INNOVATIVE CLAIMS SOLUTIONS, INC. (#2027073)

Page 8 of 11 streamline the claims process by directing injured workers to the most suitable medical providers, reducing unnecessary emergency room visits or delays in treatment. Bill review for reduction to fee schedule and appropriateness of charges is completed by the outside bill review company. However, examiners are responsible for reviewing and approving each bill for payment ensuring all prescriptions, or treatment provided, adheres to what has been authorized. All treatment requests are responded to timely and documented in the claims management system. Referrals are made to the selected Utilization Review company when treatment appears to be excessive, outside of the normal treatment for certain types of injuries or if they meet our UR referral trigger criteria. Additionally, examiners are responsible for reviewing all medical reports and documenting a brief recap of all reports in the claim management system. Medical verification of disability will be obtained in a timely manner and maintained in the claim file to document the need for continuing indemnity benefits. Medical treatment provided will be reviewed for necessity, reasonableness, and relationship to the industrial injury. Catastrophic injury claims and extensive lost-time claims will be reviewed by a qualified medical management provider. Claims referred for outside medical management services will reflect the intent and scope of services requested. Client approval will be obtained prior to a referral to any nurse case manager. Pre-existing medical conditions and medical records will be explored/obtained on all lost-time claims. ICS has partnered with a Pharmacy Benefit Manager (PBM) to offer Innovative Solutions for pharmaceutical needs for injured workers. Through this partnership, the injured worker receives a pharmacy card via text, print or online access, which they can present at any pharmacy. The pharmacy utilizes the card to validate authorization for prescribed medications, dispenses the medication to the injured worker, and submits billing to the PBM provider. Medications will be billed according to the Official Medical Fee Schedule (OMFS), with the added benefit of a $20 discount per prescription filled through mail order. The PBM diligently monitors for duplicate therapy, early refill, and ensures strict control over access to medications exclusively for the industrial injury. Our examiners, claimants, and clients have access to a Medical Provider Network (MPN) for selecting healthcare providers. This network streamlines access to care for injured workers. MPN providers offer tailored medical treatment, ensuring timely care without unnecessary delays. Our examiners can choose from a diverse range of medical specialists, even in areas where finding such expertise might be challenging. By promptly connecting injured individuals with the right providers, we aim to prevent additional costs later in the claim. Medical-legal costs will be reviewed for appropriateness and necessity. Bills which do not qualify as valid medical-legal expenses will be objected to on a timely basis. Our Ancillary Care management partners provide our clients and their injured workers with cost savings and access to healthcare providers who possess a deep understanding of the workers' compensation process. These providers are accustomed to collaborating closely with our organization, ensuring seamless communication and coordination of care throughout the claims Docusign Envelope ID: 3D604DF4-2C2C-861D-8285-1B6425D792A9