 33433 (561) 221-6895 (561) 221-6896 Van-Sice, Wade, M.D. 2055 Military Trail. Suite 204 Jupiter 33458 (561) 744-9733 (561) 746-8418 Waeltz. Mark, M.D. 10131 W. Forest Hill Boulevard. Suite 206 West Palm Beach 33414 (561) 798-6600 (561) 204-2042 Waxman, Bruce, M.D. 1411 N. Flagler Drive. Suite 9800 West Palm Beach 33401 (561) 694-7776 2055 Military Trail, Suite 200 Jupiter 33458 (561) 694-7776 1004 S. Old Dixie Highway. Suite 350 Jupiter 33458 (561) 694-7776 6092 South East U.S. Highway One Stuart 34994 (561) 781-0120 3401 PGA Boulevard. Suite 500 Palm Beach Gardens 33410 (561) 694-7776 (561) 694-3099 lolsen@pboi.com Weisz. Russell, M.D. 4800 Linton Boulevard. Suite A 201 Delray Beach 33445 (561) 496-6622 (561) 496-6577 4bonedoc@bellsouth.net Wexler, Gary. M.D. 4215 Burns Road. Suite 100 Palm Beach Gardens 33410 (561) 694-7776 (561) 694-3099 lolsen@pboi.com _ 1411 North Flagler Drive, Suite 9800 West Palm Beach 33410 (561) 694-7776 White, Laura. M.D. 6056 Boynton Beach Boulevard, Suite 215 Boynton Beach 33437 (561) 798-6600 10131 W. Forest Hill Boulevard. Suite 206 Wellington 33414 (561) 798-6600 Iaurawhite07@gmail.com Yee. Garvin. M.D. 1100 S. Main Street, Suite 101 Belle Glade 33430 (561) 798-6600 460 State Road 7. Suite 300 Royal Palm Beach 33411 (561) 798-6600 1(561) 633-4273 Young. Bruce, M.D. 9970 N. Central Park Boulevard, Suite 400 Boca Raton 33428 (561) 483-1600 Zeide. Michael M_D. 7593 Boynton Beach Boulevard, Suite 280 Boynton Beach _ _ 33437 (561) 733-5888 (561) 733-5851 Otolaryngology (ENT) Webster. Ellis. M.D. 12959 Palms West Drive. Suite 220 Loxahatchee 33470 (561) 793-5077 (561) 784-8243 elwdoc@aol.com 2150 S. Congress Avenue West Palm Beach 33406 (561) 966-6545 Pain Management Berger, Scott. M.D. 9970 Central Park Boulevard, Suite 401 Boca Raton 33428 (561) 883-3600 (561) 883-3601 52 Palm Beach County Providers SPECIALTY PROVIDER ADDRESS CITY Zip Phone Fax eMail_Address Bistline, Jane, M.D. 2047 Palm Beach Lakes Boulevard, Suite 300 West Palm Beach 33409 (561) 681-9808 (561) 689-9499 PalmBeachPainMan@aol.com Chaitoff. Kevin. M,D. _ 200 North Point Parkway West Palm Beach 33407 (561) 833-8893 7408 Lake Worth Road, Suite 600 Lake Worth 33467 (561) 833-8893 1500 N. Dixie Highway, Suite 103 West Palm Beach 33401 (561) 833-8893 (561) 833-8939 bumpheep@bellsouth.net Cooney, John. M.D. 1500 N. Dixie Highway, Suite 103 West Palm Beach 33401 (561) 833.8893 (561) 833-8939 bumpheep@bellsouth_net 200 North Point Parkway West Palm Beach 33407 (561) 833-8893 7408 Lake Worth Road, Suite 600 Lake Worth 33467 (561) 833-8893 Deziel, Lawrence, M.D. 1210 S, Old Dixie Highway Jupiter 33458 (561) 543.5073 Detrick, Keith. M.D. 440 N. State Road 7, Suite 107 Royal Palm Beach 33411 (561) 795-8655 1(561) 795-8449 140 JFK Drive Atlantis 33462 (561) 795.8655 Drourr, Nathan, M.D. 1210 S. Old Dixie Highway. 2nd Floor Jupiter 33458 (561) 833-0882 (561) 649-3029 Friedman, Robert, M.D. 1015 West Indiantown Road. Suite 202 Jupiter 33458 (561) 748-0528 (561) 748-4718 7625 Lake Worth Road Lake Worth 33467 (561) 641-7100 l Galante. Edgardo, M.D. 801 Meadows Road. Suite 110 Boca Raton 33486 (561) 347-6262 (561) 347-6264 Gatz Bart, M.D. 2828 S. Seacrest Boulevard, Suite 210 Boynton Beach 33435 (561) 369-7644 (561) 369-3471 6110 W. Atlantic Boulevard, Unit A Delray Beach 33484 (561) 369-7644 Ghignone, Marco. M.D. 2051 45th Street, Suite 108 West Palm Beach 33407 (561) 845-7432 (561) 845-9750 comprehensivepain@hotmait.cc Goldfarb, Howell, M.D. 440 N. State Road 7, Suite 107 _ Royal Palm Beach 33411 (561) 795-8655 (561) 795-8449 140 JFK Drive Atlantis 33462 (561) 795-8655 Gorfine, Lawrence, M.D. 2290 10th Avenue. Suite 600 Lake Worth 33461 (561) 649-8770 1(561) 649-0570 help@helpain.com Gruskin. Alan, D.Q. 900 N.W. 13th Street, Suite 104 Boca Raton 33486 (561) 394-3587 Hindin, Bruce, D.Q. 440 N. State Road 7. Suite 107 Royal Palm Beach 33411 (561) 795-6655 1(561) 795-8449 140 JFK Drive Atlantis 33462 (561) 795-8655 Krost. Stuart, M.D. 3618 Lantana Road. Suite 201-202 Lake Worth 33462 (561) 296-2220 1(561) 296-2221 viviantreatpain@aim.com 875 Military Trail, Suite 105 Jupiter 33458 (561) 296-2221 Le. Man. M,D. 650 Glades Road Boca Raton 33431 (561) 955-7246 (561) 955-5329 Mactear, Douglas, D.O. 2290 1 oth Avenue N., Suite 600 Lake Worth 33461 (561) 649-8770 (561) 649-0570 Mann, Bruce. M.D. 2900 North Military Trail, Suite 230 Boca Raton 33431 (954 726-5064 Moser, Mark, M.D. 760 US Highway One, Suite 203 North Palm Beach 33408 (561) 627-6025 2051 45th Street, Suite 108 West Palm Beach 33407 (561) 845-7432 1(561) 845-9750 _ Porrata, Alejandro. M.D. 140 JFK Drive Atlantis 33462 (561) 795-8655 1 440 North State Road 7. Suite 107 Royal Palm Beach 33411 (561) 795-8655 (561) 795-8449 Porrata, Humberto, M.D. 140 JFK Drive Atlantis 33462 (561) 795-8655 440 N. State Road 7. Suite 107 Royal Palm Beach 33411 (561) 795-8655 (561) 795-8449 Raso. Louis, M.D. 2141 S. Alternate AlA, Suite 110 Jupiter 33477 (561) 741-1588 (561) 741-1123 kah1963@comcastnel Regenbaum, Sheldon, M.D. 1500 N. Dixie Highway, Suite 103 West Palm Beach 33401 (561) 833-8893 (561) 838-4397 bumpheep@bellsouth.net 7408 Lake Worth Road, Suite 600 Lake Worth 33467 (561) 833-8893 200 North Point Parkway West Palm Beach 33407 (561) 633-8693 Richman, Gary, M.D. 180 JFK Drive Atlantis 33462 (561) 433-7145 (561) 433-4175 5056 Boynton Beach Boulevard. Suite 215 Boynton Beach 33437 (561) 967-6500 Riso, Anthony. M.D. 7815 N,W, Beacon Square Boulevard Boca Raton 33487 (561) 962-9600 (561) 962-9601 Rosenblatt, Aaron, M.D. 13660 S. Jog Road, Suite 13-2 Delray Beach 33446 (561) 819-6050 (561) 819-6051 arosenblatt@bellsouth.net Schroeder, Jonathan. M.D. 1210 S. Old Dixie Highway Jupiter 33458 (561) 543-5073 Stropp. Richard, M.D. 760 U.S. Highway One, Suite 203 North Palm Beach 33408 (561) 627-3993 (561) 627-3115 maureenl@ipainpb.com Tapia. Alejandro, M.D. 600 Universtiy Boulevard. Suite 105 Jupiter 33458 (561) 622-6111 (561) 622-1176 53 Palm Beach County Providers SPECIALTY PROVIDER ADDRESS CITY Zip Phone Fax eMail_Address 4700 N. Congress Avenue, Suite 103 West Palm Beach 33407 (561) 255-3131 Untracht, Michael M D. 1411 N. Flagler Drive, Suite 4000 West Palm Beach 33401 (561) 833-0882 1(561) 833-0813 1001 SE Monitery Commons Boulevard. Suite Stuart 34996 (561) 833-0882 1111 S. Federal Highway, Suite 228 Stuart 34994 (772) 221.7966 Warheit, Peter. M.D. 21644 State Road 7 Boca Raton 33428 (561) 488-8000 7815 N.W. Beacon Square Boulevard Boca Raton 33487 (561) 962-9600 1(561) 962-9601 Weidenbaum, Wayne, M.D. 1111 S. Federal Highway, Suite 228 Stuart 34994 (772) 221-7966 1001 SE Monitery Commons Boulevard, Suite Stuart 34996 (561) 833-0882 1411 N. Flagler Drive, Suite 4000 West Palm Beach 33401 (561) 833-0882 Pediatric Orthopaedics l Baynham. Bret, M.D. 2055 Military Trail, Suite 200 Jupiter 33458 (561) 694-7776 3401 PGA Boulevard. Suite 500 Palm Beach Gardens 33410 (561) 694-7776 (561) 694-3099 lolsen@pboi.com 1411 N. Flagler Drive, Suite 9800 West Palm Beach 33401 (561) 694-7776 Jeffers, Kenneth, M.D. 9960 Central Park Blvd. N, Suite 150-A Boca Raton 33428 (561) 394-8443 (561) 394-8453 _ Physical Medicine Rehabilitation/Physiatrist Estes, Melisa, M.D. 1411 N. Flagler Drive, Suite 9800 West Palm Beach 33401 (561) 694-7776 2055 Military Trail, Suite 200 Jupiter 33458 (561) 694-7776 3401 PGA Boulevard. Suite 500 Palm Beach Gardens 33410 (561) 694-7776 (561) 694-3099 lolsen@pboi.com Farber Jeffrey, M.D. 1325 S. Congress Avenue, Suite 208 Boynton Beach 33426 (561) 659-5443 (561) 659-4614 4383 Northlake Boulevard, Suite 309 Palm Beach Gardens 33410 (561) 775-0003 Graubert. Charles. M.D. 6056 Boynton Beach Boulevard, Suite 215 Boynton Beach 33437 (561) 967-6500 12983 Southern Boulevard, Suite 101 Loxahatchee 33470 (561) 790-4040 _ ' 180 JFK Drive Atlantis 33462 (561) 967-6500 1(561) 433-4175 16244 S. Military Trail, Suite 710 Delray Beach 33484 (561) 967-6500 _ Gruskin. Alan, D.O. 900 N.W. 13th Street, Suite 104 Boca Raton 33486 (561) 394-3587 _ _ Krost. Stuart. M_D_ 875 Military Trail, Suite 105 Jupiter 33458 (561) 296-2221 3618 Lantana Road, Suite 201-202 Lake Worth 33462 (561) 296-2220 (561) 296-2221 viviantreatpain@aim.com Oster, Claude, D.O. 901 Village Boulevard. Suite 702 West Palm Beach 33409 (561) 882-6214 (561) 882-6216 Picard. Daniel. M.D. 14610 S. Military Trail. Suite G2 Delray Beach 33484 (561) 381.3425 (561) 498-9744 doctorpicard@yahoo.com 1356 N.W. 2nd Avenue Boca Raton 33486 Rubenstein, Mark, M.D. 4495 Military Trail, Suite 209 Jupiter 33458 (561) 296-9991 (561) 296-9992 Shores, Aaron, M.D. 600 University Boulevard, Suite 105 Jupiter 33458 (561) 622-6111 (561) 622-1176 5405 Okeechobee Boulevard, Suite 304 West Palm Beach 33417 (561) 255-3131 Slobasky, Michael, M.D. 655 N. Military Trail West Palm Beach 33415 (800) 735-1178 (772) 223-6354 Snyder, Ronald, M.D. 4440 Beacon Circle, Suite 100 West Palm Beach 33407 (561) 845-6000 (561) 881-9019 ronesnyder@aol.com Tarrash, Jonathan, M.D. 4800 Linton Boulevard, SuiteA-201 Delray Beach 33445 (561) 496-6622 (561) 496-6577 4bonedoc@belisouth.nel Plastic Surgery Goodwin Matthew M.D. 1411 N. Flagler Drive. Suite 3000 West Palm Beach 33401 (561) 655-6622 (561) 655-6623 4800 N. Federal Highway. Suite C-1OC Boca Raton 33431 (561) 655-6622 T 54 Palm Beach County Providers SPECIALTY PROVIDER ADDRESS CITY Zip Phone Fax eMail_Address Meisel. Scott, D.O. 130 JFK Drive. Suite 134 Atlantis 33462 (561) 964-2211 1 1397 Medical Park Boulevard, Suite 180 & 1001Wellington 33414 (561) 798-1515 (561) 798-9249 Pediatric Surgery I Clancy, James, D.P.M. 180 JFK Drive Atlantis 33462 (561) 967-6500 (561)433-4175 12983 Southern Boulevard, Suite 101 Loxahatchee 33470 (561) 790-4040 6056 Boynton Beach Boulevard, Suite 215 Boynton Beach 33437 (561) 967-6500 5150 Linton Boulevard, Suite 340 Delray Beach 33484 (561) 495-6700 16244 S. Military Trail, Suite 710 Delray Beach 33484 (561) 967-6500 Hansen, Arthur, D_P.M_ 2326 S. Congress Avenue, Suite 1A West Palm Beach 33406 (561) 433-5577 1(561) 423-9211 3347 State Road 7. Suite 204 Wellington 33449 (561) 433-5577 Kinmon, Kyle, D.P.M. 1401 N.W. 9thAvenue Boca Raton 33486 (561) 395-5733 2828 S. Seacrest Boulevard, Suite 103 Boynton Beach 33435 (561) 734-5080 (561) 369-1332 kkinmon@aol.com Klein. Marc. D.P.M. 7050 W. Palmetto Park Road. Suite 18 Boca Raton 33433 (561) 447-7571 (561) 447-7574 drklein@fdn.com Palmer. Kevin. D.P.M. 9970 Central Park Boulevard. Suite 300 Boca Raton 33428 (561) 488-2200 (561) 488-1064 13590 Jog Road, Suite 7 Delray Beach 33446 (561) 637-4200 Podiatry Bakst, Richard, D.P.M. 1280 W. Lantana Road. Suite 5 Lantana 33462 (561) 586-8444 12300 ATL A1A, Suite 118 Palm Beach Gardens 33410 (561) 626-3338 (561) 776-3100 slmess25@bellsouth.net Berkin. Glenn, D.P.M. 1873 W. Woolbright Road Boynton Beach 33425 (561) 742-7768 Bess, Michael. D_P_M. 2885 N. Military Trail, Suite J West Palm Beach 33409 (561) 689-0303 (561) 884-8884 mbess@yahoo.com Chodo, Christopher. D.P.M. 625 S.E. 2nd Avenue. Suite C Boynton Beach 33435 (561) 737-1106 (561) 737-1117 Cutler. Jonathan, D.P.M. 11412 Okeechobee Boulevard Royal Palm Beach 33411 (561) 793-6170 (561) 795-3683 ambergalletta@wcfoot.com 6699 West Boynton Beach Boulevard, Suite B Boynton Beach 33437 (561) 793-6170 3618 Lantana Road Lake Worth 33462 (561) 967-4999 1200 S. Main Street, Suite 200 Belle Glade 33430 (561) 993-9968 4889 S. Congress Avenue, Suite 201 Lake Worth 33467 (561) 967-4999 9089 N. Military Trail. Suite 37 Palm Beach Gardens 33410 (561) 691-4682 Egennan, Richard. D.P.M. 2900 Military Trail, Su4e 230 Boca Raton 33431 (561) 495-9700 13489 Military Trail Delray Beach 33484 (561) 495-9700 (561) 496-5588 Frisch, Dennis. D.P.M. 30 S.E. 7th Street Boca Raton 33432 (561) 395-4243 (561) 392-8353 Gaynor, Robert, D.P.M. 6250 Lantana Road. Suite 22 Lake Worth 33463 (561) 641-7666 (561) 642-1590 Gold. Jason. D.P.M. 670 Glades Road Suite 320 Boca Raton 33431 (561) 750-3033 (561) 750-3443 dnasongoldz comcast-net 10151 Enterprise Center Blvd.. Suite 203 Boynton Beach 33437 (561) 750-3033 Harris, Gregg, O.P.M. 9980 Central Park Boulevard North, Suite 106 Boca Raton 33428 (561) 488-3338 (561) 488-1540 doctors@aol.com Hams, Martin, D.P.M. 4678 Okeechobee Boulevard West Palm Beach 33417 (561) 689-1414 (561) 689-1993 Hartstein, Alan, D.P.M. 701 Park Avenue Lake Park 33403 (561) 848-7722 (561) 848-7812 6609 Woolbright Road, Suite 418 Boynton Beach 33437 (561) 244-4980 Hartstein, Alan, D.P.M. 2650 S. Military Trail, Suite 9 West Palm Beach 33415 (561) 964-1178 675 W Indiantown Road, Suite 102 Jupiter 33458 (561) 746-8326 55 Palm Beach County Providers SPECIALTY PROVIDER ADDRESS CITY Zip Phone Fax eMail_Address Hersch. Jonathan, M.D. 6853 SW 18th Street, Suite M-111 Boca Raton 33433 (561) 417-3339 (561) 417-3409 Jaffe Steven, D.P.M. 1325 S. Congress Avenue, Suite 108 Boynton Beach 33426 (561) 734-3960 (561) 737-4632 Lapoff, Kevin, D.P.M. 6422 Lake Worth Road Lake Worth 33463 (561) 968-2222 (561) 641-4566 Iapoffkevinhdpm@bellsouth.net Levin. John, D.P.M. 6056 Boynton Beach Boulevard. Suite 215 Boynton Beath 33436 (561) 967-6500 180 JFk Drive Atlantis 33462 (561) 967-6500 1(561) 433-4175 16244 S. Military Trail, Sutie 710 Delray Beach 33484 (561) 967-6500 12983 Southern Boulevard, Suite 101 Loxahatchee 33470 (561) 790-4040 MacGill, Alan, DPM 7730 Boynlon Beach Boulevard, Suite 7 Boynton Beach 33437 (561) 369-2199 Malin, Stephen, D-P_M_ 4678 Okeechobee Boulevard West Palm Beach 33417 (561) 689-1414 I(561) 689-1993 Mattison. Brad, DPM 4800 Linton Boulevard. Building A, Suite 201 Delray Beach 33445 (561) 496-6622 10301 Hagen Ranch Road, Suite B-3 Boynton Beach 33437 (561) 364-5522 3695 W. Boynton Beach Boulevard. Suite 4 Boynton Beach 33436 (561) 364-5522 (561) 496-6577 4bonedoc@bellsouth.net Moskovits, Jonathan, D.P.M. 701 Park Avenue Lake Park 33403 (561) 848-7722 6609 W. Woolbright Road, Suite 418 Boynton Beach 33437 (561) 244-4980 1(561) 244-4979 Ostapchuk, Andrew, D.P.M. 733 U.S. Highway One North Palm Beach 33408 (561) 882-9373 1004 S. Old Dixie Highway, Suite 301 Jupiter 33458 (561) 743-0410 1(561) 745-3008 ostapandy@aol.com 2000-B Continental Drive West Palm Beach 33407 (561) 863-6651 Pinsky, Todd, D.P.M. 11020 RCA Center Drive, Suite 2010 Palm Beach Gardens 33410 (561) 881-8800 9980 Central Park Boulevard, Suite 208 Boca Raton 33428 (561) 488-4848 (561) 483-5091 nissantt92@aol.com Rispler, Glenn, DPM 5928 Okechobee Boulevard West Palm Beach 33417 (561) 471-8004 (561) 471-9304 familyfool@bellsouth.nel Rockefeller, Jeffrey, D.P.M. 675 W. Indiantown Road, Suite 102 Jupiter 33458 (561) 744-2828 (561) 746-9842 docjrock@msn.com Sapenoff, Craig. M.D. 4678 Okeechobee Boulevard West Palm Beach 33417 (561) 689-1414 (561) 689-1993 wrnsap@aol.com Sater, Allen, D.P.M. 6671 Indiantown Road, Suite 55 Jupiter 33458 (561) 747-0331 (561) 747-7047 Schilerc. John, D.P.M. 3401 PGA Boulevard, Suite 500 Palm Beach 33410 (561) 694-7776 2055 Military Trail, Suite 200 Jupiter 33458 (561) 694-7776 (561) 694-3099 lolsen@pboi.com Solomon, Martha, D.P.M. 9970 Central Park Boulevard, Suite 300 Baca Raton 33428 (561) 488-2200 13590 Jog Road. Suite 7 Delray Beach 33446 (561) 637-4200 1(561) 637-3222 Stark. Henry, D.P.M. 675 West Indiantown Road. Suite 102 Jupiter 33458 (561) 746-8326 6609 Woolbright Road Suite 418 Boynton Beach 33437 (561) 244-4980 2650 South Military Trail. Suite 9 West Palm Beach 33415 (561) 964-1178 701 Park Avenue Lake Park 33403 (561) 848-7722 (561) 848-7812 hkstarkdpm@aol.com Strolla. Scott, D.P.M. 1411 N. Flagler Drive, Suite 4100 West Palm Beach 33401 (561) 659-3930 (561) 833-1009 2700 PGA Boulevard, Suite 106 Palm Beach Gardens 33410 (954) 659-3930 Weingarten. Jay, D.P.M. 1106 W. lndiantown Raod, Suite 4 Jupiter 33458 (561) 744-6683 5911 S.E. Federal Highway Stuart 34997 (772) 223-8313 (772) 223-8675 smelchoir59@yaboo.com Zager, Joshua, D.P.M. 2800 S. Seacrest Boulevard, Suite 100 Boynton Beach 33435 (561) 704-0797 (561) 641-1921 210 Jupiter Lakes Boulevard, Bldg 4000, Suite Jupiter 33458 (561) 704-0797 Psychiatry Flaherty, David, M.D. 8188 Jog Road, Suite 201 Boynton Beach 33472 (561) 752-9490 (561) 752-9491 56 Palm Beach County Providers SPECIALTY PROVIDER ADDRESS CITY Zip Phone Fax eMail Address Silversmith, Norman. M.D. 4440 PGA Boulevard, Suite 306 Palm Beach Gardens 33410 (561) 622.1800 (561) 622-6221 csilversmith@comcast.net Sobhan, Tanveer, M.D. 10301 Hagen Ranch Road. Suite B-6 Boynton Beach 33437 (561) 762-9490 Psychology Killian, Grant, Ph.D. 950 Peninsula Corporate Cidcle, Suite 1004 Boca Raton 33487 (954) 360-4200 Warner, Michael, Psy.D. 3700 Airport Road, Suite 309 Baca Raton 33431 (561) 347-1939 Radiation Oncology Cuscela, Daniel. Q.O. 1240 S. Old Dixie Highway Jupiter 33458 (561) 744-4400 (561) 744-4408 Phillips. Bruce. M.D. 21020 State Road 7 Boca Raton 33428 (561) 883-8656 10141 Forest Hill Blvd Wellington 33414 (561) 793-6500 901 45th Street West Palm Beach 33407 (561) 881-2815 3651 FAU Blvd., Suite 100 Baca Raton 33431 (561) 826-3334 2301 West Woolbright Road Boynton Beach 33426 (561) 737-2339 1200 S. Main Street, Suite 100 Belle Glade 33430 {561) 775-7075 _ Shetty, Sunderam, MD. 1240 S. Old Dixie Highway Jupiter 33458 {561) 744-4400 10141 Forest Hill Boulevard West Palm Beach 33414 (561) 793-6500 901 45th Street West Palm Beach 33407 (561) 881-2815 (561) 881-0951 Gshetty77@aol.com Sports Medicine Buchalter. David, M.D. 4800 Linton Boulevard, Building A, Suite A 201 Delray Beach 33445 (561) 496-6622 (561) 496-6577 4banedoc@beitsouth.net Fazekas, Matthew, M.D. 1905 Clint Moore Road. Suite 301 Boca Raton 33496 (954) 265-6300 Stiebel, Matthew, M.D. 641 University Boulevard, Sulte_B-214 Jupiter 33458 (561) 845-6000 4440 Beacon Circle, Suite 100 __ West Palm Beach 33407 (561) 845-6000 (561) 845-6916 barbara@pbsprn.com Van-Sice. Wade, M-D. 2055 Military Trail, Suite 204 Jupiter 33458 (561) 744-9733 (561) 746-8418 Surgical Oncology Pidhorecky, lhor, M.D. 900 Glades Road. Suite 500 Boca_Raton 33431 (954) 265-0000 Vascular Surgery Swee. Warren. M.D. 2201 45th Street West Palm Beach 33407 (561) 594-1810 (561) 594-1844 57 ATTACHMENT 9 myMatrixx Overview of Workers' Compensation Pharmacy Benefit Management Services • • r good medicine for b siness Wendy Sumrell Director of Sales wsumrell@mymatrixx.com (770) 597-4277 • •• myMatrixx Executive Summary Matrix Healthcare Services, Inc., dba myMatrixx, has been providing pharmacy benefit management services to the workers' compensation industry since 2001. We link our clients' business strategy with our pharmacy program to provide customizable, value -based solutions that benefit our clients and their injured employees. Being an extension of our clients' mission and value statement creates consistency and trust. Our corporate culture of "working with a purpose" focuses on the well-being of injured workers, and keeping the injured worker's best interests at the forefront aligns with myMatrixx core values. We understand the need to take a broader view of the patient's needs, and we promote a holistic patient advocacy approach, including: Awareness: Helping injured employees understand how to navigate the unfamiliar world of workers' compensation Education: Building trust by providing the right amount of information at the right time Technology: Providing user-friendly resources like our prior authorization tool, mobile app, and pharmacy locator Customized network: Enabling better management of out -of -network transactions and physician dispensed medications • Patient -driven collaboration: Encouraging injured workers to take an active role in proper medication therapy management by empowering them with evidence -based information Additionally, our advanced technology and business intelligence enables us to provide meaningful, actionable data to all stakeholders: patients, claims handlers, managed care partners, and clinicians. Technology also allows for adaptability because one size does not fit all. Information can be customized based on demographic data. For example, a 30-year old who was injured on the job at Starbucks may only be interested in bite -size information that is impactful, such as a brief educational video. in contrast, a 60-year old who has been prescribed multiple medications might be more comfortable with detailed information from a trusted provider, such as a pharmacist he or she can speak with over the phone. myMatrixx is leading the conversation on analytics that positively affect patient outcomes. We are also at the forefront of issues that are of particular importance to the workers' compensation industry: the aging workforce, rising rates of physician dispensing, managing comorbidity of conditions, and reducing the use of compounded medications, opioids, and the MED {morphine equivalent dose) of other narcotics. Through the use of interactive dashboards and advanced analytics, our team of business intelligence professionals provides timely insights into key metrics that drive appropriate medication therapy management, utilization, savings, and network penetration. Our PBM platform is the most efficient and easiest to use in the industry, largely because our corporate culture helps us attract talent --both new and seasoned --who are driven to innovate and continually improve our proprietary technology and processes. myMatrixx has successfully developed our programs and systems to strategically handle organic growth, and myMatrixx continues to gain significant share in the PBM marketplace while remaining privately held, financially strong and stable. 02016 Matrix Healthcare Services, Inc. All rights reserved. Confidential and proprietary information. 2 • •• myMa#mx Overview of Pharmacy Benefit Management (PBM) Services myMatrixx provides measurable savings on pharmacy costs, no -risk First Fills, clinical intervention programs to ensure the right drugs are dispensed for the right reasons, and a 24/7/365 support line. Injured workers have access to more than 64,000 participating retail pharmacies, along with an option for convenient mail service/ home delivery of medications. Over the past 15 years, myMatrixx has expanded its offerings to include durable medical equipment (DME) and other ancillary products and services. Clients include public and private self -insured employers, third party administrators, workers' compensation insurance carriers, and managed care organizations. myMatrixx provides: • National network of more than 64,000 pharmacy locations Innovative clinical programs to improve outcomes and control pharmacy costs • 24/7/365 live customer service and clinical pharmacist support ■ Online portal for 24/7 access, management and real-time reporting of claims data ■ myMatrixx Mobile app for 24/7 access to claims data —anytime, anywhere • Evidence -based clinical programs and 24-hour clinical support • Customizable workers' compensation formulary • Actionable business intelligence and data analytics • Accurate, transparent billing No -risk First Fill program Customizable prescription ID cards and communications • Injured worker -centric adjudication platform • Streamlined, electronic prior authorization process • Real-time clinical alerts and status updates for claims handlers ■ Out -of -network Rx management • Team approach to implementation and program management By increasing network compliance and supporting the goal of returning employees back to work in an efficient and clinically appropriate mariner, we provide our clients with lower costs on pharmacy and better outcomes for their injured workers. ;urac ACCREDITED Watri,er5' Con• yn..ra.�rn and PilVfai and Casa,a'ty PllarrnaK y Bgnafa Upn/4;0-040 t E Rgaga 07 01:70 t 0 02016 Matrix Healthcare Services, Inc. All rights reserved. BUSINESS INSURANCE .R BEST TOW�RES Confidential and proprietary information. 3 m Matrixx -�' myMatrixx 36 Online Claims Portal myMatrixx 360° is our robust web portal that provides online access, management, and real-time reporting of pharmacy claims and for ordering ancillary products and services. This proprietary technology was developed with customizable rules that allow clients to uniquely manage all aspects of their injured worker population including pharmacy, formulary, clinical, and other needs. Our system allows an unlimited number of designated users to access the entire lifecycle of a claim from pharmacy First Fill to the closing of the claims. Claims handlers also have convenient 24/7/365 access to view claims for status updates and to place orders. The myMatrixx 360° web portal provides complete transparency and allows the claims handler or nurse case manager to view all information related to a claim at any time including reports, evaluations, nursing notes, prescriptions and more. Claims handlers receive email alerts with status updates and a detailed history at the completion of the claim. Alerts can be customized by group and claims professional, based on requirements. tr x. �� btIe The proprietary myMatrixx Mobile app, the first tool of its kind designed for both claims handlers and injured workers, enables authorized users to log in to the myMatrixx mobile site to securely access claims information from their smartphone or any other Internet -enabled device —anytime, anywhere. The app also allows injured workers to access a digital version of their prescription ID card, as well as our pharmacy locator that includes interactive driving directions. Every eligible injured worker receives a welcome letter with a traditional, paper ID card within 24 hours of receiving a new claim. The myMatrixx Mobile app provides the additional option of downloading their Rx card information to their mobile phone or other wireless device to access their pharmacy card details with no waiting. The myMatrixx Mobile pharmacy locator can be accessed from our web portal or via the myMatrixx Mobile app, providing injured workers with a simple, convenient way to locate an in -network pharmacy close to their home -- and their mobile Rx e-card provides them with instant access to prescription information to present at the pharmacy. Designed for "on the go" users, the secure myMatrixx Mobile environment: Directs injured workers to network pharmacies near their home Enables authorized users to view detailed claims data to make informed decisions when authorizing medications 4. Allows for faster prescription authorizations Increases network penetration by making it less likely for the pharmacy to process the claim through a third party biller 02016 Matrix Healthcare Services, Inc. All rights reserved. Confidential and proprietary information. 4 • myMatrixx Business Intelligence Capabilities myMatrixx is committed to providing actionable intelligence to our clients. Through our BI (Business Intelligence) solution, we are able to surface key performance indicators using standard reports, custom reports and interactive dashboards. Our BI practice has been developed to provide accuracy, timeliness and flexibility. Our goal at myMatrixx is to assist your company or your client obtain rich analytics that support strategic and operational decisions. Our BI solution incorporates 3 key process steps: Source Total Data ICS File Data ThIrd%Party Hosted Data Integrate Deliver ill Business intelligence Solution Analyze Custom Al Dashboards Custom Reports Integrate — our data integration strategy enable us to ensure accuracy through validation and cleansing Deliver — we use modern data warehouse technologies such as OLAP to efficiently store and organize data Analyze — by utilizing best -of -breed tools such as Tableau, we are able to mine data, create rich visualizations and ultimately give meaning to data to "tell a story" We have the ability to surface a wide range of key metrics such as savings, formulary utilization, generic efficiency/utilization, physician performance, high -risk patients, geography and much more. We can also provide this metrics at each level within a customer's organization, such as clients, branch and adjuster. The myMatrixx BI solution is part of our overall reporting service. We can provide custom reports in any format as well as custom interactive electronic dashboards. All at no additional cost. Standard and Customized Reports When our clients have a unique reporting need, we provide a no -charge service to create custom reports based on their specific requirements. With this service, our clients always have visibility to data when they want it and in the way they want to see it. All myMatrixx reports, including custom and ad hoc reports, are available to view in real-time and/or print from the myMatrixx 360° web portal, 24 hours a day, 7 days a week, 365 days a year. 02016 Matrix Healthcare Services, Inc. All rights reserved. Confidential and proprietary information. 5 Standard pharmacy reports include, but are not limited to: • Savings (Retail, Mail Service & Bill Review) • Network Utilization/Penetration • Generic Penetration • Generic Efficiency • Cost per Script (with breakdowns by type) • Cost per Claim by Age • Medication Exceptions • Utilization of Opioids/Narcotics • Rejections • Reversals ▪ Pharmacy and Physician Exceptions • Formulary Management • Authorization Overrides • Prescriber Report Card Measurable Results The myMatrixx program provides ease of use for claims handlers, increases network compliance, and supports your goals of returning employees back to work in an efficient and clinically appropriate manner. 88% In -Network Utilization (Penetration) Rate 82.3% Generic Substitution Rate 99.3% Generic Efficiency Rate 8% Mail Service Penetration Rate 25% Average Savings Rate of Clinical Interventions 95% PBM Client Satisfaction Rate 98% Client Retention Rate I Click P myMatrixx has a national retail network of over 64,000 pharmacies, including all major chains as well as most regional and independent pharmacies. This represents access to 95.5% of retail pharmacies nationwide. Every pharmacy in our network is electronically connected to myMatrixx to facilitate real-time communications and to simplify and expedite authorization decisions. Examples of participating pharmacy chains (not a complete list) Albertson's Giant Eagle Leader Drug Publix Super D BJ's Pharmacy Hannaford Foods Lewis Pharmacy Raley's SuperRx Costco Happy Harry's Lifechek Drug Randalls Target Cub Pharmacy Harris Teeter Long's Drug Reasors Tom Thumb CVS Health H.E.B. Medicap Rite Aid Tops Pharmacy Dominick's Homeland Medicine Shoppe Safeway USA Drug Drug Emporium Hy-Vee Meijer Sam's Club U-Save Duane Reade Ingles Navarro Discount Say -On Vons Eagle Pharmacy Kaiser Permanente Neighbor Care Schnuck's Walgreens Eaton Apothecary Kerr Drug Osco Shopko Walmart Fred's King Soopers Pathmark ShopRite Wegmans Fred Meyer Kinney Drugs Piggly Wiggly Smith's Food & Drug Weis Pharmacy Fry's Pharmacy Kmart Price Chopper Snyder Food & Drug Winn Dixie Genovese Kroger Price Cutter Stop & Shop Yokes 02016 Matrix Healthcare Services, Inc. All rights reserved. Confidential and proprietary information. 6 0 myMatrixx Prior Authorization Process The myMatrixx authorization process is leading the industry by leveraging technology to improve response times, reducing the likelihood of a prescription being reversed and processed through a third party biller. We provide a detailed report of the transactions that were rejected and later approved or denied. We also track and report authorizations by claims handler, the time it took to approve a medication after notification was sent, and the reason a medication was approved or denied. Claims handier is notified that prescription requires Prior Authorization Nurse Case Manager or Claims Handler reviews data and makes informed decision Pharmacy is electronically contacted by myMatrixx with the decision Approved medications are dispensed and claims are processed and billed All decisions are logged into the myMatrixx 360. web portal First Fill Our First Fill program allows injured workers who have not been added to the myMatrixx system via open -claim eligibility to receive up to a 30-day fill of their prescription. We have a standard First Fill formulary that can be customized to meet your needs. myMatrixx goes at risk for all First Fills. Injured Worker Communication myMatrixx representatives call each injured worker as new claims are filed to let them know that a pharmacy card is on its way to them. The pharmacy card is sent as part of a myMatrixx customized welcome letter that explains our pharmacy program. myMatrixx mails the prescription drug card and welcome letter to all eligible injured workers within 24 hours of receiving a new claim. These customizable ID cards are produced in-house and mailed directly from our corporate office in Tampa, Florida. myMatrixx Welcome Packet Customized Rx ID card A Question & Answer document detailing the use of both our retail and mail service pharmacies i= Listing of nine participating pharmacies closest to injured worker's home Custom material requested by client, including material produced in Spanish or other languages 02016 Matrix Healthcare Services, inc. Ali rights reserved. CLIENT LOGO HERE Processor: myMatrixx BIN*. 014211 Name: Jae Sample Member ID: 123456769 Group # 1060XXXX Client Name Confidential and proprietary information. 7 • Formulary myMatrixx offers standard and custom formularies. We can customize at the injured worker level or by injury type. The myMatrixx Workers' Compensation formulary was developed by our Pharmacy and Therapeutics (P&T) committee, with input from our clinical pharmacists, utilizing dynamic data and analytical tools. Our team reviews the formulary on a quarterly basis and makes necessary adjustments in response to pharmaceutical market changes, generic introductions, brand drug innovations, new drug entities, and clinical effectiveness. Out -of -Network Bill Management All paper bills are checked against previously rejected transactions to eliminate duplication. The bills are integrated with the injured worker's file in the myMatrixx 360° web portal and available for viewing within 48 hours. Our bill review team will re -price any bills based on state fee schedules and/or contracted rates and send an EOB to the pharmacy. This process can be customized to conform to your unique business rules. myMatrixx contacts each network pharmacy via phone and fax to provide the correct billing information and for conversion of all future prescriptions. Our conversion process all but eliminates third party paper bills. The myMatrixx pharmacy outreach program is critical to driving in -network penetration and yields a high probability that the next prescription is processed in -network. IWP (Injured Workers' Pharmacy) is part of the myMatrixx pharmacy network; therefore, myMatrixx will electronically process all IWP transactions at the contracted rate, applying all DUR edits and your business rules. myMatrixx does not currently have any agreements in place with StoneRiver for the following reasons: • Cannot apply discounts • No DUR • Transactions held 30 days • Communication with pharmacy for conversion 90 - 120 days • Guaranteed payment - regardless of compensability • Rx claims maintained on different platform myMatrixx requests that all paper bills be sent to us within 30 days of receipt. This ensures that we can immediately contact the retail pharmacy, provide them with our billing information and procedures, and ultimately convert the bill to an in -network transaction. All bills become reviewable for our clinical systems on a go -forward basis. Our seamless bill review program provides full visibility to all out -of -network bills. The bills are integrated with the injured worker's file in the myMatrixx 360° web portal and available for viewing within 48 hours. There are no additional fees for myMatrixx bill review and conversion services. ©2016 Matrix Healthcare Services, Inc. All rights reserved. Confidential and proprietary information. 8 • Get Ahead of the Innovative Clinical Programs The myMatrixx evidence -based clinical program, Get Ahead of the Claim, provides a comprehensive approach to drug therapy management, with a special emphasis on reducing the use of opioids. Proactive clinical management enables us to inform and advise physicians and our clients regarding dangerous drug trends, prescribing practices, and high -risk patient activity in order to modify or eliminate unsafe prescribing practices with the following tools and programs: myRisk Predictor' • Step Therapy Prescriber Report Cards • Alert, Review and Manage (ARMY' One Drug Review • Drug Regimen Review • Peer to Peer (pharmacist to physician} Consultations • myMatrixx nen'of 1olal511,nd myMatrixx Opioid Trend (Book of Business) 33 63% 2.1i8 2(X 9 2010 2011 2012 2013 2014 2015 myRisk Predictor is a proprietary, predictive modeling tool used to identify claims that post a higher risk for opioid abuse, misuse or fraud. By combining predictive modeling with historical data and unique algorithms developed by our clinical team, a customized risk score is produced for each injured worker. Identifying at -risk individuals early in the claims process provides an opportunity to intervene with proactive clinical programs designed to drive down pharmacy costs and improve patient outcomes. The combination of review, intervention, and continued drug therapy management leads to better outcomes. Since the majority of the recommendations made to improve therapy involve weaning and or discontinuation of therapy, financial savings is one measure of outcomes. Step Therapy is also used to help control the costs and risks posed by the overuse and/or abuse of opioids and other prescription drugs. This step approach provides sound clinical options, such as initiating therapy with a lower dose or short -acting opioids and only "stepping up" to agents like OxyContin if the injured patient does not experience relief from pain. This program focuses on managing opioid use and can have a significant impact on cost control for our clients, as well as improving the care and outcome for their injured workers. 02016 Matrix Healthcare Services, Inc. All rights reserved. Confidential and proprietary information. 9 Prescriber Report Cards To help our clients evaluate physician prescribing practices, myMatrixx uses its extensive database to provide detailed reports on individual prescribing patterns. The Prescriber Report Card, our physician profiling product, provides prescriber -specific reporting data and dispensing metrics compared to national and regional peers such as generic dispensing, formulary usage and targeted clinical initiatives. myMatrixx can integrate the prescriber -specific data into your medical database and the data can be used to influence prescribing patterns to encourage generic substitution. Pre- and post - report views can be utilized over time to determine prescriber behavior changes. w..nsw n.erpe Num h-.s. ,...4-�..... • iAL myMatr?xx imam Count Tama Oai.li WI MD OW MU de 4044 al am d44 . aw.% NMI Cote pea Claw. V. 11: iN: 1N1 NMI 16' $iM 1.11 Vo On, Of tr..4.07 luen •. 11 Ati 19 4% 4.1l . ae I4. Rl »% 14I4 4 i 11 t % Off Vri ala 1 WR14 C141111 a4 an W NM m a1e4 G11a4 O11M wiles imp. pr _lraw A An I 4nt 4.Y +:1 e•ti1 4,1 44,1 -r.v pro Ccwnpre !OC 1.111 1101 N4 WM 1111 Vint Met WI n, srr.utr, lG.w'. fi::1 I%5.1 n..n». mt., 12 IT 1b' ei ID$r. ap W. 91Me nr r 4ri ..... r 111 k as as. lilIlIlil Alert, Review and Manage (ARM) is a proprietary, customizable program that uses business intelligence to monitor injured worker populations for areas of concern. The myMatrixx ARM program flags prescription claims where targeted intervention with the physician, retail pharmacy, and/or injured worker may be warranted —to assist in changing prescribing patterns based on the alert. Following review of the ARM alert, these cases are managed in a manner consistent with ACOEM or Official Disability Guidelines (ODG). Our clients receive an alert when an injured worker should be referred for case management, drug screening, One Drug Review, detailed Drug Regimen Review and/or patient -provider agreement (PPAs/opioid contracts). In recent Drug Regimen Reviews completed by myMatrixx, 90% resulted in at least one change in drug therapy, with nearly 39% resulting in discontinuing or weaning a medication. In addition, as part of our clinical outreach program, our pharmacy staff has created a series of customizable opioid intervention letters that are intended to be sent at specified intervals. The myMatrixx pharmacists follow up on the letters with the prescribing physician with a peer to peer teleconsultation. myMatrixx clinical intervention programs save our clients an average of 25% per injured worker. Security All myMatrixx employees receive mandatory HIPAA training each year. Moreover, myMatrixx has completed the SSAE 16 Service Organization Controls (formerly SAS70) Type I examination that indicates selected processes, procedures and controls have been formally evaluated and tested by an independent accounting and auditing firm. CJ2016 Matrix Healthcare Services, Inc. All rights reserved. Confidential and proprietary information. 10 • • • myMatr?x'= myMatrixx employs a layered security model designed to protect data. We are committed to an iterative process of testing, reviewing, remediating, and upgrading our data security standards so that our posture continues to change as the security and threat landscape changes. We use outside credentialed partners to perform our analysis as well as engaging in internal threat assessments. User access is controlled via our online web portal, which implements the latest standards in security. Encrypted web access (https) and physical access is not provided to application servers. Injured workers and their claims are created separately from all other groups in the web portal, guaranteeing that only your claims handlers will have access to this information. All data and information systems follow extensive security architecture to ensure the protection of all patients' electronic data. myMatrixx uses Continuous Data Protection (CDP) to safeguard and back up its critical applications and data. All CDP is stored for 7 days. Point in time backups are taken and stored for 7 years in compliance with HIPAA applicable guidelines. To protect the confidentiality, integrity and availability of all data, controls include the following technologies: • Firewalls at all external connection points • All data is kept in a secure, offsite SSAE 16-compliant data center • Managed IDS and IPS sensors • P2P data encryption (in motion and at rest) • SSL/SSH encrypted sessions • Requirements for complex user lDs & passwords • Third party proactive log management services • File integrity monitoring • Virtual private networks • 2048 bit encrypted SSL • HIPAA compliance, as applicable • Back-up facility • Business continuity with hot site tested annually Data Transmission myMatrixx supports the use of electronic data interchange (EDI) to receive and load claims data. We currently have over 200 different EDI feeds, consisting of batch files and real-time web services. In order to ensure a clean bill export, or accurate data reporting, we collect all required information prior to billing via an alerting system that prompts internal action if any required data is missing. myMatrixx can support a wide range of data transfer formats including comma delimited, Excel, XML and Web Services. Our EDI framework allows for easy customization in order to adapt to any client specification. All data is transferred using a mutually agreed upon method that is safe and secure in compliance with applicable HIPAA requirements. O2O16 Matrix Healthcare Services, Inc. All rights reserved. Confidential and proprietary information. 11 • r6 myMatrixx myMatrixx uses a few standard secure protocols and encryption methods to transfer data between systems. Secure File Transfer Protocol (SFTP) is the preferred method of transfer, but we can also provide FTP with PGP encryption on the file using an additional layer of security through private key exchange. We encrypt the entire system database at rest for an additional measure but also perform several third -party 'scratch' tests to identify any potential gaps or flaws in the current security infrastructure. We invest significantly in monitoring and managing that effort with every implementation. EDI claims feeds greatly reduce the time required to set up new orders and also reduce data entry errors, so we encourage our clients to provide EDI claim feeds (although they are not required). myMatrixx will build an EDI process with your clearinghouse to meet your exact requirements, resulting in a single platform for an unlimited number of authorized users to access all medical and pharmacy data --in real time --to better manage injured workers' care. Network Connectivity The myMatrixx 360° web portal and the myMatrixx Mobile app are available to an unlimited number of designated users 24 hours a day, 7 days week, 365 days a year. Our web portal offers several methods of authenticating user credentials. In addition to the traditional username and password data store, we offer encrypted methods of accessing the system through a single sign - on methodology. Using a blend of SHA-1 hash technology and our own unique hash algorithms, we can offer access into the web portal through a client system or desired access method. myMatrixx has sustained a 99% uptime (excluding scheduled maintenance) over the last 12 months across all systems. Scheduled maintenance outages are handled off -hours and with ample notification if client systems may be affected. Implementation The myMatrixx Implementation team will ensure a smooth transition to our PBM platform by: 1. Mailing prescription ID cards to claimants five business days ahead of the "Go Live" date to ensure claimants receive their Rx card prior to the "Go Live" date 2. Completing pharmacy conversion, mail service conversion, and patient notification calls during the week prior to the "Go Live" date 3. Completing the implementation of EDI bridges ahead of the "Go Live" date to ensure new claims and existing claim updates are communicated in a timely manner The implementation phase to the myMatrixx 360° web portal averages 30-45 days but varies depending on each client's unique requirements. We have extensive experience implementing both existing and new claims, and we customize the approach for each client based on their business needs. During the requirements and discovery kick-off meeting, the myMatrixx implementation team will work with you to determine the best approach to transitioning new and existing claim activity to roll out a program with minimal impact to the end users. ©2016 Matrix Healthcare Services, Inc. All rights reserved. Confidential and proprietary information. 12 To ensure a secure and seamless transition, myMatrixx will utilize your current file formats and create customized business rules for you during implementation. For quality assurance, test environments are used throughout the development stages, and we strive to keep the data in parallel to current processes as far ahead as possible. Program Management All clients are assigned to a Client Services Manager and support team who are responsible for program management, training and ongoing support. This team is dedicated to the success of your program and is led by a member of the myMatrixx executive team. The Client Services Manager will ensure an integrated approach across all myMatrixx teams, monitoring service standards and coordinating the overall client relationship, as well as representing the client's interests across myMatrixx by: • Developing a procedure manual for your program to handle ongoing processes and protocols. • Managing training on the program and web portal. • Holding stewardship account review meetings to cover all aspects of the program, including utilization reports and trends. • Monitoring all aspects of the myMatrixx service and taking action to resolve any issues. • Representing the client's interests within myMatrixx to ensure that service adjustments are made where necessary. • Serving as the liaison with other internal myMatrixx departments such as IT, Clinical Services, and Accounts Receivable. • Coordination of visits to client sites (with other team members as required). Extensive Initial Training and Ongoing Training Opportunities myMatrixx provides in-depth classroom and one-on-one training on how to use the myMatrixx 360° web portal, which includes hard copy training manuals, online and onsite training for no additional fee. In addition, we offer a variety of beneficial continuing education (CEU) courses for our clients and your claims handlers free of charge. Topics cover areas related to workers' compensation, claims management, and medical services. Client Satisfaction myMatrixx tracks client satisfaction in two ways. First, myMatrixx uses Net Promoter Score® (NPS) to measure client satisfaction. This standard is also used by leaders in other industries, including Apple, Samsung, Costco and Amazon. Each November, myMatrixx sends customer surveys to each of our clients, as well as to all their myMatrixx web portal users. Our annual NPS, along with the accompanying comments provided by our clients and web portal users, give us an objective assessment of our performance from our customers' perspective. We use both the quantitative and qualitative data to develop companywide training initiatives that focus on areas targeted for improvement. D2016 Matrix Healthcare Services, Inc. All rights reserved. Confidential and proprietary information. 13 mylVlatrixx Second, the myMatrixx Client Services team monitors all complaints and recognitions on a daily basis. All complaints are resolved to the customer's satisfaction, logged, categorized and used for further enhancements and educational purposes. Through recognizing and taking action on both complaints and positive recognitions, we have been able to continuously enhance the customer experience. myMatrixx offers a report which includes complaints and recognitions in an effort to demonstrate a complete picture of service satisfaction. In our most recent survey, 95% of our clients indicated our PBM services meet or exceed their expectations. 24/7 Custc mer Service myMatrixx customer service representatives are available 24 hours a day, 7 days a week, 365 days a year to assist claims professionals, injured workers and pharmacies. Delivering an unimaginably great customer experience is our top priority. Comments from the myMatrixx Annual Client Satisfaction Survey: "myMatrixx provides a comprehensive Rx portal that is easy to integrate with. The people I have dealt with have been very friendly and knowledgeable." "The company is proactive in its service and regulatory compliance. Not only cost effective but provides a wealth of information on pharmacy issues. The website is super. The company does not sit on its laurels but strives for continued innovation and success." "I have already recommended you to all my adjusters I assist because your service is amazing. Fast response and friendly customer service." "myMatrixx has been one of the few companies we have worked with that stands behind their word. They are very responsive to calls regarding any issues that we have and are willing to work with us to resolve them promptly." "Excellent customer service, user friendly website for medication approval. Love the whitepapers and web training seminars. You rock!" "You make my job so much easier. Everyone I have ever dealt with at myMatrixx has bent over backwards to assist me above and beyond what 1 ask for. You have a wonderful team and I consider you a true partner!" Client Retention Rate 2001 -2015 ©2016 Matrix Healthcare Services, inc. Alf rights reserved. Client Satisfaction Rate 2015 AnriuwlISurvay Confidential and proprietary information. 14 ATTACHMENT 10 Transition Plan City of Miami Case Management Implementation Plan ID Task Name Duration Start Finish iPredecessors 1 j Notice of Award (Assumed Date) 1 day Wed 2/1/17 Wed 2/1/17 2 Implementation Meetings 3En i AmeriSys planning meeting after contract award 1 day Wed 2/1/17 Wed 2/1/17 4 in j Leadership meetings between AmeriSys & City of Miami 2.5 days Wed 2/1/17 Fri 2/3/17 5 n Submission of Policies and Procedures 1 day Wed 2/15/17 Wed 2/15/17 7 Discuss possible data transfers 1 day Wed 2/15/17 Wed 2/15/17 8 IS 9 _ g j Request sample data files from City @ leadership meeting 8 hrs Wed 2/1/17 Wed 2/1117 10. j Staff meeting for assigment of tasks 1 day Wed 2/1/17 Wed 2/1/17 11 ER j Employer/Location number import / data entry 3 days Wed 2/1/17 Fri 213/17 12 rli 1 Payroll class codes to employer import 2.5 days Wed 2/1/17 Fri 2/3/17 13 n j Programming for claimant/claim data import 2.5 days Wed 211/17 Fri 2/3/17 14 ri j Programming for FNOI Export/Claim Add 5 days Wed 2/1/17 Tue 2/7/17 16 n j Training for the City staff on web portal 0.5 days Wed 2/1/17 Wed 2/1/17 18 Ei j Complete final testing of data 13 days Wed 2/1/17 Fri 2/17/17 — 19 N j Load final data conversion (if provided) 5 days Wed 2/1/17 Tue 2/7/17 20 In Load Final -Final Data (data that has occurred between Load Final Data and end of 1 day expiring contract) Wed 2/1/17 Wed 2/1/17 21 a, i Test FNOI Export/Claim Add 7 days Wed 2f1/17 Thu 2/9/17 22 n Discuss data transfers in detail and begin implementation plan 1 day Wed 2/1/17 Wed 2/1/17 23 _ Discuss configuration of web portal users and features 1 day Wed 2/1/17 Wed 2/1/17 24 Reporting 25 ail i Present samples of revised reports 2 days Wed 2/1/17 Thu 2/2/17 26 Ln j Discuss 'ad hoc' Reports 1 day Wed 2/1/17 Wed 2/1/17 27 F4 j Develop monthly reports 20 days Wed 2/1/17 Tue 2/28/17 —28 p j Send reports for revision 1 day Wed 2/1/17 Wed 2/1/17 29 j Program for PRS Reporting Tool Format 12 days Wed 2/1/17 Thu 2/16/17 30 Training — 31 I•P j Orientation Program 5 days Wed 2/1/17 Tue 2/7/17 32 i! j Triage Program, MMT Goals, Systems 16 days Wed 2/1/17 Wed 2/22/17 33 1TA j Policies & Procedures. QA 5 days Wed 2/1/17 Tue 2/7/17 — Task kzi.,i.:&y,,•.''L-.A Inactive Task Manual Summary Split 111111111191k111115449911 Inactive Task Start -only C Milestone ♦ Inactive Milestone Finish -only 3 Date, Mon 11/21/16 Summary Irmil. Inactive Summary Progress Deadline ..L- Project Summary Manual Task liiiiiiillallE1111111111111111 External Tasks -i-Mr, ° 4.1s Duration -only _ _ _ External Milestone 4 Manual Summary Rollup Page 1 City of Miami Case Management Implementation Plan ID 34 35 36 g:31 j n j Mi j 1 nI n Task Name Prioritizing Rapid Assessment Medical Case Management System training Contract Start Begin Administrative Begin Medical contract at 00:01 Duration Start FinishPredecessors Implementation of Contract Management Component of the 5 days 5 days 10.5 days 10.5 days 1 day 1 day Wed 2/1/17 Wed 2/1117 Wed 2/1/17 Wed 2/1/17 Wed 2/1117 Wed 2/1/17 Wed 2/1/17 Tue 2/7/17 Tue 2/7/17 Wed 2/15/17 Wed 2/15/17 Wed 2/1/17 Wed 2/1/17 37irR 39 40 41 Date. Mon 11/21/16 Task Inactive Task Split ,,,,,,,,,,,,„,,,,,,.,,,, Inactive Task Milestone ♦ Inactive Milestone Rollup _ Manual Summary Start -only Finish -only Progress Deadline iiipailp E 7 Summary Iffm. Inactive Summary irmEmiimii Project Summary Manual Task External Tasks �'',_,;AW, Duration -only External Milestone ♦ Manual Summary iiiiMINIMMInni y,,..,.,., .�..o._r..:r Page 2 ATTACHMENT 11 AmeriSys Sample Reports AmeriSys* Sample Reports SAMPLE REPORTS TABLE OF CONTENTS 1. Bill Review Note 2. Explanation of Bill Review 3. Savings Report 4. Medical Bill Review Activity Report 5. Sales Journal by Payer by Product with Source 6. Sales Journal by Payer by product 7. Medical Payment Exception Version 1 8. Medical Payment Exception Version 2 9. EOB Payment Status Report 10. EOB Reconsideration History 11. EOB Status Report 12. Provider Utilization 13. Ancillary Provider e-billing Accept /Reject Reports 14. Network Hits by Employer 15. Network Penetration Report 16. Cost Containment Savings Report Bill Review Note Bill Review Note (Ability to send via email to department or medical provider) xr ...•..,..,.-.®w «.�,. �_,-.... ..Aft .• �. a * r w i .00ANA. Ow. . • •••-aa vaP' \.s eiF+r'q`+W lwW u> i -0 Explanation of Bill Review Run On: Monday. August 20, 2012 Claim Adjuster: Patient Control; Provider Fed Tax: Explanation of Bill Review Payer Name and Address NORTH DEKALB ORTHOPEDICS, PC 505 IRVIN COURT SUITE 200 DECATUR GA 30030 Page f of 1 01It L121I0BVR Claimant: Employer: SSN: Claim Date:09t2512011 Claim Nbr Attend Phy License: ZZ9999999999 WC State: GA Facility License: Rendering NM; Provider Type: Doctor AETNA WORKERS COMPENSATION Division Insurer Number: 0000 Dates is/ Sed. Service SaNice HCPCS Meddlers Units Redcnton FeeSche Billed dule + Network + Allowed a 10 07/2512012' Billed: 99203 07/25/2012 Paid: 99203 OFFICE/OUTPATIENT VISIT, NEV Reduction Applied Per: Coventry 08 Reimbursement le based an the applicable reimbursement manual 93 Paldn.o modification to the information provided on the medical bill; payment made pursuant to contranlual arrangement (AETNA WORKERS COMPENSATION ACCESS) 20 07/25/2012 I Bitted: 72100 07/2512012 Paid: 72100 X.R4Y EXAM OF LOWER SPINE Reduction Applied Per. Coventry D8 Reimbursement is based an the applicable reimbursement manual 93 Paid:no modlfication to the information provided on the medical bill; payment made pursuant to contractual arrangement (AETNA WORKERS COMPENSATION ACCESS) 30 07125/20121 5ihar: 73510 1,00 5138,30 $37.05 365.67 $3328 07/25/2012 Paid: 73510 Plat* et Service. 11 Diagnosis: 1 /GRAY EXAM OF HIP Reduction Applied Per: Coventry 08 Reimbursement is based on the applicable reimbursement manual 93 Paidno modification to the information provided on the medical bill; payment made pursuant to contractual arrangement (AETNA WORKERS COMPENSATION ACCESS) 1 1.00 S152.00 559,29 Place or Serwce: 11 Diagnosis: I Diagnoses Cedes; I - 724.2 LUMBAGO 1 1.00 $125.30 $31.92 558.08 Place of Service: 11 Diagnosis' 1 Billed Fee Schedule 3413.00 588:57 S92.71 $35.02 Network Other Allowed S 183 02 3161 01 Message to Provider ANY REDUCTION IS IN ACCORDANCE WITH DISCOUNTS PROVIDED BY AETNA WORKERS COMPENSATION ACCESS. FOR QUESTIONS REGARDING REDUCTIONS, PLEASE CALL 1-80D-AETNA•88 Messages Provider: NORTH DEKALB ORTHOPEDICS PC 505 IRVIN CT 4200 DECATUR GA 30030 If you have any questions regarding this review, please mail a copy of your bill and this report AmerlSys (407) 94g-3100 140 Alexandria Blvd, Suite H Oviedo FL 32765-6031 Re cnWed (kW WM/2U 2 BR Rocaimd 0Ror: 0e, 7412 P aefRd Dee, Dan 7r20t2 RR Savings Report Savings Reports Fee Schedule sou Pod Amount Renew !Allowance Savings (ill Ficv�ew Savings we 1 f Refection r Denied Swings Rejection! Denied Savings % Rehear ft Savings Malwrork % 1 Total Toted 1 5ewuepia Samna l fed14 St,S)t,054.6ty _— if.217 aer.53 $a,m 40 0.14% S111214.51 031t% S3ffi.1T4.34 M.43 ; 3376.367.3i 23 et; 1 Total Savings Report DESCRIPTION TEST RESULTS AMERISYS PROVIDER BILLS ela Total Charges Submitted $480,7fi 1.71 Savings: Duplicate BilHs 1.235.78 0.26 % Insufficient Data 29.00 r 0 01% Fee Schedule 211,990,04 44.10% Professional Review 722.65 0.15% Contracted 32.254.82- 6.71% Pharmacy 35,022.87 7 29% Total Savings $ 281,255,16 58 50% Total Allowed $ 190,496.55 41 50% Please note this information comes from a live data base and does not reflect the previous savings report sample. Medical Bill Review Activity Report Rim Date: kW, June 211, 2013 All Medical Bills gills Lines on sills Count Percent Count Percent Amount Percent Amount Percent Allowed AmeriSys (AmeriSys DataBase) Medical Bill Review Activity Report All Payers Date Range: 01/01/2013 Through 05/31/2013 Billed Charges Fee Schedule Reduction Other PPO Reduction Percent Reduction Percent Recommended Total % Allowed Allowance Reduction Physicians Hosp-In Hosp-Out: All Other Ambulatory Surgery Physical Therapy Diagnostics Chiropractic DME Rx Other Total: Page 1 of 2 16,267 100.0 % 29 100,0 0/0 231 100.0 % 108 140.0070 3,123 100.0 % 296 100.0 % 38 100.0 % 221 100.0 0/0 1,268 100.0 % 627 100.0 % 45,377 100.0 % $10,356,024.61 100.0 % 419 100.0 % $1,646,004.81 100.0 1,326 100.0 15 $1,062,473.22 100.0 15 310 100.0 0/0 5652,79656 100.0 % 10,648 100.0 % $616,972.77 100,0 % 324 100.0 % $507,690.04 100.0 0/0 448 100.0 % $19,695.99 100.0 0/0 554 100.0 % $93,028.97 100.0 % 1,865 100.0 0/0 $353,996.98 100.0 % 2,740 100.0 % $306,014.27 100.0 % $4,513,838.59 $1,137,935.05 $559,969.00 $303,205.29 $178,870.25 $298,578.90 $8,445.22 $2,890.03 $4,499.80 $96,473.57 43.6% 69.1 % 52.7 % 46.4% 29.0 % 58.8 % 42.90/0 3.1 % 1.3% 31.5 $5,842,186.02 $508,069.76 $502,504.22 $349,591.27 $438,102.52 $209,111.14 $11,250.77 $90,138.94 $349,497.18 $209,540.70 $311,885.05 3.0% $137,606.39 2.5 % $170,120.83 10.3 % $29,059.71 8.6 % $78,411.77 7.40/0 $41,055.07 9.7 % $16,007,76 2.5% $35,569.54 10.7 0/0 $4,515.00 0.7 15 $106,187.21 24.5 % $18,022.37 3.5 % $54,695.97 28.6 % $0.00 0.0 % $0.00 0.0 % $3,412.28 3.7 %0 $35,617.29 41.1 % $11,369.91 3.2 % $42,556.74 12.6 % $23,091.46 7.5 % $3,096.60 1.7 /c $5,704,579.63 $479, 010.05 $461,449.15 $314,021.73 $331,915.31 $154,415.17 $11,250.77 $54,521.65 $306,940.44 $206,444.10 $5,392,694.59 $308,889.27 $383,037.38 $298,013.97 $327,400.31 $136,392.80 $11,250.77 $51,109.37 $295,570.53 $183,352.64 47.9 % 81.2 % 63.9 0/0 54.3 % 46.9 % 73.1 % 42.9 0/0 45.10/0 16.5 % 40.1 % 22,208 100.0 % 64,011 100.0 % $15,614,698.22 100.0 % $7,104,705.70 45.5 % $8,509,992.52 $636,836.43 4.1 % $485,444.52 6.2 % $8,024,548.00 $7,387,711.63 52.7 0/0 Sales Journal by Payer by Product with Source Rant On: Fri Jun 28, 2013 AmeriSys (AmeriSys DataBase) Sales Journal by Payer by Product with Source Invoice Date: 05/01/2013 to 05/31/2013 XXX Limited Assignment Invoice Invoice Date Claimant Name AmeriSys Claim Id Claim Number CM Total UR Total BR Total Other H . oiwe h,ta] I13F006.1 05:03:2013 James C1IGOOHK S851.25 S851.25 113E0291 05123/2013 James CI1GOOli1C 551125 $511.25 113E0116T 05.03.2(113 Ernie • C12C003S 5519.90 S519.90 113E00G7 05,'09:2013 Timothy CL2D002D 5659.40 $659.40 1130029,1 05 23.2013 Dean Cl2GOOGC S437.30 S437.30 113E009S 05/07,2013 Kathryn C12.10005 5683.60 S6138.60 113E009C 05 07 2013 Dustin C12L00G6 S843.60 S843.60 1.13E009L 05/072013 Dustin C12L00G7 S904.85 $904.35 113E0006 05,(19.2013 Steven CI30002R S682.62 S682.62 113E007D 05/06/2013 Stephanie C13B003y' $821.95 $821.95 113E007C 05 06.2013 April C I3B00AN 034-099-0002756 51,001.46 S1,001.46 LinritedAssignment Total: S7,922,18 S0.00 50.00 S0.00 S7,922,18 Labor Market Survey Invoice Invoice Date Claimant Name Claim Id Claim Number CM Total UR Total BR Total Other Invoice Total 113 E:021-17 05,29/2013 Dean C1311)00DT 216990-LMS Labor Market Survey Total: S868.20 S868.20 S868.20 50.00 50.00 50.00 S868.20 Medical Management Invoice Invoice Date Claimant Name Claim Id Claim Number CM Total UR Total BR Total Other invoice Total 113E029W 05 23.2013 1n-.\nn ('12D01i[N 215190 S702.45 S702.45 113E0290 05.'23/2013 Robert E. C12E00G6 218197 5991.55 S991.55 113E0220 05,22 2013 Christopher C12LOOG \ S478.55 S478.55 113E00(35 05:09I2013 Brian C1200041 190758 5920.55 $920.55 II3EOORI 05 20,2013 Brian C1200041 190758 S729.40 3729.40 113E00RN 05,2012013 Brian ('1200041 190758 5652.20 $652.20 113E022N 05.22 2013 Mark Cl2KOOHB 222414 S747.90 S747.90 113E009R 05/07/2013 Charles C12L0025 222293 5139.20 5139.20 113E0064 05.092013 Johann C130001J 226414 S574.20 S574.20 113E029T 0523/2013 Johann C13E001.1 226414 $984.10 5984.10 113E0228 05.212013 Tyler (.13E007R 034-101-0003896 S1,078.00 S1,078.00 Medical Management Total: $7,998.€0 S0.00 S0.00 S0.(10 S7,998.10 Voc Services Invoice Invoice Date Claimant Name Claim Id Claim Number ('51 Total UR Total BR Total Other Invoice Total 113E00RJ 05,20,2013 Terry C12J00JF S304.50 S304.50 113E029P 05.232013 Pleasant 012K00A7 S572.45 S572.45 XXXX Invoice Invoice Date Claimant Name Voc Services Total: S876.95 Total: S17,665.43 S0.00 S0.00 50.00 S0.00 50.00 S0.00 S876.95 S 17,665.43 Claim ld Claim Number CM Total LIR Total BR Total Other Invoice Total iI3E00AD 0510912013 Page 1 of 112 Lv1ARJORIE C07F03E1 $16.00 $16.00 Sales Journal by Payer by Product Run On: Fri Jun 28, 2013 AmeriSys (AmeriSys DataBase) Sales Journal by Payer by Product XXX Limited Assignment Invoice ID Invoice Date SSN Name 05/01/2013 - 05/31/2013 AmeriSys Claim ID / No. Invoice Total 113 E006J 113E0291 113 E006L I13E00G7 II 3E029J I13E009S I 13 E009C 113 E009L 113E00F6 Il3E007D 113E007 C 05/03/13 05/23/13 05/03/13 05/09/13 05/23/13 05/07/13 05/07/13 05/07/13 05/09/13 05/06/13 05/06/13 Labor Market Survey James James Ernie Dean Kathryn Dustin Dustin Steven Stephanie Gold April C 1 I GOOHK / 157692 CI1GO0HK/ 157692 C12C003S / 216225 C 12D002D / 200481 C 12G000C / 216990 C 12,10005 / 188080 C l 2LOOG6 / 218618 Cl2LOOG7 / 212954 C 13BOO2R / 223983 C 13B003Y / 221907 C 13BOOAN / 034-099-0002756 Limited Assignment Total: $851.25 $511.25 $519.90 $659.40 $437.30 $688.60 $843.60 $904.85 $682.62 $821.95 $1,001.46 $7,922.1 S Invoice ID Invoice Date SSN Name Claim ID / No. Invoice Total I13E02H7 05/29/13 ***-**-19I8 Medical Management Invoice ID Invoice Date SSN Dean C 13D00DT / 216990-LMS $868.20 Labor Market Survey Total: $868.20 Name Claim ID / No. Invoice Total II 3E029W I13E029Q 113E0220 I13E00G5 I13E00RI I l3E00RN I13E022N I13E009R I13E00G4 I13E029T I13E0228 05/23/13 05/23/13 05/22/13 05/09/13 05/20/13 05/20/13 05/22/13 05/07/13 05/09/13 05/23/13 05/21/13 Voc Services *"-**-7061 Jo -Ann •-"*-2033 Robert E. ***-**-4998 Christopher ***-* *-4204 Brian ***-**-4204 Brian ***-**-4204 Brian ***-**-5472 Mark ***-**-7956 Charles ***-**-5815 Johann ***-**-5815 Johann ***-**-6128 Tyler Invoice ID Invoice Date SSN C l 2DOOEN / 215190 C 12E00G6 / 218197 CI 2E0OGA / 218246 C 12G004I / 190758 C 12G004I / 190758 C l 2GOO4I / 190758 C l 2KOOHB / 222414 C12L0025 / 222298 CI 3E001 J / 226414 CI3E001J/226414 Cl3E007R /034-101-0003896 Medical Management Total: $702.45 $991.55 $478.55 $920.55 $729.40 $652.20 $747.90 $139.20 $574.20 $984.10 $1,078.00 $7,998.10 Name Claim ID / No. Invoice Total 113 E00RJ 05/20/13 113E029P 05/23/13 ***-**_3957 :<<**_*:-7067 Terry Pleasant C 12JOOJF / 034-100-0003470 C 12K00A7 / 213205-VOC Voc Services Total: $304.50 $572.45 $876.95 Total: $17,665.43 Page 1 n/' 118 Medical Payment Exception Version 1 Run Dale: Fri, June 28, 2013 - 2:18 pm ArneriSys (AmeriSys DataBase) Medical Payments Exception Report Entry Date: 06/01/2013 - 06/28/2013 Selected Provider Types: Ambulance, Ambulatory Surgical Center. C'cn Regis. Nurse/Advanced Nurse Practitioner. Chiropractor. Dentist, Doctor, Durable Medical Equipment, FL Med EDI Exempt, Hume Health 1 Skilled Nursing Payer: XXX Adjuster: WC EOB State Status Posted Date Entry Date -- to Posted EOB Rec. Date -- to Posted Bill Rev. Rec. Date -- to Posted Sent tor Payment Ext. Slat. Ext. Desc. EDI Date of Entry Date Payment EDI ID EOB ID Provider Claim & Number FROM Service TO Voided EOB ID Prov_ Type Allowed Amount SSN DOA Claimant Name Fl. Finn:red FL Adjudicated FL Adjudicated 1.1. Adjudicated FL Adjudicated 1.1 31401HI 06/27/2013 0 BROWARD GENERAL MEDICAL CENTER [)odor 116/26/0013 0 C13EOOL9 / HA10530133013 + -021J7 05/30/21113 CINDY 06/27/2013 0 06/17/2013 06/17/2013 06/19/2013 116/17/2013 0 sent LrI3F17H 05/02/2013 46 06/10/2013 7 LI3F00H5 04/18/2013 04/18/2013 LI3E00A4 ASF OF SOUTH FLORIDA Ambulatory Surgical C12GCOL4 / HAW0730120175 '''x*-*'F-3588 07/30/2012 BELINDA $2.514.00 (16/10/2013 06/10/2013 06/12/2(113 06/14/2(113 1.13FOOCZ 05/22/2(113 (15/22/2013 06/07/2013 3 sent LrI3FOKP F13F0003 ORTHO FLORIDA FLOSSM Doctor $57.00 05/31/2013 10 CO7F05CE / PRO1230053616 ***-**-1594 12/30/2(105 DIANE 1)6/07/2013 3 06/10/2013 06/10/2013 06/12/2013 06/14/2013 LI3FOOD I 05/17/2013 05/17/2013 06/07/2013 3 sent Lr13F0L0 F13F0003 Orthopaedic Center of South Florida Doctor $209.60 05/31/2013 10 CO7F03KN / LK 112702LATT * - *-1337 11/27/2002 VERNA E 06/07/2013 3 06/11/2013 06/11/2013 06/11/21113 L13F00L32 05/22/2013 05/22/2013 1)6/07/2013 4 seer F13F0002 Memorial Healthcare System -Practice Mg Ductnr 05/31/2013 11 C13D001 P 1 COL0402132433 }**-**-6433 04/02/2013 SOPHIA C 06/07/2013 4 51) 00 H. Adjudicated 06/1t112013 Obi it1120I.t Obi l2/2013 06/14/2013 1.131,00D3 05/28/2013 05/28/21113 06/07/2013 3 sent Lri3F0L3 F13F0003 FLORIDA SPINE GROUP Chiropractor $107.00 05/31/2013 10 C12FOOFL/ DES0619129762 ***-*'-2156 06/19/2012 JEANNETTE 06/07/2013 3 Page 1 (//'S.? Report Options: Display Both Paid & Unpaid, Show zero Allowed, Show only Florida WC State. Show Voided EOB Medical Payment Exception Version 2 Run Dale: Fri, June 28, 2013 - 2: I8 pnr AmeriSys (AmeriSys DataBase) Medical Payments Exception Report Posted Date: 06/01/2013 - 06/28/2013 Selected Provider Types: Ambulance, Ambulatory Surgical Center. ('crt Regis. Nurse/Advanced Nuke Practitioner, Chiropractor. Dentist. Doctor. Durahle Medical Equipment. Fi. Med ED1 Exempt. Home Health, / Skilled Nursing Payer: XXX Adjuster: WC EOB State Status Posted Date Entry Date -- to Posted EOB Rec. Date -- to Posted Bill Rev. Rec. Date -- to Posted Sent for Payment Ext. Stat. Ext. Desc. Date of Payment EDI Entry Date EDI ID EOB ID Provider Claim & Number FROM Service TO SSN Voided EOB ID Prov. Type Allowed Amount DOA Claimant Name (IA Adjudicated GA Adjudicated GA Adjudicated GA Adjudicated GA Adjudicated 06/13/2013 06/ 15/21) 1 2 05/06/2013 (16/13/2013 06/15/2012 05/06/2013 06/13/2013 06/ 15/2(112 05/06/2013 II6/13/2013 116/15/ 012 05/06/2013 (16/ 13/2013 03/04/2013 05/ 16/2013 06/18/2013 1)6/18/21113 5 sent 368 43 06/18/2013 06/18/2013 5 sent 368 43 06/18/2013 06/18/2013 5 sent 368 43 06/18/2013 06/18/2013 5 sent 368 43 06/27/20 f 3 1)6/27/2013 14 sent 115 42 GA Adjudicated 06/27/2013 (16/27/2(113 06/13/2013 03/14/2013 05/30/2111 3 14 sent 105 28 1.13h0ONL 02/21/21)12 02/21/2012 LI2F01YL1 Vincent Boswell MD,PC Doctor C07GOOR7 / 8-3269A01-15 *''*-,'*-5960 07/24/2007 Willie LI3EOONM 03/15/2012 Vincent Boswell MD,PC CO7GOOR7 / 8-3269A01-15 1.I31?(I0NN 03/05/21)1 _ Vincent Boswell MD,PC CO7GOOR7 / 8-3269A01-15 1.I3E00NK 02/13/2012 Vincent Boswell MD,PC CO7GOOR7 / 8-3269A01-15 L 13E019.1 02/14/2013 Orthopedic South Surgical Center CO9GOCIK / 9-5544A01 1.1 31 i017_S Daniel Kinglet( MD C11C0ODF/1-7321A01 03/13/2013 03/15/2012 LI2FOIYR Doctor r."°"-"-5960 07/24/2007 Willie 03/05/2(112 1.I2F111YS Doctor ***-**-5960 07/24/2007 Willie 02/13/2012 L12FOIYP Doctor °"-5960 07/24/2007 Willie 02/14/2013 L13C)082 Ambulatory Surgical ***-4*-7035 05/15/2009 ROBERT 03/13/2013 L13C0136 Doctor s*° *-**-573(1 03/ 16/201 1 Sandra Page 1 o/'80 Report Options: Display only Unpaid. Exclude zero Allowed. Show all WC State, Exclude Voided and Recreated negative EOB $25.20 $25.20 $25,20 $25.20 $4.425 29 $259.61 EOB Payment Status Report Run Date: Fri. June 2/& 2013 [Jtillog Id AtneriSys (AmeriSys DataBase) EOB Payment Status Report Entry Date: 06/23/2013 - 06/29/2013 External Void Allowed Reason Claim Id Fed Tax Id Fldowedi Id Rcvdate Status Status Entry Date Posted Date tJtiling ID Amount code LI3FOIG8 CO7F03FF LI3F01G9 CO7FO3FF LI3F01DL Cl2F0056 LI3FOIDQ C13F005C LI3FO1DR CI3FOO4A L13FOIDS CI3E00D5 L13F0IFQ CIIKOO6Q 1,13F01FR CO9110071 L13FOIFS CI3BOOA1 L13F01FT CI3BOOAI L13FOIFW CIIK006Q L 13F01 EX C12AOOG6 L13FOIFY C13F006J I.I3F01FZ CO3L016K L 13F01 G0 CO9DOOK6 L 1 3 F01713 C 121.000Q LI3FOIHU C12B004E LI3FOIHV Cl2B004E LI3FOIHW Cl3EOOHF L13F0115 CO3L014H L 13F0116 CO3L0 16K L13F0117 ('03L016K LI3F0118 C04H006Z L 13F0119 C07A000t1' L 13F01 IA CO8.100RA LI3FO11B CO8KOODN L13FOIIC CO9DOOK6 LI3FOIID CO9EOOBK L I3FO I IE C 101-1005Q Page 1 of ' 16 6/25/2013 A donotsnd 6/26/2013 6/28/2.013 $0.00 6/26/2013 A donotsnd 6/26/2013 6/28/2013 $0.00 6/26/2013 A new 6/26/2013 6/26/2013 $34.98 6/24/2013 A new 6/26/201 3 S 163.00 6/24/2013 A new 6/26/2013 $111.09 6/24/2013 A new 6/26/2013 $193.08 6/25/2013 A new 6/26/2013 $192,52 6/25/2013 A new 6/26/2013 $0.00 6/25/2013 A new 6/26/2013 $0.00 6/25/2013 A new 6/26/2013 $0.00 6/25/2013 A new 6/26/2013 $0.00 6/25/2013 A new 6/26/2013 $ 111.09 6/25/2013 A new 6/26/2013 $583.31 6/25/2013 A new 6/26/2013 $194.24 6/25/2013 A new 6/26/2013 $42I.09 1/14/2013 A New 6/24/2013 6/24/2013 L13A0OSG $7,553.92 6/26/2013 A new 6/27/2013 $227.58 6/26/2013 A new 6/27/2013 S227.58 6/26/2013 A new 6/27/2013 $103.00 6/27/2013 A new 6/27/2013 6/27/2013 S501.55 6/27/2013 A new 6/27/2013 6/27/2013 $244,88 6/27/2013 A new 6/27/2013 6/27/2013 $56.95 6/27/2013 A new 6/27/2013 6/27/2013 $6.35 6/27/2013 A new 6/27/2013 6/272013 $10.86 6/27/2013 A new 6/27/2013 6/27:2013 $183.40 6/27/2013 A new 6/27/2013 6'272013 54326 6/27/2013 A new 6/27/2013 6/27/2013 S22.91 6/27/2013 A new 6/27/2013 6/27/2013 52' 26 6/27/2013 A new 6/27/2013 6/27/2013 $32.05 EOB Reconsideration History Run Date: Friday, June 28, 2013 14:35 EOB Message: LI2F01YR CO7GOOR7 Comment: EOB Message: L l 2F01 YS C07GOOR7 Comment: EOB Message: L 13 AOOSG Cl2L000Q Comment: EOB Message: LI3EO02P CIOHOO4I Comment: EOB Message: L 13C0082 CO9GOOIK Comment: EOB Message: L12FOIYP C07GOOR7 AmeriSys (AmeriSys DataBase) EOB Reconsideration History Date Voided: 06/01/2013 - 06/28/2013 Entry User: Seletha XXX Void Due To Bill Claim Fed Tax Id Received Entry Void Status Provider Name Entry Error L13E01TN CI IKQOG 05,28,2013 05/29/2013 06/21/2013 V Orthopaedic Center of South Florida Y Comment: NT 06121/2013 11:08 - EOB: Ll3FO14U was created by voiding: LI3EO1TN. The void reason was: Bill review entry error EOB Message: Bill review entry error LI3E00A4 Cl2GOOL4 05/02/2013 05/03/2013 06/17/2013 V ASF OF SOUTH FLORIDA Y Comment: NT 06/1712013 15:12 - EOB: L13FOOH5 was created by voiding: LI3EOOA4. The void reason was: Bill review entry error EOB Message: Bill review entry error Entry User: Robert Poling Bill Claim Fed Tax Id Received Entry Void Status Provider Name 06/15, 2012 06/22/2012 06/13/2013 V Vincent Boswell MD,PC Cotnment: NT 06/13/2013 14:08 - EOB: L13EOONK was created by voiding: L12FO1YP. The void reason was: Bill review entry error- SUPPLY CALCULATION 1.5 + $4 Bill review entry error- SUPPLY CALCULATION 1.5 + $4 06/15 2012 06/22/2012 06/13/2013 V Vincent Boswell MD,PC NT 06/13/2013 14:14 - EOB: LI3EOONM was created by voiding: L12F01YR. The void reason was: Bill review entry error Bill review entry error- SUPPLY CALCULATION 1.5 + $4 Bill review entry error Bill review entry error- SUPPLY CALCULATION 1.5 + $4 06 15 2012 06/22/2012 06/13/2013 V Vincent Boswell MD,PC NT O6/13/2013 14:13 - EOB: LI3EOONN was created by voiding: LI2FOIYS. The void reason was: Bill review entry error Bill review entry error- SUPPLY CALCULATION 1.5 + $4 Bill review entry error Bill review entry error- SUPPLY CALCULATION 1.5 + $4 Void Due To Entry Error Y 01 14 2013 01 ;; 16 2013 06/24/2013 V South Fulton Medical Center NT 06j24, 2013 09:52 - EOB: LI3AOOSG was Voided and EOB: L13F017B was created. Void reason of: Hospital / ASC Implant Recon due to user: N Hospital / ASC Implant Y Y 04 302013 05 01 2013 06/05/2013 V The Rawlings Company,LLC N NT 06r05 2013 10:23 - EOB: L 13EOO2P was Voided and EOB: L 13F006E was created. Void reason of: DUPLICATE BILLING/ PER ADJ DO NOT PAY TO RAWLINGS CO. -refer to Ll 1I0295 Recon due to user: N DUPLICATE BILLING/ PER ADJ DO NOT PAY TO RAWLINGS CO. -refer to L 11 10295 03/04/2013 03/04/2013 06/13/2013 V Orthopedic South Surgical Center N NT 06/13/2013 14:19 - EOB: L13E019J was created by voiding: L13C0082. The void reason was: Bill review entry error - ASC MULTIPLE PROCEDURES Bill review entry error - ASC MULTIPLE PROCEDURES Page 1 of 2 EOB Status Report Run Dale: Fri, June 28, 2013 AmeriSys (AmeriSys DataBase) EOB Status Report 06/01 /2013 - 06/28/2013 External PPO Network External Application Total Do Not New / Do Not Posted Date Aging Days EOB New Send Sent Accepted Rejected Unknown Resubmit Send Sent Accepted Rejected Unknown L13F0192 sent 1 D 0 1 0 0 0 0 sent 0 0 1 0 0 0 L 13F019 3 sent 1 D 0 1 0 0 0 0 sent 0 0 1 0 0 0 L13F0194 sent 1 D 0 1 0 0 0 0 sent 0 0 1 0 0 0 L 13F0195 sent 1 D 0 1 0 0 0 0 sent 0 0 1 0 0 0 L13F0196 sent 1 D 0 0 0 0 0 sent 0 0 1 0 0 0 L13F0197 sent 1 D 0 0 0 0 0 sent 0 0 1 0 0 () L13F0198 sent 1 D 0 0 0 0 0 sent 0 0 1 0 0 0 LI3F0199 sent I D 0 0 0 0 0 sent 0 0 1 0 0 0 LI3F019A sent 1 D 0 0 0 0 0 sent 0 0 1 0 0 0 L13F019B sent 1 D 0 0 0 0 0 sent 0 0 1 0 0 0 L]3F019C sent 1 D 0 0 0 0 0 sent 0 0 1 0 0 0 LI3F019D sent 1 D 0 0 0 0 0 sent 0 0 1 0 0 0 L13F019E sent 1 D 0 0 0 0 0 sent 0 0 t 0 0 0 LI3FOI9F sent 1 D 0 0 0 0 0 sent 0 0 I 0 0 0 LI3FOI9G sent 1 D 0 0 0 0 0 sent 0 0 1 0 0 0 LI3FO19H sent I D 0 0 0 0 0 sent 0 0 1 0 0 0 L13F0191 sent 1 D 0 0 0 0 0 sent 0 0 l 0 0 0 L I3F019J sent 1 D 0 0 0 0 0 sent 0 0 1 0 0 0 LI3F019K sent 1 D 0 0 0 0 0 sent 0 0 l 0 0 0 L13F019L sent 1 D 0 0 0 0 0 sent 0 0 1 0 0 0 L13F019M sent 1 D 0 0 0 0 0 sent 0 0 1 0 0 0 LI3F019N sent I D 0 0 0 0 0 sent 0 0 1 0 0 0 L13F0190 sent 1 D 0 0 0 0 0 sent 0 0 1 0 0 0 LI3FO19P sent I I) 0 0 0 0 0 sent 0 0 1 0 0 0 LI3F019Q sent 1 D 0 0 0 0 0 sent 0 0 1 0 0 0 L13F0040 sent 1 D 0 0 0 0 0 sent 0 0 1 0 0 0 L I3FOOS5 sent 1 D 0 0 0 0 0 sent 0 0 1 0 0 0 LI3FOOUZ sent 1 D 0 0 0 0 0 sent 0 0 1 0 0 0 LI3FOOV4 sent 1 D 0 0 0 0 0 sent 0 0 1 0 0 0 L13FO1ON sent I D 0 0 0 0 0 sent 0 0 1 0 0 0 L13F010Y sent 1 D 0 0 0 0 0 sent 0 0 1 0 0 0 LI3FOIIC new I D 0 0 0 0 0 new 1 0 0 0 0 0 LI3F01IE new 1 D 0 0 0 0 0 new 1 0 0 0 0 0 LI3FO11F new 1 D 0 0 0 0 0 new 1 0 0 0 0 0 Puge 48 o/ 63 Provider Utilization Run Dare: Fri. June 28. 2013 AmeriSys (AmeriSys DataBase) Utilization Analysis for Providers Proc. Provider Code Loss Date Diag Code Sers ice description Quoted Quoted Allowed Allowed Billed Billed Units Amt Units Amt Units -Amt Neighborhood Family Doctor - Pr00A000 al 23 2000 99203 8472 OFFIC OUTPT VISIT E&M NEW MODERAT SEA 0.00 0 1.00 S40.00 1.00 51 I5.00 1018 1999 99202 841 OFFIC OUTPT VISIT E&M NEW LOW -MOD SE1 0.00 0 1.00 S30.00 1.00 S85.00 12:07' 1999 99203 720 OFFIC/OUTPT VISIT E&M NEW MODERAT SEA 0.00 0 1.00 S40,00 1.00 S 106.00 11 18 1999 99203 72885 OFFIC OUTPT VISIT E&M1 NEW MODERAT SE\ 0.00 0 1.00 $40.00 1.00 S 106.00 10 18 1999 20610 841 ARTI IROCENTESIS/ASPIR INJ; MIAJOR JT BUR 0.00 0 1.00 S35.00 1.00 565.00 01 23 2000 99213 8472 OFFIC'OUTPT VISIT' E&M EST LOW -MOD SEVI 0.00 0 1.00 S29.00 I.00 5110.00 12 07 1999 99213 720 OFFICOUTPT VISIT' E&M EST LOW -MOD SEV1 0.00 0 1.00 50.00 1.00 S97.00 12 29 1999 99204 7242 OFFICOUTPT VISIT E&M NEW MOD -HI SEVEI 0.00 0 1.00 S58.00 1.00 S143.00 12 18 1999 99203 8419 OFFIC OUTPT VISIT E&M NEW MODERAT SEA 0.00 0 1.00 S40.00 1.00 S115.00 12 18 1999 99213 8419 OFFIC OUTPT VISIT E&M EST LOW -MOD SEVI 0.00 0 1.00 S29.00 1.01) 597.00 01 23 2000 99213 8472 OFFIC OUTPT VISIT E&M EST LOW -MOD SEVI 0.00 0 1.00 S29.00 1.00) S110.00 12 071999 99213 720 OFFIC OUTPT VISIT E&M EST LOW -MOD SEVI 0.00 0 1.00 529.00 1.00 S97.00 Subtotal for Provider: 0.00 0 12.00 S399.00 12.00 $1,246.00 Pathology Assoc Of North Florida - Pr00A003 08 16 200E 81003 7806 UA D1P STICK TABLET REAGENT; WO MICRO 0.00 0 1.00 S2.00 1.00 S9.00 12 12 1996 85014 7242 BLD CT: OTHER THAN SPUN 1IEMATOCRI'C 0.00 0 1.00 S 1.00 1.00 S4.00 06 15 1992 88304 784 LEVEL 111-SURG PATH GROSS'MICRO EXAM 0.00 0 1.00 $52.00 1.00 577.00 04 092002 81003 8080 UA DIP STICK_ TABLET REAGENT; WO MICRO 0.00 0 1.00 52.II(1 1,00 59.00 04 09 21102 85014 8080 BLD CT; OTHER THAN SPUN E IEMATOCR IT 0.00 0 1.00 51.00 1.00 54.00 1() 05 200() 85610 7235 PROTHROMBIN TIME: 0.00 0 1.00 S3.00 1.00 57.00 081)3 1999 85730 72283 THROMIBOPL:\s 11N 11MIE PART; PLASMA WHt 0.00 0 2.00 53.00 2.00 510.00 04 09 2002 86850 8080 ANTIB SCREEN RBC EA SERUM TECH 0,00 0 1.00 S0.00 1.00 S13.00 04 179 2002 85610 8080 PROTHROMIBIN TIME 0.00 0 1.00 80.00 1.00 57.00 12 12 1996 85025 7242 BLD CT: FIG PLATELET CT AUTO & AUTO CON 0.00 0 1.00 56.00 1.00 S9.00 04 09 2002 87086 8080 CULTURE BACTERIAL. URIN; QUAN COLONY 0.00 0 1.00 53.00 1.00 S14.00 08 16 21101 85025 7806 BLD CT: FIG 'PTA fELET C'T AUTO & AUTO CON 0.00 0 1.00 S5.00 1.0() S9.110 04 09 20112 86850 8080 ANTIB SCREEN RBC EA SERUM TECH 0.00 I) 1,00 S3.00 1.00 513.00 04.09 2002 87086 8080 CULTURE BACTERIAL URIN; QUAN COLONY 0.00 0 1.00 S3.00 1.01) 514.00 04;09/2002 80048 8080 BASIC METABOLIC PANEL 0.00 0 1.00 S4.00 1.00 S19.00 04 (19 2002 87086 8080 CULTURE BACTERIAL URIN; QL1AN COLONY 0.00 0 I.00 53.00 1.0() 514.00 04.09,2002 85610 80813 PROTHROMBIN TIME 0.00 0 1.00 S3.00 1.1)0 57.00 09 02 1993 80053 729E COMP METABOLIC PANEL 0.00 0 1.00 SS.0 0 I.00 525.00 04 09 2()02 85014 8080 BLD CT; OTHER THAN SPUN HEMIATOCRIT 0.00 0 1.00 51.00 1.00 54.00 10 05 2000 85(118 7235 BLD CT; 1-IGB 0.00 0 1.00 S2.00 1.00 S4.00 12 12 1996 85014 7242 BLD CT; OTHER TIIAN SPUN I IEMATOCRIT 0.00 0 1.00 SI.0(1 I.00 $4.00 08 031999 85025 72283 BLD CT: HG PLATELET CT AUTO & AUTO CON 0.00 0 1.00 S6.00 1.00 S9.00 04 09.2002 85610 8080 PROTHROMBIN TIME 0,00 0 1.00 53.00 1.0() S7.00 10 05 2()00 80048 7235 BASIC METABOLIC PANEL 0.00 0 1.00 54.00 1.00 519.00 04 09 2(1(12 85610 8080 PROTHROMBIN TIME 0.00 1) 1.01E SO.00 1.00 S7.00 08.03 1999 86920 72283 COMTPATTEST EA UNIT; IMMED SPIN TECH 0.00 0 2.00 S3.00 2.00 $25.00 Page 1 ©J'40610 Ancillary Provider e-biding Accept /Reject Reports Accept/R.0 c4 Rd 'bu im. . rc Ancillary Provider (2013) Accept/ Reject Ratio Relec4e00 Wn+kuu,vri ,kS.m3naaA • ew, b•.11taww.Me C's3-v+h'n se6® CU.0 Mu.a , aw w.r., Ancillary Provider (2013) Accept/ Reject Transactions Detail ,isro-ea Winn Id :Imp YI Viroo • .9.91••-r 99-. ,...9 9941,9•49/ I...cwt-. 59.9.9,91116- 1p.m:sq., O. CA* C.,99.9.999* SSO 1..21/2/tiv P.Inmile... .1-7,._esseJ ,11., AUJ nL-.'-, LI: 0: -9,...i .1,:•:•i•••:5, 2:15.-...1‘(0_, .-.999,99 :1...... e& 22,11 .1.1 11 22/,2"./A 3.,,, ".,., /eA1i,E, 123.12: 549.-',9 3074*.LS 759.97, r.„,,,,....1 ,.., •.,l Y. ,i !9g.)!. TOO-'9999 Ma' 9540 ,, .-,.,...,, 4 •99M -W, , At; 09 999 :15,3221,1 //,,,,,.,,,, :A, ,,,,, :PI M •99.-99,9, 23t2. a • .1 ,,,....',1., „ ,..._,,„, -,,,..../„/„. ,.._,..2,1, 31At /.1-,ra ou.kn .....A., A..,, ....., ::41*4,-. vuw,-,,,, 1../...,..5. ,5,...., 4,115 ir 39 99-r9=9,- 2.39.9-19. 4.. ',at 1:rio u. '.9.7.1T5 *9 M ,•74 ,..,, 91A.1907 947.9z,v: :, 111:2222 SIM 'Val/ .11414 10 11 1-4/1.7% 1311,1201 1/7r,A1•32/ 7.10, ,991 Iltl, ..9i1.9.9 2.:911.11, ,9,9,••-41 0,41)07A , :, M.: ,atsta ,As-e .6..4 :LAI, 44-.:5E1 T1134347 :•-•0•1020•1'941. .--' - ,...s9., 1.9.....va ....1.-A ...14 WOO 9/19310 2l4a.la:r ri*1si5r, 45.1C91[0. ...:—J. Sj:90.4 400.,4 90,13, :3! V 4.711.9i3. 20 407,17 IVA.: 775-0.(Sn 9-, Ffretr. ,A9.#139i TO. il 911.49 810.7109 19.3901: .E,I4401.1 ATEt.". /...--A,1N 1E4.11 .i.143,1 23443/AP. 0.1221421 ., 17-33 WAA3/LY 21241 / Ar....t IX / 4.1. '1 1/214421. 22:1-14i ...,,,h ti,i-i-xu 334 , ,:991.91S *92.4494? .14.9.499: :.:9::4449:.1 4.9.07,1:19 .:-....1.9 I, 0:217•0 431A441.. 410.404.. -,- • t7.9.1.019 1-14112 Ci.re.s•I .. ; '-',". 074..A.•25 7.1/72.9 --1 7.1ati:i 5,.290147 T.9.,01..1 t.7...11 • : .... -- ,• 70131 17437* 61 214732M Ati 4.‘224A0LI 4.: ..,2•1”. 1: 44Ha0713V.3 .. • . A . 33,, .. :titer.: 3922010 34019011.2 :1./.941143 ......-,st 0I2/A3: , 499909079.01 iWiT,...:371107004 ,049.1 0,047.0 Ci..19.9:9111 (39197.T.91 Arp.e.s.9.,. ... +I. •il.:9,-,,. 415 :1•19:4•:‘, ,111`9.1,1.1 Orr -,r, 1o!•/:10 ... ,_ _. r.117122.3 /144,042/2. •441. t.• • • ...• , ,79:M.A7 0999,99,1 ::..9•9:•,,, 512111,3 Carr-auld .•.....-..... .• . - . . ... ..,...1:912. ,..ar,Or: a„9,9 . „ • , .. ,. '''11 ..:. :A...034 44.412.114 can; ..9.1,1 -.--',..., ....:Li-,i,i2 2,1.,...-.,-K. W., ..41111 141,7.11:. E4244.14.9 Otort:949! 4m99./ 474... ‘9-, -L.,. .,.,•:-•• ere:•••••'5.9u.- ,:-.-,..1,4I.14 4,1a00•!,. ....WC -we 1393, --'1-041. 9.f..Ca .... "..,‘J ,...,-..4r-k 9 ,:',X,-979): 0113•e9.191 •_ :.,1 °L'S' 24115/07111 14.rirnz 412174,12.41 ,.7.7. iii: WS LI CLW:EDI C099900 94247691 1.-9...t.M.,.. •Lliorr.a.r9i t.:.10,40444 41.10111:1' ,:011.,..1 — ' .• ..,..,-1. 414 T•19 44191043 .1 .71:99,9991 1 19,11, .: . • 1 411,1011 /711117-1/11 2 C43a94110 •-, , 4579399.9 39(194911,1 7-193114' Network Hits Report by Employer Run Date: Tuesday, March 11, 2014 AmeriSys (USIS Database) Network Hits Report by Employer 01/01/2013 - 12/31 /2013 Submitted Duplicate Insuf Data Hits Billed Fee Schedule Other Network Allowance Sample Client XXx I':m131ovcr L13G0$7H Coventry $307.00 $0.00 $307.00 $0.00 $0.00 1 $0.00 1 100.0% $307.00 $307.00 100.0% $177.00 $0.00 $177.00 $0.00 $3.90 $3.90 100.0% $126.10 $126.10 $307.00 $0.00 $0.00 1 $307.00 $177.00 $0.00 $3.90 $126.10 57.7% 0.0% 3.0% 41.1% $307.00 $0.00 $0.00 1 $307.00 $177.00 $0.00 $3,90 $126.10 57.7% 0.0% 3.0% 41.1% Page 1 of 1 Network Penetration Report Run Date: Tuesday, March 11, 2014 AmeriSys (USIS Database) Network Penetration Report 10/01/2013 - 12/31 /2013 Submitted Duplicate Insuf Data Hits Billed Fee Schedule Other Network Allowance Sample Payer No Network $91.728.67 $7.224,57 50.00 56 1.4% S84.504,10 4.1% $28,697.00 ($31.00) $0.00 0.0% $55,838.10 AmeriSys Preferred $20,881.51 $759.59 50.00 156 4.0% $20,121.92 1.0% $5,436.08 $0.00 $30.40 0.0% $14.655.44 AmeriSys Ancillary 5564,236,40 8157,00 $0.00 1558 40.1% $564,079.40 27.3% $309,535.23 $20.00 $72,862.19 63.4% $181,661.98 AmeriSys Pharmacy $20,511.39 $102.30 $0.00 153 3.9% $20,409.09 1.0% $12,595.76 $0.00 ($8,295,38) -7.2% $16,108.71 Coventry 51.346,784.80 $757.24 $0.00 1710 44.0% $1,346,027.56 65.2% $622,987,36 $1,312.24 $44,123,22 38.4% $677.600.25 Matrix $29,500.89 $0.00 $0.00 249 6.4% 529,500.89 1.4% $0.00 $0.00 86,176.54 5.4% 523,324.35 myMatrixx $292.81 $0.00 $0.00 1 0.0% $292.81 0.0% $0.00 $0.00 $73.11 0.1 % $219.70 $2,073,936.47 $9,000.70 50.00 3883 $2,064,935.77 $979,251.43 47.4% 51,301.24 $114,970.08 0.1% 10.6% $969,408.53 46.9% Cost Containment Savings Report DEMO Company Serviced by USIS Cost Containment Savings Report 5/23/ 1900 thru 5/23/2016 Account: 119 - DEMO Company Per id s ^_nts a5rDAM Mw1 Changed Fee Schedule Reduciess Fee Schedule Or Reduc torts Nervlrorx Reductions Amount Pali tie 2,464,661.05 PmeiderTssElescipion 873,091 25 1,591,569.80 1,859.65 !Fee Schedule Rieke:N le Ambulance Ambulatory Surgical Center Cert Regis. Nurse/Advanced Nurse Practitioner Doctor Durable Medical Equpment Horne Health 1 Skilled Nursing Hospital Indepesidani Lab Pharmacy Physical Therapy Pheinorligoellhouplon Cert Regis. Nurse/Advanced Nurse Practitioner Dentist Doctor Durable Medical Equipment Home Health ! Skilled Nursing Hospital inclependant Lab Other Pharmacy Physical Therapy Transportation 2,695.51 13,987.90 6,888.78 361,074.31 469 06 20,009.10 439,723.62 6,148.59 5.13 22.089.25 Nelimak RYldrM= 1,611.19 114.17 71, 666.52 8,135.78 14 766.30 38, 607.33 1,854.9i 94 F) 13,659.04 42.382.36 1,.552.62 Raids Type t3esoittion 011arigetkaues Doctor 2,464, 661.05 1,859_65 1,424,797.73 164,912.42 1,424,797.73 Fee Schedule Reductions 12.092 stin Ambulance Ambulatory Ceti Regis. ▪ Nurse/Advanced— ▪ Doctor Durabte Medical Equipment ▪ Hcxiie Health ' Skilled Nat Hostatal Mil Indera±+dant Lab — Pharmacy Phy36ai Therapy Network Reductions Gent Rees — NurseJAdysncad__ _. - Dentist i Doctor — Durable Medical Equvpmere Hon H+3aalh r Skilled Nur . Hoststal Independent LAU Nil Other — Pnstriacy - Phystc-it TherePy Trera.pxrtabnn Other Reductions 1,039,863.32 This report is currently only available from the US/SiNet (ERIC) portal. We will have it available from the AmeriSys portal by September2016. ncctcr ATTACHMENT 12 Risk and Insurance, Revitalizing the Program — Teddy Award Winner 2015 Teddy Award Winner Revitalizing the Program In three years, the Columbus Consolidated Government was able to substantially reduce workers' compensation claims costs, revamp return -to -work and enhance safety training. By: Janet Aschkenasy November 2, 2015 • 7 min read Topics: Claims November 2015 Issue I Public Sector WC Cost Containment I Workers' Comp Return to Work I Safety I Teddy Award 1 Anne -Marie Amiel assumed her post at Columbus Consolidated Government in Georgia three years ago, becoming the first risk manager for the consolidated City of Columbus and the County of Muscogee government in over a decade. Since then, she and a colleague have been successfully reconfiguring the government's workers' compensation, liability claims and safety programs. Given the short amount of time she's been working there and her limited resources, it's uncanny how many accomplishments the first consolidated city -county in Georgia has produced. Amiel has not only substantially reduced the time spent by employees on leave by revamping the return -to -work program, but she has reduced costs per claim, enhanced the workers' comp process and begun overhauling safety and training procedures. The reduced volume of lost -time days experienced by the public entity and its 3,000 employees has been a great benefit to Columbus in more than just fewer days off the job. hi 2011, the average number of days out of work for government employees was about 109, Arnie' said, noting that she took oversight of the program for the entire year in 2013, when the number dropped to 53. In 2014, the number was 28, nearly half of the 59-day figure projected by the Department of Labor's National. Disability Guidelines for that year, Amiel said. So how did she do it? An enhanced return -to -work program for employees with limited capacity played a big role. "Often the doctor says that an employee can come back to work but cannot do all Anne -Marie Amiel, Risk manager, Columbus Consolidated Government. Georgia the essential functions of their job," said Amiel. "If someone has a knee injury, for instance, they often can't be driving heavy equipment but could be driving something smaller." Amiel understood that offering light duty to more employees was not only good for the company and its self -insured workers' conip program, but was also psychologically beneficial to workers. "If someone is injured and out of work for more than 12 weeks, psychologically they tend to start thinking of themselves as disabled, and it gets to be harder and harder to bring them back to work," Amiel said. To make the process more effective, she centralized the return -to -work program instead of leaving it to various government divisions to handle their own employees. In the past, Amiel said, many of Columbus' departments would provide only as much light or transitional duty as could be absorbed within their own divisions, meaning that large numbers of employees unable to take on full duties had no choice but to stay at home and collect workers' compensation checks. Under Amiel's supervision, that has changed. "I have worked with all of our departments to allow their employees to be provided light duty in another department when there is none available in their own." One striking example of the new policy resulted in additional monetary benefits to the government. A police officer who was not able to perform her normal duties was placed in the public works department, where she helped create a database of addresses for Columbus, and identified a cross-referencing system failure with a local utility's database. "I have worked with all of our departments to allow their employees to be provided light duty in another department when there is none available in their own." — Anne -Marie Amiel, risk manager, Columbus Consolidated Government, Georgia As it turned out, a local water utility was using an outdated address list, meaning that Columbus' water bill mistakenly included trash collection charges for several new addresses, while Columbus was collecting trash at those locations without pay. Now able to collect accurate fees for services provided, "the increase in Columbus' revenue due to that one light -duty assignment between 2013 and 2014 has been approximately $ 100,000," Amiel said. "1 am still assigning people from other departments to public works duty to help them with the water department database," said Amiel. "Like most employers these days, we have a lot of tasks that need to be completed but insufficient personnel to perform them," she said. "Utilizing light -duty employees to accomplish these tasks is beneficial to both employer and employee." Lower Costs Per Claim That was only the beginning. Through Amiel's efforts, the government's total incurred cost per claim (the sum of medical and indemnity benefits and other incurred costs fir all claims, divided by the total number of all claims) has dropped dramatically. Costs per claim dropped by more than 60 percent over three years. from S9,971 in 2011 to $3,641 in 2014. After Amiel began exercising oversight of the program, the organization's total medical costs per indemnity claim dropped from S6,307 in 2011 to $2,014 in 2014. An indemnity claim is paid when the employee is out of work and is receiving the wage benefit from workers' compensation. One key step leading to these improvements was a change in Columbus' third -party administrator and a move to managed care in early 2014. Today, Columbus is using USIS/AmeriSys as its TPA and managed care organization (MCO). The shift was transformational, said Amiel. CCG's lost days dropped sharply from 2011 to 2014 — from 109 to 28. "Under the old system, the people managing our claims were not medical professionals," she said. "I really wanted a medical professional who could triage with our employees when they were hurt and help guide them to the correct treatment." At AmeriSys, a nurse case manager handles the medical side of all claims — and only Columbus' claims. That makes a difference, Amiel said. "With a workforce of over 3,000 employees, we need people who understand our culture and who get to know our employees,'" she said. Also instrumental to Columbus' improvements was moving away from the state's so-called "panel system." "In Georgia, the law says that if you use that system you need a list of six unique medical providers your employees can tap when they are injured," Amiel said. "The panel needs to include one minority member, for instance, one orthopedic specialist, and one walk-in provider, among others. "The problem has increasingly become we have larger practices buying out smaller ones so it can be difficult to find six quality providers." Managed care acts as an alternative to the panel system for Columbus, she said. "Under managed care, what happens is the MCO gets approval from the state workers' comp board for a whole network of providers and we now have access to over 200 providers," Amiel said. "Our MCO system provides both 24/7 coverage and medical management of claims, plus a larger network of available medical providers than does the panel system. have visited all of our regular medical providers so that I could make sure they know the city has a `face' and someone on whom they could call if they need more information on an employee or if they want to discuss potential light duty work." The new system's utilization review is also "one of the keys to cost control of injury claims." She noted that under the panel system "any dispute brought before the State Board of Workers' Compensation would essentially have a doctor's opinion on one side and a professional adjuster's on the other. If you were a judge, would you not take the opinion of the doctor over the adjuster? I know I would." she said. With the MCO system, there is a peer review system at an earlier stage than a court hearing. That peer review can result in medical professionals talking to other medical professionals and coming to a consensus on the appropriate course of treatment. That works to the benefit of the employee and gives the employer a greater confidence on the treatment plan being implemented, she said. "When one utilizes an MCO system there is a much more robust peer review system," Amid said. Loss Control Strategies Since bringing on the new TPA, Arniel said, she has been tracking accident trends and using that information to discuss potential safety improvements to work environments with Columbus' department heads. "For instance, we have stepped up employee training and workplace inspections provided to our employees, including different forms of driver training to include not only standard vehicles, but also vans and larger trucks," she said. "I have also rewritten our accident review policy to bring it more in line with national standards," she said. "We have adopted a system that is widely in place nationally, whereby employees are assigned points for various types of at -fault accidents according to the degree of severity. For example, a trash truck that hit a mailbox would be assigned fewer points than the driver of a city vehicle that hit a stopped car at an intersection. "Disciplinary actions are given in a progressive manner," she said. Among those who are impressed by Amiel's efforts is Columbus, Ga. Mayor Teresa Tomlinson. "We have seen a transformation in our workers' comp claims system through a more engaged management effort and best practices techniques," Tomlinson told Risk and Insurance®. "In three years, we are down from [roughly] $ 10,000 per claim to $4,000 per claim. That comes from having diligent in-house workers' comp personnel and a systematic approach to deal with the injuries and claims of our employees expeditiously. "We are better able to assess their needs and get them healthy and confident to return in just 28 days on average." "Of course," she said, "the best investment we can make for taxpayers is education and training through our safety plan. If the injury never happens, we are all better off and that's our goal. "In the event of an injury, our efforts turn to investing in a system that gets our valued employees healthy and safely back to work." ATTACHMENT 13 SSAE 16 excerpt A-LIGN INDEPENDENT SERVICE AUDITOR'S REPORT ON A DESCRIPTION OF USIS, INC.'S SYSTEM AND THE SUITABILITY OF THE DESIGN AND OPERATING EFFECTIVENESS OF CONTROLS To USES, Inc.: We have examined USES, Inc.'s CUSIS or 'the Company.) description of its Third Party Administration Services System at its Orlando, FIorida location for processing user entities' claims for the period Apnl 1, 2015 through March 31, 2016, and the suitability of the design and operating effectiveness of controls to achieve the related control objectives stated in the description. The description indicates that certain control objectives specified in the description can be achieved only if complementary user entity controls contemplated in the design of USIS's controls are suitably designed and operating effectively along with retaled controls at the service organization. We gave not evaluated the suitability of the design and operating effectiveness of such complementary user entity controts. USIS uses Suntrust Bank for deposit box services and ERIC Systems for primary claims management software Csubservice organizatieert. Tile description in Section 3 includes only the controis and related control objectives of USIS and excludes the control objectives and related controls of the subservice organizations. Our examination did not extend to controls ot the subservice organtations_ In Section 2 of this report, USIS has provided an assertion about the fairness of the presentation of the description and suitability of the design and operating effectiveness of the controls to achieve the related control objectives stated in the description. USIS is reepons lite for preparing the description and for the assertion: including the completeness. accuracy. arid method of presentation of the description and the assertion, providing the services covered by the description, specifying the contmi objectives and stating them in the descnptien, identifying the risks that threaten the achievement of the control objectivee, selecting the criteria, and designing, implementing, and docunienting controls to achieve the related control objectives stated in the description. Our responsibility is to express an opinion on the fairness of the presentation of the description and on the suitability of the design and operating effectiveness of the controls to achieve the related control objectives stated in the description, based on our examination. We conducted our examination in accordance with attestation standards established by the American Institute of Certified Public Accountants_ Those standards require that we plan and perform our examination to obtain reasonable assurance about whether, all material respects, the description is fairly presented and the controls were suitably designed and operating effectively to achieve the related control objectives stated in the description for the period April 1, 2015 through March 31, 2016. An examination of a description of a service triganation's system and the suitability of the design and operating effectiveness of the service organization's controls to achieve the related control objectives stated M the description invotees performing procedures to obtain evidence about the fairness of the presentation of the description and the suitability of the design and operating effectiveness of those controls to achieve the related control objectives stated in the description. Our procedures included assessing the risks that the description is not fairly presented and that the controls were not suitably deigned or operating effectively to achieve the related control objectives stated in the clescripficm. Our procedures also included testing the operating effectiveness of those controls that we consider necessary to provide reasonable assurance that the related central objectives stated in the description were achieved_ An examination engagement of this type also includes evaluating the overall presentation of the description and the suitability of the control objectives stated therein, and the suitability of the criteria specified by the service organization and described in Section 2. We believe that the evidence we obtained is sufficient and appropriate to provide a reasonable basis for our opinion. Proprietary and Coriedential 2 Because of their nature, controls at a service organization may not prevent, or detect and correct, all errors or omissions in processing or reporting transactions. Also, the projection to the future of any evaluation of the fairness of the presentation of the description, or conclusions about the suitability of the design or operating effectiveness of the controls to achieve the related control objectives is subject to the risk that controls at a service organization may become inadequate or fail. In our opinion, in all material respects. based on the criteria described in USIS's assertion in Section 2 of this report, • the description fairly presents the system that was designed and implemented for the period April 1, 2015 through March 31, 2016. • the controls related to the control ob}ectives stated in the description were suitably designed to provide reasonable assurance that The control objectives would be achieved if the controls operated effectively for the period April 1, 2015 through March 31, 2016 and user entities applied the complementary user entity controls contemplated in the design of IJSIS's controls for the period April 1, 2015 through March 31, 2016. • the controls tested, which together with the complementary user entity controls referred to in the scope paragraph of this report, if operating effectively, were those necessary to provide reasonable assurance that the control objectives stated in the description were achieved, operated effectively for the period April 1, 2015 through March 31, 2016. The specific controls tested and the nature. liming, and results of those tests are listed in Section 4. This report. including the description of tests of controls and results thereof in Section 4. is intended solely for the information and use of USIS. user entities of USIS's system during some or ail of the period April 1, 2015 through March 31, 2016. and the independent auditors of such user entities, who have a sufficient understanding to consider rt. along with other information including information about controls implemented by user entities themselves, when assessing the risks of material misstatements of user entities' financial statements. This report is not intended to be and should not be used by anyone other than these specified parties. A-CIC., May 20, 2016 Tampa. Florida Proprietary and Confidential 1 3 ATTACHMENT B2 Managed Care Price Proposal Request For Proposals: MANAGED CARE AmeriSys* PRICE PROPOSAL Attachment B2 USIS, Inc. Contact Person: Ron Warble, Executive Vice President Firm's Liaison: Cheryl Gulasa 140 Alexandria Blvd., Suite H Oviedo, Florida 32765 Phone: 800.752.0886 ext. 3150 Fax: 407.949.3140 Federal Employer Identification Number: 204580645 City of Miami, Florida RFP No.605386 ATTACHMENT B2 MANAGED CARE PRICE PROPOSAL SCHEDULE INSTRUCTIONS: The Proposer's price shall be submitted on this form "Price Proposal Schedule", and in the manner stated herein. Proposer is requested to fill in the applicable blanks on this form and to make no other marks. AmeriSys has not provided an all-inclusive flat fee the variables of Telephonic and Field Nurse Case Management Assignments. AmeriSys would have to include an artificially inflated price to cover potential Assignments that may not occur. For the City's protection we are only offering a proposal with itemized charges in the tables provided. If proposing more than one category of services (Part I or Part II) Proposer must complete one Price Proposal Schedule for each category of service. This Price Schedule is for Part II Services only: Managed Care/Medical Bill Review/Audit Services. 1. INITIAL TERM (Years 1 through 3) A. Proposed Total Fees and Costs for Initial Term (Years 1 through 3): The proposed total fees and costs shall include all fees, including one-time and recurring, and value added options, for Part II Services only. (Total fees and costs should be the aggregate price for the initial three years) B. Breakdown of Total Fees and Costs for Initial Term (Years 1 through 3) The Proposer shall break down its price for providing the Managed Care/Medical Bill Review/Audit Services as specified in Section 3, Specifications/Scope of Work. The proposed fees shall be based on: a) the three (3) year initial term Agreement; b) flat fee broken down on an annual basis for the three (3) year term; c) the cost for anticipated staffing levels, based on the Proposer's proposal; and d) the implementation costs, 1. Proposed Staffing Positions FTE Annual Salary Total Costs 1 Supervisor $ $ 2 $ $ 3 $ $ 4 $ $ 5 $ $ 6 $ $ 7 $ $ 8 $ $ 9 $ $ 10 $ $ 11 $ $ 12 $ $ Proposed Total Fees and Costs $ Third Party Claims Administration Ro,,92916 City of Miami, Florida RFP No.605386 2. Proposed Annual Costs (inclusive of staffing costs) Base Cost ($) Projected Increase (%) Total Costs Year 1 $ $ Year 2 $ $ Year 3 $ $ Proposed Grand Total (Years 1 through 3) $ 3. Proposed One -Time Implementation Costs Item Description Total Costs 1 $ 2 $ 3 $ 4 $ 5 $ Proposed Total Fees and Costs $ Notes: 1) The City reserves the right to correct and re -calculate any errors found in Proposer's calculation. 2) Total Fees and Costs from Tables 1, 2, and 3, In Section 1B above, should equal the aggregate costs in Section 1A above. 2. OPTION TO RENEW YEARS (Two, One -Year Periods - Years 4 and 5) The Proposer shall state its proposed price below for the costs during the optional renewal years. This Price Proposal Schedule is for Part II Services Only: Managed Care/Medical Bill Review Services A. Proposed Total Fees and Costs for Initial Term (Years 1 through 3): The proposed total fees and costs shall include all fees, and value added options, for Part II Services Only. (Total fees and costs should be the aggregate price for the two renewal years) B. Breakdown of Total Fees and Costs for Initial Term (Years 1 through 3) The Proposer shall break down its price for providing the Managed Care/Medical Bill Review Services as specified in Section 3, Specifications/Scope of Work, during the option to renew years. The proposed fees shall be based on: a) the two (2) additional years of the Agreement; b) flat fee broken down on an annual basis for the two years; and c) the cost for anticipated staffing levels, based on the Proposer's proposal. City of Miami, Florida RFP No.605386 4. Proposed Staffing Positions FTE Annual Salary Total Costs 1 Supervisor $ $ 2 $ $ 3 $ $ 4 $ $ 5 $ $ 6 $ $ 7 $ $ 8 $ $ 9 $ $ Proposed Total Fees and Costs $ *Use additional paper if required 5. Proposed Annual Costs (inclusive of staffing costs) Base Cost ($) Projected Increase (%) Total Costs Year 1 $ $ Year 2 $ $ Proposed Grand Total (Years 4 and 5) $ Notes: 1) The City reserves the right to correct and re -calculate any errors found in Proposer's calculation. 2) Total Fees and Costs from tables 4 and 5, in Section 2B above, should equal the aggregate costs in Section 2A above. 3. ADDITIONAL SERVICES (Initial Term and Option to Renew Years1 The Scope of Work outlined herein identifies the work that the selected Proposer shall perform under the Agreement. To address future City requests for any additional work; modifications, or changes outside of the scope of work, please provide not -to -exceed hourly rates for personnel who will be assigned to this contract. 6. Additional Services Personnel Proposed Not -To -Exceed Hourly Rates $ $ $ $ $ 4 City of Miami, Florida RFP No.605386 *Use additional paper if required Notes: 1) The proposed prices above in Sections 1A, shall be fixed and firm for the initial term of the Agreement. The proposed prices for the option to renew years, in Sections 2A, may be negotiated prior to the renewal of the contract for each option to renew period, at the sole discretion of the City. Any extensions to the Agreement beyond the five year period, will be at the then current rates. 2) All out-of-pocket expenses, including employee travel, per diem and miscellaneous costs and fees, should be included in the Proposers proposed price, as they will not be reimbursed separately by the City. Refer to CH.112.061 of the Florida Statutes regarding adherence to travel expenses. 3) Notwithstanding the proposed hourly rates in Sections 3, Additional Services, above, the City reserves the right to negotiate the not -to -exceed pricing on a year by year basis, at the City's sole discretion. 4) The positions identified in the table above shall be the same as the key positions identified in the Proposer's proposal. The City expects that the personnel in those positions will be performing the services. 4. BREAKDOWN OF MANAGED CARE/MEDICAL REVIEW/AUDIT SERVICES The Proposer shall state the not to exceed charges in the columns provided in Tables 7 and 8, for the itemized Managed Care Services listed on the following pages: AmeriSys has not provided an all-inclusive flat fee the variables of Telephonic and Field Nurse Case Management Assignments. AmeriSys would have to include an artificially inflated price to cover potential Assignments that may not occur. For the City's protection we are only offering a proposal with itemized charges in the tables provided. 5 City of Miami. Florida RFP No.605386 A. MANAGED CARE/BILL REVIEW/AUDIT SERVICES - ITEMIZED Proposer shall list the not -to -exceed charge for each Service itemized below in Table 7: 7. Itemized Managed Care/Bill Review/Audit Services Services Charges Fee Schedule (Bill Review / UCR / System Savings) $7.00 per Bill All Other Savings • Clinical Validation/Nurse Review (CV) • Preferred Provider Networks (PPO) • Out Of Network (OON) • Specialty Networks/ Physical Therapy (PT) 0% 23.5% of Savings* 23.5% of Savings* 23.5% of Savings* *Savings below Fee Schedule Electronic Receipt of Medical Bills $2.00 additional per bill Telephonic Case Management $75.00 per Hour $74.00 per Medical Triage Hospital Certification Program $125 Inpatient Pre -Certification* *Physician Advisor Fees not Included Utilization Review Program $75.00 per Hour* *Physician Advisor Fees not Included Physician Review/Peer Review $275.00 - $325.00 per Hour Task Based Field Case Management • Task 1: One Visit Task • Task 2: Two Visit Task • Task 3: Labor Market Survey • Task 4: Vocational Assessment • Task 5: Home Visit • $605.00 • $780.00 • $600.00 • $650.00 • $650.00 Medical Case Management and Vocational Rehabilitation — Hourly $89.00 per hour Medical Case MgmtlVoc $92.00 per hour Cat Claims $110.00 per hour MA, CA, PA, NY Priority Care 365 $100.00 per call Contracted with MedCor Durable Medical Equipment (DME) Program- First Script AmeriSys Preferred Provider Network Cost of medical equipment — No charge for PPO Reductions $7.00 charge per bill City of Miami, Florida RFP No.605386 Medical Cost Projection (MCP) and Clinical Recommendations $95•00 per Hour Life Care Planning - $125.0 per Hour Pharmacy Benefit Management (PBM) First Script myMatrixx No charge for Bill Review or PPO reductions for PBM transactions CypressCare $2.00 for Bill Review No charge for PPO reductions Rx Peer to Peer Review (P2P) Drug Utilization A Pharmacist to Physician (peer to peer) $250 flat rate Rx Drug Utilization Assessment (DUA) Drug Regimen Review - $150/hour (3 hour minimum) One Drug Review - $250 flat rate Drug Utilization Review — No Charge Alert, Review and Manage (ARM)® - No Charge myRisk Predictor® - No Charge Return to Work Coordinator (Injury Coordinator) Coordinator - $$,750 per month Durable Medical Equipment (DME) Program- First Script AmeriSys Preferred Provider Network Cost of medical equipment — No charge for PPO Reductions $7.00 charge per bill Dental Review Program Charged on a per review basis OSHA Reporting NA — Refers to Part I Taxes (All applicable taxes will be added to the service fees where required) 7 City of Miami, Florida RFP No.605386 B. OTHER SERVICES - ITEMIZED: Proposer shall list the not -to -exceed charge for each Service itemized below in Table 7: 8. Other Services SERVICES CHARGES On-line Access No Charge GB International Claims Services NA Consultative Services Loss Control Consulting Services $120.00 per hour Appraisal Services TBD Fraud Prevention — Gallagher Bassett Investigative Services (GBIS) Special Fraud Investigations - SIU $85 per hour plus expense Surveillance Investigations $75 per hour plus expense Targeted Field Investigations $80 per hour plus expense Targeted Database Investigations Rate per report MSA Workers Compensation Medicare Set -Aside Allocation (WCMSA) $2 200 per allocation Rush Fees (MSA completed within 7 days) $450 per case Revisions: 3 - months free, 150/hour Liability Medicare Set -Aside Allocation (LMSA) $2,000 Fee MSA Submission to CMS $700 Fee Compliance Services Conditional Payment Research (CPR) $200 Flat Fee Conditional Payment Negotiations (CPN) $375 Flat Fee Secure Final Demand for Settlement (SFD) $4 if included in CPR or CPN Otherwise $350 Bundled CP Resolution Services $700 Flat Fee Benefit Coordination & Recovery Contractor Notification $45 Flat Rate Medicare Eligibility Inquiry (MEI) $150 Flat Rate SSDI Verification $175 Flat Rate Release / Settlement Agreement Review $125/hour max $375 Lien Resolution (Advantage Plan, Medicaid, Part D) $500 Flat Rate per Lein Resolution Taxes (All applicable taxes will be added to the service fees where required) 8 City of Miami. Florida RFP605386 EXHIBIT C MANAGED CARE/MEDICAL BILL REVIEW/AUDIT SERVICES PRICE SCHEDULE The charges shown below are the maximum not -to -exceed charges for each service that will be provided as stated in the Scope of Services (Exhibit B). These charges are for Managed Care/Medical Bill Review/Audit Services only. The charges shall remain firm and fixed for the first two (2) years of the Contract. The City reserves the right to negotiate the rates for Year 3, and for renewal and/or extension periods. 1. Itemized Managed Care/Bill ReviewfAudit Services Services Charges Fee Schedule (Bill Review / UCR / System Savings) $7.00 per Bill All other Savings (Network Access Fees): 1) Clinical Validation/Nurse Review 2) Preferred Provider Networks (PPO) 3) Out Of Network 4) Specialty Networks/ Physical Therapy 0% 22% 22% 22%0 Electronic Receipt of Medical Bills $0.00 Telephonic Case Management $75.00 per Hour $74.00 per Medical Triage Hospital Certification Program $125 Inpatient Pre -Certification* *Physician Advisor Fees not Included Utilization Review Program 1) Advanced Medical Review > $75/hour billed in six (6) minute increments not to exceed 1.5 hours or $100.00 for review of the medical necessity of diagnostics, therapies, Durable Medical Equipment (DME) and injections related to an injured employee's condition. Each requested modality is reviewed individually.* 2) Complex Care Review (Concurrent Review) > $75/hour billed in six (6) minute increments not to exceed three (3) hours or $225.00 to address either the medical necessity and/or causal relationship of a physician's single proposed plan of treatment or the need for an ongoing single treatment related to an injured employee's condition.* 3) Retrospective Review > $75/hour billed in six (6) minute increments not to exceed twelve (12) hours or $900.00 to address either the medical necessity and/or causal relationship of multiple physicians' proposed plan of treatment or the need for ongoing treatments related to an injured employee's condition.* *Physician Advisor Fees not Included 1 City of Miami, Florida RFP605386 Physician Review/Peer Review $275.00 - $325.00 per Hour Dependent on Specialty Task Based Field Case Management Task 1: One Visit Task Task 2: Two Visit Task Task 3: Labor Market Survey Task 4: Vocational Assessment Task 5: Home Visit Medical Case Management and Vocational Rehabilitation Priority Care 365 1) $605.00 2) $780.00 3) $600.00 4) $650.00 5) $650.00 $89.00 per hour Medical Case MgmtlVoc $92.00 per hour Cat Claims $110.00 per hour MA, CA, PA, NY NA DME Program AmeriSys Preferred Provider Network Cost of medical equipment — • No charge for PPO Reductions • $7.00 charge per bill Medical Cost Projection (MCP) and Clinical Recommendations $95.00 per Hour - (Not to exceed $1,750 per (MCP)) Life Care Panning - $125.00 per Hour- (Not to Exceed $2,000) Pharmacy Benefit Management (PBM) — First Script myMatrixx No charge for Bill Review or PPO reductions for PBM transactions CypressCare $2.00 for Bill Review No charge for PPO reductions Rx Peer to Peer Review (P2P) Drug Utilization A Pharmacist to Physician (peer to peer) $250 flat rate Rx Drug Utilization Assessment (DUA) Drug Regimen Review - $1501hour (3 hour minimum) One Drug Review - $250 flat rate Drug Utilization Review — No Charge Alert, Review and Manage (ARM)® - No Charge myRisk Predictor® - No Charge _ Return to Work Coordinator (Injury Coordinator) N/A DME Program- First Script AmeriSys Preferred Provider Network Cost of medical equipment — • No charge for PPO Reductions • $7.00 charge per bill Dental Review Program Charged on a per review basis Occupational Safety and Health Administration Reporting NA — Refers to Part I 2 City of Miami, Florida RFP605386 2. Other Services Services Charges On-line Access No Charge GB International Claims Services NA Consultative Services Loss Control Consulting Services $120.00 per hour Appraisal Services To be determined and negotiated Fraud Prevention Special Fraud Investigations $85 per hour, plus expense Surveillance Investigations $75 per hour, plus expense Targeted Field Investigations $80 per hour, plus expense Targeted Database Investigations Rate per report MSA Workers Compensation (WC) Medicare Set -Aside (MSA) Allocation $2,200 per allocation Rush Fees (MSA completed within 7 days) $450 per case Revisions 3 — month free, $150/hour Liability Medicare Set -Aside Allocation $2,000 Fee MSA Submission to Centers for Medicare and Medicaid Services $500 Fee Compliance Services Conditional Payment Research $125 Flat Fee Conditional Payment Negotiations $250 Flat Fee Secure Final Demand for Settlement $0 if included in CPR or CPN Otherwise $350 Bundled CP Resolution Services $500 Flat Fee Benefit Coordination & Recovery Contractor Notification $45 Flat Rate Medicare Eligibility Inquiry $50 Fiat Rate Social Security Disability Income Verification $50 Flat Rate Release / Settlement Agreement Review $125/hour max $375 Lien Resolution (Advantage Plan, Medicaid, Part D) $500 Flat Rate per Lien Resolution Note: Taxes (All applicable taxes will be added to the service fees where required) 3 City of Miami, Florida Contract No. RFP 605386 EXHIBIT D INSURANCE REQUIREMENTS 24 Managed Care/Medical Bill Review/Audit Services City of Miami, Florida RFP No.605386 EXHIBIT D INSURANCE REQUIREMENTS INDEMNIFICATION Provider shall pay on behalf of, indemnify and save City and its officials harmless, from and against any and all claims, liabilities, losses, and causes of action, which may arise out of Provider's performance under the provisions of the Agreement, including all acts or omissions to act on the part of Provider, including any person performing under this Agreement for or on Provider's behalf, provided that any such claims, liabilities, losses and causes of such action are not attributable to the negligence or misconduct of the City and, from and against any orders, judgments or decrees which may be entered and which may result from this Agreement, unless attributable to the negligence or misconduct of the City, and from and against all costs, attorneys' fees, expenses and liabilities incurred in the defense of any such claim, or the investigation thereof. The Provider shall furnish to the City of Miami, clo Procurement Department, 444 SW 2nd Avenue, 6th Floor, Miami, Florida 33130, Certificate(s) of Insurance which indicate that insurance coverage has been obtained which meets the requirements as outlined below: The Provider shall, at its own cost and expense, acquire and maintain during the term of the Agreement, with carriers having an AM Best Rating of A-VII or better, sufficient insurance to adequately protect the respective interests of the parties, including the Provider's indemnity obligations. Specifically, the Provider must carry the following minimum types and amounts of insurance on an occurrence basis or in the case of coverage that cannot be obtained on an occurrence basis, then coverage can be obtained on a claims -made basis with a three (3) year tail following the termination or expiration of this Agreement: a) Commercial General Liability: Written on an occurrence form, including but not limited to premises -operations, broad form property damage, products /completed operations, contingent and contractual exposures, personal injury and advertising injury, with limits of at least $1,000,000 per occurrence and $2,000,000 general aggregate. This coverage should be written on a primary and non-contributory basis, and should list the City as an additional insured; b) Workers' Compensation Insurance: Statutory Workers' Compensation Insurance and Employers' Liability insurance in the minimum amount of $1,000,000 each employee by accident, $1,000,000 each employee by disease and $1,000,000 aggregate by disease with benefits afforded under the laws of the state or country in which the services are to be performed. Policy will include an alternate employer endorsement providing coverage in the event any employee of the Provider sustains a compensable accidental injury while on work assignment with Company. Insurer for Vendor will be responsible for the Workers' Compensation benefits due such injured employee; c) Commercial Automobile Liability: If an automobile is used by the Provider in connection with the performance of its obligations under this Agreement, then Comprehensive Automobile Liability Insurance for any owned, non -owned, hired, or borrowed automobile used in the performance of Provider's obligations under this Agreement is required in the minimum amount of $1,000,000 each accident combined for bodily injury and property damage. City of Miami should be listed as an additional insured; Managed Care Services City of Miami, Florida RFP No.605386 d) Professional Errors and Omissions Liability: Insurance in the minimum amount of $10,000,000 per claim and policy aggregate, protecting the City against Provider's professional negligence, failure to perform professional duties and breach of contractual obligations under this Agreement, including but not limited to, coverage for claims services and certification that there is no security breach or unauthorized use exclusion on this policy; e) Network SecuritylPrivacy Liability (Cyber Liability): Insurance in the minimum amount of $5,000,000 per occurrence including but not limited to protection of private or confidential information whether electronic or non -electronic; network security and privacy liability; protection against liability for systems attacks; denial or loss of service; introduction, implantation or spread of malicious software code; security breach; unauthorized access and use; including regulatory action expenses; cyber extortion coverage; and notification and credit monitoring expenses f) Employee Dishonesty/Fidelity: Insurance including 3rd Party Liability in the minimum amounts of $1,000,000 each occurrence for acts of all Staff; and g) Excess Umbrella Liability (Excess Follow Form): Minimum limits of $10,000,000 per occurrence/aggregate. This coverage is excess over all applicable liability policies. The above insurance limits may be achieved by a combination of primary and umbrella/excess liability policies. 1. Prior to the execution of this Agreement (or seven (7) calendar days prior to the start of work under this Agreement) and annually upon the anniversary date(s) of the insurance policy's renewal date(s), the Provider will furnish the City with a Certificate of Insurance evidencing the coverages set forth above and naming the City, its subsidiaries, affiliates, authorized distributors, directors, officers, employees, partners and agents as an "Additional Insured" on the Provider's Commercial General Liability and Commercial Auto Liability policies listed above and name the City, its subsidiaries, affiliates, authorized distributors, directors, officers, employees, partners and agents as a "Loss Payee" on the Provider's Fidelity policy. 2. The Provider shall provide the City thirty (30) calendar days written notice of any cancellation, non -renewal, termination, material change or reduction in coverage. 3. The Provider's insurance as outlined above shall be primary and non-contributory coverage. 4. The coverage territory for the stipulated insurance shall be on a worldwide basis. 5. The Provider must ensure that any subcontractors or other service providers the Provider engages to provide the services required under this Agreement, acquire and maintain at all times, with insurance companies with a minimum A.M. Best Rating A-VII, the same levels of insurance coverage as are outlined above. The Provider and subcontractors of the Provider, will cause their insurance companies to waive their right of recovery against the City. 6. The stipulated limits of coverage above shall not be construed as a limitation of any potential liability to Company, and failure to request evidence of this insurance shall not be construed as a waiver of the Provider's obligation to provide the insurance coverage specified. BINDERS ARE UNACCEPTABLE. 2 Managed Care Services City of Miami, Florida RFP No.605386 The insurance coverage required shall include those classifications, as listed in standard liability insurance manuals, which most nearly reflect the operations of the Provider. All insurance policies required above shall be issued by companies authorized to do business under the laws of the State of Florida, with the following qualifications: Certificates will indicate no modification or change in insurance shall be made without thirty (30) days written advance notice to the certificate holder. NOTE: CITY RFP NUMBER AND/OR TITLE OF RFP MUST APPEAR ON EACH CERTIFICATE, AND THE CITY MUST BE LISTED AS THE INSURED AND/OR ADDITIONAL INSURED. Compliance with the foregoing requirements shall not relieve the Provider of his liability and obligation under this section or under any other section of this Agreement. --If insurance certificates are scheduled to expire during the contractual period, the Provider shall be responsible for submitting new or renewed insurance certificates to the City at a minimum of ten (10) calendar days in advance of such expiration. --In the event that expired certificates are not replaced with new or renewed certificates which cover the contractual period, the City shall: (a) Suspend the Agreement until such time as the new or renewed certificates are received by the City in the manner prescribed in the RFP. (b) The City may, at its sole discretion, terminate this Agreement for cause and seek re - procurement damages from the Provider in conjunction with the General and Special Terms and Conditions of the solicitation. The Provider shall be responsible for assuring that the insurance certificates required in conjunction with this Section remain in force for the duration of the contractual period; including any and all option terms that may be granted to the Provider. 3 Managed Care Services BROWN-3 OP ID: JW ACOREY 4.....---- CERTIFICATE OF LIABILITY INSURANCE OATS (MMIDDrYYYY) 03/29/2017 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGAT1VELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the pollcy(ies) must be endorsed. if SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER Brown & Brown of Florida, Inc. Daytona Beach Office P.O. Box 2412 Daytona Beach, FL 32115-2412 M. Decker Youngman CONTACT LAURIE KOHLER #17125 NAME' F , Nol: 386-323-9159 'A/c, N , E><t1: FAX ADDREss: IkohlerI bbdaytona.com INSURER(SI AFFORDING COVERAGE NAM a 8ISURERA;Travelers Prop & Cas of Amer 25674 INSURED BROWN & BROWN INC ETAL P0BOX 2412 DAYTONA BEACH, FL 32115 INSURER e :Continental Casualty Co 20443 INSURER C:Travelers indemnity 25658 INSURER o : XL Specialty ins Inc. 37885 INsuRER E:Allied World Assurance Co Inc 19489 r INSURER F: / /,, COVERAGES CERTIFICATE NUMBER: SION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO/THE INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES EXCLUSIONS AND CONDITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY INSURED NAMED ABOVE FOR THE POLICY PERIOD OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, PAID CLAIMS_ INSR LTA TYPE OF INSURANCE ADOL SUBN INS1) vivo POLICY NUMBER POUCY EFF 1MMUDDIYYYY),4MM100//Y POLICY EXP YY) LNMns A X COMMERCIAL GENERAL UABIare X TC2JGLSA9527B87417 I 01/01/2017 ls _ ,' 11 C� ' i 1I01I2018 EACH OCCURRENCE S 1,000,000 X Ccou CLAIMS-MADEPREMISES DAMAGE TC3 RNT6D (Ee 01111D ) 1 OOa,000 3 , MED EXP (Any one person) 3 5,000 PERSONAL & ADV INJURY S 1,000,000 GEN'LAGGREGATE X POLICY OTHER: OTHER' LIMIT APPLIES PER. LDC GENERAL AGGREGATE 3 2,000,000 PRODUCTS - COMP/OP AGO $ 2,000,000 s A AUTOMOBILE X LIABILITY - X SCHEDULED AUTOS NONAWNED AUTOS X TC2JCAP9527B88217 01/01/2017 I. I. 01101/2018 COMBINED SINGLE LIMIT (Ea accident} $ 1 000,000 me BODILY INJURY (Per son) 3 BODILY INJURY (Par ea7den(} $ PROPERTY DAMAGES (Per accident) S B X UMBRELLA LAAB EXCESSL1AB X OCCUR CLAIMS -MADE 8011849429 01/01/2017 01101/2018 EACH OCCURRENCE S 10,000,000 AGGREGATE S 10,000,000 ❑ED 1 RETENTIONS $ A C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y ANY PRopRIETCR/PARTNERjEXECL'TIVE DNfA CFFICER2MEMBE.R EXCLUDED? (Mandatoryln NH) If yea. desalt:1e tinder DESCRIPTION OF OPERATIONS below TC2JUB9517B58017 TRKUB9518B76117 01101I2017 01/0112017 0110112018 13110112018 X PER 1 OTH- STATUTE ER. E L EACHACCIDENi S 1,000,000 EL D[SEASE-EAEMPLOYEE S 1,000,000 E L DISEASE - PCUCY LIMIT S 1,000,000 D E INS AGENTS E&O CYBER LIABILITY ELU14796717 03080277 01/01/2017 01/01/2017 01101/2018 01/01/2018 EACH LOSS 10,000,000 SEE PG 2 OESCRIPTfON OF OPERATIONS! LOCATIONS / VEHICLES fACORD 101, Additional Remarks Schedule, may he attached N mare space le required) NAMED INSURED: USIS INC. RFP 605386 THIRD PANTY CLAIMS ADMINISTRATION SERVICES. CITY OF MIAMI IS ADDITIONAL INSURED ON THE GENERAL LIABILITY ON A PRIMARY & NON-CONTRIBUTORY BASIS, PER FORMS CG D2 48 08 05 AND CG DO 37 04 05 AND ADDITIONAL INSURED ON THE AUTO LIABILITY, PER FORM CA T4 37 08 08. UMBRELLA CERTIFICATE HOLDER CANCELLATION CITYM-i CITY OF MIAMI PROCUREMENT DEPT 444 NW 2ND AVE 6TH FLOOR MIAMI, FL 33130 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOI^, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE © 1988.2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD NOTEPAD INSURED`SNAME BROWN & BROWN INC ETAL BROWN-3 PAGE 2 OP ID: JW oat. 0312912017 DATA BREACH = INFORMATION SECURITY & PRIVACY INSURANCE WITH ELECTRONIC MEDIA LIABILITY POLICY AGGREGATE $10,000,000 INCLUDING COVERAGE FOR PRIVACY NOTIFICATION COSTS; REGULATORY DEFENSE AND PENALTIES' W$BSITE MEDIA CONTENT LIABILITY NOTEPAD: HOLDER CODE CITYM-1 INSUREDS NAME BROWN & BROWN INC ETAL BROWN-3 OP ID: JW PAGE 3 Data 03129/2017 POLICY I9 FOLLOW PORM OVER THE GENERAL LIABILITY, AUTO LIABILITY, AND EMPLOYERS LIABILITY, PSR FORM G-15057-C 0605. '`����1? Cr CERTIFICATE OF PROPERTY INSURANCE OP ID: AT DATE (MMIDD(YYYY) 03/2912017 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER TFIE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. If thls certificate Is being prepared for a party who has an insurable Interest In the property, do not use this form. Use ACORD 27 or ACORD 28. PRODUCER Brown & Brown of Florida, Inc. Daytona Beach Office P.O. Box 2412 Daytona Beath, FL 32115.2412 M. Decker Youngman INSURED aAODUCER CONTACT NAME: DeBord PHONE 386-239-5703 1119, Eatl: ADDP.Ess: tdebord©bbdaytona.com CUSTOMER ID: BROWN-5 INSURER(S) AFFORDING COVERAGE l rA/CC, Noy: 386-238-8917 NAIC BROWN & BROWN, INC., ET AL P.O. BOX 2412 Daytona Beach, FL 32115-2412 INSURER A; Executive Risk Indemnity INSURER B INSURER C : INSURER 0 : INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: REVISIQN NUMBER: IBC L(1 �JJB nIRU H N IMJRA LJtt11fYl r[/i.I IIJ PRd CKVI sIg Schedule. 11 mom spec. Is nqulndj /� NAMED INSURED: USIS, INC. I THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURE NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTACT OR OTHER CUMENT WTH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBE HEREIN 15 SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CI�AiMS 1NSR LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE IMMIDDIYYYY) POLICY EXPIRATION DATE IMWDELITYYY1 COVERED PROPERTY LIMITS PROPERTY CAUSES OF LOSS DEDUCTIBLES - `,'0y \ \.k'', ,\ \; BUILCING PERSONAL PROPERTY BUSINESS INCOME EXTRA EXPENSE RENTAL VALUE BLANKET BUILDING BLANKET PERS PROP BLANKET BLDG & PP S $ BASIC BUILDING s BROAD $ Contonte SPECIAL. — $ EARTHQUAKE $ WNO $ FLOOD $ $ $ CAUSES INLAND MARINE OF LOSS NAMED PERILS TYPE OF POLICY $ $ POLICY NUMBER $ 5 A X TYPE Commercial CRIME OF !POLICY Crime 82220236 01/01/2017 01/01/2018 A Employes Theft $ 1,000,000 $ s BOILER & MACHINERY I EQUIPMENT BREAKDOWN — $ $ S $ SPECIAL COND MONS / OTHER COVERAGES {Attach ACORD 1ST, Additional Renaults Schedule, If mor) apace Is required) CERTIFICATE HOLDER CANCELLATION CITYM-1 CITY OF MIAMI PROCUREMENT DEPT 444 N.W. 2ND AVE. MIAMI, FL 33130 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE --- ® 1995-2009 ACORD CORPORATION. All rights reserved. ACORD 24 (2009/09) The ACORD name and logo are registered marks of ACORD City of Miami, Florida Contract No. RFP 605386 EXHIBIT E CORPORATE RESOLUTIONS AND EVIDENCE OF QUALIFICATION TO DO BUSINESS IN FLORIDA (To be provided upon document execution) 25 Managed Care/Medical Bill Review/Audit Services sutllhii.+1r2 - 1 lt+riJ:i I)erartn1ent ++f State PaticIorI F,c;.:'cus Name Sear:r I Socrrit Fictitious Name Detail Fictitious Name AMERISYS Filing Information Registration Number G06'0192C017 Status ACTIVE Filed Date 24 12 2:65 Expiration Date 12 31 2021 Current Owners 1 County ORANGE Total Pages 4 Events Filed 2 FEhEiN Number 55-085'4459 Mailing Add ess 5-23 MAJOR BOULEVARD STE 452 OP,„ANDO FL 32313 Owner Information US!S INC 5723 MAJOR 5OULVARD STE 452 ORLANDO FL 32313 FEIJEIN Number: 20-4530545 Document Number: P06000044222 Document Images Vevir^a;eir. PDFf,r^a: = V.ew image it PDF format •= - - V ew image ,r PDF fcr^•a: -- _ _. P.- _ i s' r= _ ` s: F-catious Name 5earcn hap: do,.sullhii.t+r.;tripts \.':tttir,li-[)CIRL4i,,,Q.tlt+cnunl-( Ilh1(11ta111)11171 rdoc... , ='7 _'1117 12 5 'Q15 Deta,l by FEl EIN Number Detail by FEIIEIN Number Florida Profit Corporation UStS. INC. Filing Information Document Number P06000044222 FEIIEIN Number 20-4580645 Date Filed 03 27 2006 State FL Status ACTIVE Last Event AMENDMENT Event Date Filed 04 11 2006 Event Effective Date NC NE Principal Address 5728 irtaior B v d Suite 450 Orlando. FL 32819 Changed: 04 13,2015 Mailing Address 220 S. Ridgewood Avenue Daytona Beach, FL 32114 Changed: 04 112015 Registered Agent Na ne & Address C T CORPORATION SYSTEM 1200 SOUTH PINE ISLAND ROAD PLANTATION. FL 33324 Name Changed: 03,20/2012 Address Changed: 03120 2012 OfficerrDirector Detail Name & Address Title President, Director Boone, Sam R.. Jr. 220 S. Ridgewood Avenue ht:c searr:n s_ nt z era Inquiry ccrpora:0-.,se.vch SearcrRes,.ItDe:ar nedirytype=Fe,Nc,mbar&orrectronrype=tribal&sear:hNarneOrder=2174580645P 1,3 12 C'2416 Daytona Beach, FL 32114 Detail by FE! EIN Number Title Treasurer Calderon, Jennifer 615 Crescent Executive Court Lake Mary. FL 32746 Title VP Lanni, James 220 S Ridgewood Arenue Daytona Beach, FL 32114 Title VP. Secretary Lloyd. Robert W. 220 S. Ridgewood ArsrL.e Daytona Sea:h, FL 32114 Title VP. Assistant Secretary Robinson. Anthory 220 S Ridgewood Afe. Daytona Beath. FL 32114 Title Executive Vice President Warble. Rona'd 140 Alexandra al., d., Suite H Oviedo. FL 32765 Ttie VP Watts. Andy 220 S. Ridgewood A,<e Daytona Beach. FL 321'4 Annual Reports Report Year Filed Date 2014 04 30:2014 2015 04. 13,2015 2016 04 08, 2016 Document Images sear7'1 Sure z Se.i',_'-PeSulrDetad"r"q i7irtypeaFe Numbe."&,irrertrr;r yY=1rIha5earrnN 9a-,e0,'7er=7n,t5..30e,.15P 2 3 126 '2'316 Detail by FEI EIN Number r- -7 .• -•- http sear sunt 2org SarcrP.,=.suilDe:311',--,prype=FeINL.rnotIr.7... _3 3