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HomeMy WebLinkAboutLien On Me - 2018-12-17File #: 18-483 City of Huntington Beach f3PPR6 vED 7-0 MEETING DATE: 12/17/2018 REQUEST FOR CITY COUNCIL ACTION SUBMITTED TO: Honorable Mayor and City Council Members SUBMITTED BY: Fred A. Wilson, City Manager PREPARED BY: Michele Warren, Director of Human Resources Subject: Approve and authorize execution of a Professional Services Contract for Workers' Compensation Program Medical Bill Review Services with Lien On Me in the amount of $525,000, as contained in Workers' Compensation Internal Services Fund (55131001-69410) Statement of Issue: The City of Huntington Beach issued an RFP for a variety of ancillary Managed Care program services in support of the administration of its self -insured Workers' Compensation program. Managed Care services include medical bill review, utilization review and pharmacy benefit. The City issued an RFP and conducted an RFP review and evaluation process regarding the respondent proposals for medical bill review services. Lien On Me was awarded the highest review score for medical bill review, and staff recommends Lien On Me be granted a three-year contract as the most responsive bidder. Financial Impact: Funding for the implementation of the fiscal items contained in the professional services agreement will come from the Workers' Compensation Internal Services Fund (55131001.69410). The three-year not to exceed contract amount is $525,000. Adequate funds are available in FY 2018/19 to cover the remaining part of the fiscal year. No additional appropriation is required. Future fiscal years will be budgeted accordingly. Recommended Action: Approve and authorize the Mayor and City Clerk to execute "Professional Services Contract Between the City of Huntington Beach and Lien On Me for Workers' Compensation Medical Bill Review Services" for a period of three (3) contract years; and, authorize the City Manager to execute the contract and related documents. Alternative Action(s): Do not approve the professional services agreement and direct staff to issue another RFP for medical bill review services for the workers' compensation program. Analysis: City of Huntington Beach Page 1 of 3 173 Printed on 12/12/2018 powered by LegistarT1 File #: 18-483 MEETING DATE: 12/17/2018 The City of Huntington Beach is required by law to provide Workers' Compensation benefits to employees. Currently, and in the past, the City's Workers' Compensation Managed Care program services (medical bill review, utilization review and pharmacy) were bundled together with the W/C claims TPA contract services provider. In an effort to provide a more cost-effective structure for the City and improve program efficiency, the City desires to "unbundle" the Managed Care component services (bill review, utilization review and pharmacy). For the past six to nine months, Risk Management has evaluated its overall Workers' Compensation program structure to determine a) if the bundled Workers' Compensation third -party claims administration and Managed Care services program structure is in the City's overall best interests and b) whether the bundled program is providing the most cost-effective structure for the City and c) whether the bundled design is providing the City and its employees with the most responsive, customer service -oriented program possible. After reviewing all of the relevant factors, Risk Management concluded that the City would save money and get better, more effective service by unbundling. Managed Care services (bill review, utilization review and pharmacy) represent large costs in a Workers' Compensation program, and Risk Management has taken the time to understand what impact pricing variations and customer service will have on overall program results. Following best practices to search the market for cost competitive/superior quality Workers' Compensation Managed Care Program services, the City of Huntington Beach issued a Request for Proposal (RFP) regarding the Workers' Compensation claims managed care programs (bill review, utilization review and pharmacy). The City's intent via the RFP process was to evaluate and select the best qualified respondents for each program service (bill review, utilization review, and pharmacy). The City issued the RFP via Planet BIDS and received seven (7) qualified respondents for workers' compensation claims medical bill review services. The seven (7) qualified respondents were interviewed and Lien On Me received the highest evaluation score (90%). The process summary for all respondents included the following phased evaluation steps: Phase 1 Evaluation of the proposal materials provided by Bidders/Respondents based upon the RFP criteria. Each respondent was evaluated and scored against the proposal submittal evaluation criteria as listed in the RFP. The proposals were evaluated by Risk Management. Phase Il, Respondents were selected for interviews based on highest evaluation scoring of proposals submitted consistent with the RFP criteria, with a minimum of 60% score or higher. Phase lll, Interviews were held with the seven (7) qualifying respondents. The panel evaluators scored each respondent based upon responses to criteria consistent with the RFP. The panel evaluators consisted of internal and external Risk Management professionals, including a Risk Manager, Senior Risk Management Analyst, Risk Management Analyst and Workers' Compensation Administrator. City of Huntington Beach Page 2 of 3 Printed on 12/12/2018 174 powered by Legistar;M File #: 18-483 MEETING DATE: 12/17/2018 Of the seven (7) qualified respondents that were interviewed, Lien On Me received the highest evaluation score (90%). Based upon prior year costs for medical bill review, it is conservatively estimated that the City will save approximately 5%-10% utilizing this vendor. Staff recommends City Council award the contract for medical bill review services to Lien On Me and authorize the City Manager to execute the agreement. Environmental Status: N/A Strategic Plan Goal: Strengthen economic and financial sustainability Enhance and Maintain City Service Delivery Attachment(s): 1. Professional Services Contract - Lien On Me 2. Professional Service Award Analysis - Rank 1 and 2 City of Huntington Beach 175 Page 3 of 3 Printed on 12/12/2018 powered by Leoistar7'1 PROFESSIONAL SERVICES CONTRACT BETWEEN THE CITY OF HUNTINGTON BEACH AND LIEN ON ME FOR WORKERS' COMPENSATION MEDICAL BILL REVIEW SERVICES THIS AGREEMENT ("Agreement") is made and entered into by and between the City of Huntington Beach, a municipal corporation of the State of California, hereinafter referred to as "CITY," and LIEN ON ME, a California corporation hereinafter referred to as "CONSULTANT." WHEREAS, CITY desires to engage the services of a consultant to provide Workers' Compensation medical bill review services; and Pursuant to documentation on file in the office of the City Clerk, the provisions of the Huntington Beach Municipal Code, Chapter 3.03, relating to procurement of professional service contracts have been complied with; and CONSULTANT has been selected to perform these services, NOW, THEREFORE, it is agreed by CITY and CONSULTANT as follows: 1. SCOPE OF SERVICES CONSULTANT shall provide all services as described in Exhibit "A," which is attached hereto and incorporated into this Agreement by this reference. These services shall sometimes hereinafter be referred to as the "PROJECT." CONSULTANT hereby designates Goldie Galstjan who shall represent it and be its sole contact and agent in all consultations with CITY during the performance of this Agreement. 2. CITY STAFF ASSISTANCE CITY shall assign a staff coordinator to work directly with CONSULTANT in the performance of this Agreement. agree/ surfnet/professional svcs mayor I Of I I 10/12 3. TERM: TIME OF PERFORMANCE Time is of the essence of this Agreement. The services of CONSULTANT are to commence on tDtfC �r / ;1. �U/ $ (the "Commencement Date"). This Agreement shall1. automatically terminate three (3) years from the Commencement Date, unless extended or sooner terminated as provided herein. All tasks specified in Exhibit "A" shall be completed no later than 3 years from the Commencement Date. The time for performance of the tasks identified in Exhibit "A" are generally to be shown in Exhibit "A." This schedule may be amended to benefit the PROJECT if mutually agreed to in writing by CITY and CONSULTANT. In the event the Commencement Date precedes the Effective Date, CONSULTANT shall be bound by all terms and conditions as provided herein. 4. COMPENSATION In consideration of the performance of the services described herein, CITY agrees to pay CONSULTANT on a time and materials basis at the rates specified in Exhibit "B," which is attached hereto and incorporated by reference into this Agreement, fees, including all costs and expenses, not to exceed Five Hundred and Twenty-five Thousand Dollars ($525,000). MEMBER �11MV In the event CITY requires additional services not included in Exhibit "A" or changes in the scope of services described in Exhibit "A," CONSULTANT will undertake such work only after receiving written authorization from CITY. Additional compensation for such extra work shall be allowed only if the prior written approval of CITY is obtained. 6. METHOD OF PAYMENT CONSULTANT shall be paid pursuant to the terms of Exhibit "B." agree/ surfnet/professional svcs mayor 2 of 11 10/12 7. DISPOSITION OF PLANS, ESTIMATES AND OTHER DOCUMENTS CONSULTANT agrees that title to all materials prepared hereunder, including, without limitation, all original drawings, designs, reports, both field and office notices, calculations, computer code, language, data or programs, maps, memoranda, letters and other documents, shall belong to CITY, and CONSULTANT shall turn these materials over to CITY upon expiration or termination of this Agreement or upon PROJECT completion, whichever shall occur first. These materials may be used by CITY as it sees fit. 8. HOLD HARMLESS CONSULTANT hereby agrees to protect, defend, indemnify and hold harmless CITY, its officers, elected or appointed officials, employees, agents and volunteers from and against any and all claims, damages, losses, expenses, judgments, demands and defense costs (including, without limitation, costs and fees of litigation of every nature or liability of any kind or nature) arising out of or in connection with CONSULTANT's (or CONSULTANT's subcontractors, if any) negligent (or alleged negligent) performance of this Agreement or its failure to comply with any of its obligations contained in this Agreement by CONSULTANT, its officers, agents or employees except such loss or damage which was caused by the sole negligence or willful misconduct of CITY. CONSULTANT will conduct all defenses at its sole cost and expense and CITY shall approve selection of CONSULTANT's counsel. This indemnity shall apply to all claims and liability regardless of whether any insurance policies are applicable. The policy limits do not act as limitation upon the amount of indemnification to be provided by CONSULTANT. 9. PROFESSIONAL LIABILITY INSURANCE CONSULTANT shall obtain and furnish to CITY a professional liability insurance policy covering the work performed by it hereunder. This policy shall provide coverage for CONSULTANT's professional liability in an amount not less than One Million Dollars agree/ surfnet/professional svcs mayor 3 of 11 10/12 ($1,000,000.00) per occurrence and in the aggregate. The above -mentioned insurance shall not contain a self -insured retention without the express written consent of CITY; however an insurance policy "deductible" of Ten Thousand Dollars ($10,000.00) or less is permitted. A claims -made policy shall be acceptable if the policy further provides that: A. The policy retroactive date coincides with or precedes the initiation of the scope of work (including subsequent policies purchased as renewals or replacements). B. CONSULTANT shall notify CITY of circumstances or incidents that might give rise to future claims. CONSULTANT will make every effort to maintain similar insurance during the required extended period of coverage following PROJECT completion. If insurance is terminated for any reason, CONSULTANT agrees to purchase an extended reporting provision of at least two (2) years to report claims arising from work performed in connection with this Agreement. If CONSULTANT fails or refuses to produce or maintain the insurance required by this section or fails or refuses to furnish the CITY with required proof that insurance has been procured and is in force and paid for, the CITY shall have the right, at the CITY's election, to forthwith terminate this Agreement. Such termination shall not affect Consultant's right to be paid for its time and materials expended prior to notification of termination. CONSULTANT waives the right to receive compensation and agrees to indemnify the CITY for any work performed prior to approval of insurance by the CITY. 10. CERTIFICATE OF INSURANCE Prior to commencing performance of the work hereunder, CONSULTANT shall furnish to CITY a certificate of insurance subject to approval of the City Attorney evidencing the foregoing insurance coverage as required by this Agreement; the certificate shall: agree/ surfnet/professional sves mayor 4 of 11 10/12 A. provide the name and policy number of each carrier and policy; B. state that the policy is currently in force; and C. shall promise that such policy shall not be suspended, voided or canceled by either party, reduced in coverage or in limits except after thirty (30) days' prior written notice; however, ten (10) days' prior written notice in the event of cancellation for nonpayment of premium. CONSULTANT shall maintain the foregoing insurance coverage in force until the work under this Agreement is fully completed and accepted by CITY. The requirement for carrying the foregoing insurance coverage shall not derogate from CONSULTANT's defense, hold harmless and indemnification obligations as set forth in this Agreement. CITY or its representative shall at all times have the right to demand the original or a copy of the policy of insurance. CONSULTANT shall pay, in a prompt and timely manner, the premiums on the insurance hereinabove required. 11. INDEPENDENT CONTRACTOR CONSULTANT is, and shall be, acting at all times in the performance of this Agreement as an independent contractor herein and not as an employee of CITY. CONSULTANT shall secure at its own cost and expense, and be responsible for any and all payment of all taxes, social security, state disability insurance compensation, unemployment compensation and other payroll deductions for CONSULTANT and its officers, agents and employees and all business licenses, if any, in connection with the PROJECT and/or the services to be performed hereunder. 12. TERMINATION OF AGREEMENT All work required hereunder shall be performed in a good and workmanlike manner. CITY may terminate CONSULTANT's services hereunder at any time with or without cause, and whether or not the PROJECT is fully complete. Any termination of this Agreement by CITY shall agree/ surfnet/professional svcs mayor 5 of 11 10/12 be made in writing, a 60-day notice of which shall be delivered to CONSULTANT as provided herein. In the event of termination, all finished and unfinished documents, exhibits, report, and evidence shall, at the option of CITY, become its property and shall be promptly delivered to it by CONSULTANT. 13. ASSIGNMENT AND DELEGATION This Agreement is a personal service contract and the work hereunder shall not be assigned, delegated or subcontracted by CONSULTANT to any other person or entity without the prior express written consent of CITY. If an assignment, delegation or subcontract is approved, all approved assignees, delegates and subconsultants must satisfy the insurance requirements as set forth in Sections 9 and 10 hereinabove. 14. COPYRIGHTS/PATENTS CITY shall own all rights to any patent or copyright on any work, item or material produced as a result of this Agreement. 15. CITY EMPLOYEES AND OFFICIALS CONSULTANT shall employ no CITY official nor any regular CITY employee in the work performed pursuant to this Agreement. No officer or employee of CITY shall have any financial interest in this Agreement in violation of the applicable provisions of the California Government Code. 16. NOTICES Any notices, certificates, or other communications hereunder shall be given either by personal delivery to CONSULTANT's agent (as designated in Section 1 hereinabove) or to CITY as the situation shall warrant, or by enclosing the same in a sealed envelope, postage prepaid, and depositing the same in the United States Postal Service, to the addresses specified below. CITY and CONSULTANT may designate different addresses to which subsequent notices, certificates or agree/ surfnet/professional sves mayor 6 of 11 10/12 other communications will be sent by notifying the other party via personal delivery, a reputable overnight carrier or U. S. certified mail -return receipt requested: TO CITY: City of Huntington Beach ATTN: Human Resources Director 2000 Main Street Huntington Beach, CA 92648 17. CONSENT TO CONSULTANT: Lien On Me 330 N. Brand Blvd. - Ste 350 Glendale, CA 91203 When CITY's consent/approval is required under this Agreement, its consent/approval for one transaction or event shall not be deemed to be a consent/approval to any subsequent occurrence of the same or any other transaction or event. 18. MODIFICATION No waiver or modification of any language in this Agreement shall be valid unless in writing and duly executed by both parties. 19. SECTION HEADINGS The titles, captions, section, paragraph and subject headings, and descriptive phrases at the beginning of the various sections in this Agreement are merely descriptive and are included solely for convenience of reference only and are not representative of matters included or excluded from such provisions, and do not interpret, define, limit or describe, or construe the intent of the parties or affect the construction or interpretation of any provision of this Agreement. 20. INTERPRETATION OF THIS AGREEMENT The language of all parts of this Agreement shall in all cases be construed as a whole, according to its fair meaning, and not strictly for or against any of the parties. If any provision of this Agreement is held by an arbitrator or court of competent jurisdiction to be unenforceable, void, illegal or invalid, such holding shall not invalidate or affect the remaining agree/ surfnet/professional sves mayor 7 of 11 10/12 covenants and provisions of this Agreement. No covenant or provision shall be deemed dependent upon any other unless so expressly provided here. As used in this Agreement, the masculine or neuter gender and singular or plural number shall be deemed to include the other whenever the context so indicates or requires. Nothing contained herein shall be construed so as to require the commission of any act contrary to law, and wherever there is any conflict between any provision contained herein and any present or future statute, law, ordinance or regulation contrary to which the parties have no right to contract, then the latter shall prevail, and the provision of this Agreement which is hereby affected shall be curtailed and limited only to the extent necessary to bring it within the requirements of the law. 21. DUPLICATE ORIGINAL The original of this Agreement and one or more copies hereto have been prepared and signed in counterparts as duplicate originals, each of which so executed shall, irrespective of the date of its execution and delivery, be deemed an original. Each duplicate original shall be deemed an original instrument as against any party who has signed it. 22. IMMIGRATION CONSULTANT shall be responsible for full compliance with the immigration and naturalization laws of the United States and shall, in particular, comply with the provisions of the United States Code regarding employment verification. 23. LEGAL SERVICES SUBCONTRACTING PROHIBI CONSULTANT and CITY agree that CITY is not liable for payment of any subcontractor work involving legal services, and that such legal services are expressly outside the scope of services contemplated hereunder. CONSULTANT understands that pursuant to Huntington Beach City Charter Section 309, the City Attorney is the exclusive legal counsel for agree/ surfnet/professional sves mayor 8 of 11 10/12 CITY; and CITY shall not be liable for payment of any legal services expenses incurred by CONSULTANT. 24. ATTORNEY'S FEES In the event suit is brought by either party to construe, interpret and/or enforce the terms and/or provisions of this Agreement or to secure the performance hereof, each party shall bear its own attorney's fees, such that the prevailing party shall not be entitled to recover its attorney's fees from the nonprevailing party. 25. SURVIVAL Terms and conditions of this Agreement, which by their sense and context survive the expiration or termination of this Agreement, shall so survive. 26. GOVERNING LAW This Agreement shall be governed and construed in accordance with the laws of the State of California. 27. SIGNATORIES Each undersigned represents and warrants that its signature hereinbelow has the power, authority and right to bind their respective parties to each of the terms of this Agreement, and shall indemnify CITY fully for any injuries or damages to CITY in the event that such authority or power is not, in fact, held by the signatory or is withdrawn. 28. ENTIRETY The parties acknowledge and agree that they are entering into this Agreement freely and voluntarily following extensive arm's length negotiation, and that each has had the opportunity to consult with legal counsel prior to executing this Agreement. The parties also acknowledge and agree that no representations, inducements, promises, agreements or warranties, oral or otherwise, have been made by that party or anyone acting on that party's behalf, which are not embodied in this agree/ surfnet/professional svcs mayor 9 of 11 10/12 Agreement, and that that party has not executed this Agreement in reliance on any representation, inducement, promise, agreement, warranty, fact or circumstance not expressly set forth in this Agreement. This Agreement, and the attached exhibits, contain the entire agreement between the parties respecting the subject matter of this Agreement, and supersede all prior understandings and agreements whether oral or in writing between the parties respecting the subject matter hereof. 29. EFFECTIVE DATE This Agreement shall be effective on November 1, 2018 with approval by the City -A APFROVED $y co UAICIL o N 0EcEH8EQ 1- ,Zo) g. Council. This Agreement shall expire when terminated as provided herein. IN WITNESS WHEREOF, the parties hereto have caused this Agreement to be executed by and through their authorized officers. agree/ surfneUprofessional svcs mayor 10 of 11 10/12 IN WITNESS WHEREOF, the parties hereto have caused this Agreement to be executed by and through their authorized officers. CONSULTANT, Lien On Me, a California corporation By: �- L2i'Q5 pn=ajne ITS: (circle one) hairm residenWicc President AND By: t_ / print name ITS: (circle one) Secretary/ hief Financial OfticeriAsst. Secretary - Treasurer / CITY OF HUNTINGTON BEACH, a municipal corporation of the State of California 11 of 11 ayor Q 7�G2 4wdjl&d ity Clerk iz/.t7#R d.S s Director agree/ surfnet/professional svcs mayor - 10/12 18-6762/185946 EXHIBIT "A" A. STATEMENT OF WORK: (Narrative of work to be performed) Reduce the total cost of Workers' Compensation medical bills through a combination of rules based technology, clinical expertise, fee schedules, and reasonable and customary rates through the integration of a proprietary PPO network and bill review service. CONSULTANT will engage their skilled and trained individuals to read and comprehend medical reports, operative reports, ICD-9 diagnosis and other applicable documents to determine if the level of service billed is appropriate and consistent with the level of service provided to the injured worker. B. CONSULTANT'S DUTIES AND RESPONSIBILITIES: CONSULTANT's duties and responsibilities shall follow provisions specified in the City of Huntington Beach Scope of Work shown in Exhibit A.1. Detailed services shall include but is not limited to the Scope of Work in Exhibit A.1. C. CITY'S DUTIES AND RESPONSIBILITIES: City shall collaborate with CONSULTANT to promote compliance with Scope of Work requirements; foster a high level of communication, trust, transparency, and commitment which is imperative to the success of the program. D. WORK PROGRAM/PROJECT SCHEDULE: Work program is required per the Scope of Services as requested by the CITY. EXHIBIT A EXHIBIT A.1 LIEN ON ME - SCOPE OF SERVICES Medical Bill Review (MBR) • The consultant shall demonstrate the ability to review medical bills for compliance with the California Official Medical Fee Schedule (OMFS) and agree to review and process properly coded medical bills within five (5) business days of receipt of the bill. If it takes hospital or complex bills longer than 5 days due to lack of cooperation from provider, PPO delays, then consultant will contact the City/TPA to strategize the best way to move forward. • The consultant will demonstrate the ability to maximize savings through the application of PPO and/or Pharmacy Benefit Management (PBM) programs. • The Consultant will manually review surgical bills for unbundling and upcoding. • The consultant's bill review platform shall accurately evaluate and reduce provider charges in compliance with the California OMFS and have the capability to integrate PPO networks for additional reductions. Additionally, consultant shall have the capability to apply other bill review methods such as direct negotiations, when the OMFS is not applicable. • Disputed bills will be handled directly by Consultant. The City may override decisions made by the Consultant if it is determined to be in the best interests of the City. • Consultant must have the ability to integrate UR determinations into bill review software so payments are recommended for authorized medical services only. • Consultant will use its best efforts to assist the City to recover overpayments and mis- payments to wrong provider. • A knowledgeable bill review expert witness must be made available to defend Consultants bill review activities at the Workers' Compensation Appeals Board (WCAB) conferences and hearings at the Consultant's expense. The consultant shall comply with all Independent Bill Review (IBR) statutes and regulations and provide robust IBR appeal services at no additional cost to the City. IBR appeals services shall include, but not be limited to, prompt preparation of the litigation appeal file upon notice of appeal, and presentation of the appeal file to the City within seven (7) calendar days of the due date of the response, if necessary. • Consultant will not include duplicate reductions in their savings equation/calculation for the City. • The consultant will reimburse the City for penalties incurred by the City in favor of a provider that the City is able to prove were a result of the Consultant's negligence or willful action or inaction. • The consultant shall meet specific reporting and information requirements as set forth in the California Workers' Compensation Information System (WCIS) regulations. The consultant is responsible for submitting required data elements for all medical services for which a billing or other report of provided medical services has been received for review. The consultant shall submit the data within ninety (90) days of the medical bill review payment by electronic data interchange (EDI) in the manner set forth by the California EDI Implementation Guide for Medical Bill Payment Records. The consultant is responsible for submitting data elements omitted or made in error in order to submit complete, valid and accurate data on behalf of the City. The consultant is responsible for completion and submission of mandatory annual reports with required data elements as set forth in the WCIS regulations. • In accordance with Labor Code Section 4603.4, the consultant must create a process to accept electronic claims for payment of medical services. • The Consultant will perform the initial programming requirements for the interface between the Consultant and the City's claims management system — initial programming is included at no charge. • The Consultant agrees to produce and provide the City with standard written reports. The Consultant will provide monthly reports on referrals for all services and numbers of bills reviewed as it relates to the services. The Consultant will provide the City with any detailed reports as requested, included at no charge. • Consultant will obtain claims adjuster approval for all medical bill negotiations. EXHIBIT "B" Payment Schedule (Fixed Fee Payment) (**SEE EXHIBIT B.1— FIXED FEE PAYMENT SCHEDULE) 1. CONSULTANT shall be entitled to monthly progress payments toward the fixed fee set forth herein in accordance with the following progress and payment schedules. 2. Delivery of work product: A copy of every memorandum, letter, report, calculation and other documentation prepared by CONSULTANT shall be submitted to CITY to demonstrate progress toward completion of tasks. In the event CITY rejects or has comments on any such product, CITY shall identify specific requirements for satisfactory completion. 3. CONSULTANT shall submit to CITY an invoice for each monthly progress payment due. Such invoice shall: A) Reference this Agreement; B) Describe the services performed; C) Show the total amount of the payment due; D) Include a certification by a principal member of CONSULTANT's firm that the work has been performed in accordance with the provisions of this Agreement; and E) For all payments include an estimate of the percentage of work completed. Upon submission of any such invoice, if CITY is satisfied that CONSULTANT is making satisfactory progress toward completion of tasks in accordance with this Agreement, CITY shall approve the invoice, in which event payment shall be made within thirty (30) days of receipt of the invoice by CITY. Such approval shall not be unreasonably withheld. If CITY does not approve an invoice, CITY shall notify CONSULTANT in writing of the reasons for non -approval and the schedule of performance set forth in Exhibit "A" may at the option of CITY be suspended until the parties agree that past performance by CONSULTANT is in, or has been brought into compliance, or until this Agreement has expired or is terminated as provided herein. 4. Any billings for extra work or additional services authorized in advance and in writing by CITY shall be invoiced separately to CITY. Such invoice shall contain all of the information required above, and in addition shall list the hours expended and hourly rate charged for such time. Such invoices shall be approved by CITY if the work performed is in accordance with the extra work or additional services requested, and if CITY is satisfied that the statement of hours worked and costs incurred is accurate. Such approval shall not be unreasonably withheld. Any dispute between the parties concerning payment of such an invoice shall be treated as separate and apart from the ongoing performance of the remainder of this Agreement. Exhibit B EXHIBIT B.1 LIEN ON ME — FIXED FEE PAYMENT SCHEDULE MEDICAL BILL REVIEW Rate Fee Schedule (per bill) $ 7.00 Flat Fee per bill $ 7.00 Non- Network/ Non -Fee Schedule Fees - % of Savings $(*1) 10% PPO Network Bills - % of Savings $ *2) 20% Hospital In -Patient Fees $ 250.00 Hospital Out -Patient Fees $ 200.00 Duplicates $ No Charge Reconsiderations $ *3) No Charge Pharmacy Bills $ 7.00 Expert Witness $ *4) No Charge Full Pays $4.00 (*1) - Non-Network/Non-Fee Schedule & PPO Network Bills - capped at $7,000.00 per bill. (*2) - B1ueCross PPO at 23 % of Savings. (*3) - No charge for LOM Reconsiderations ONLY. (*4) - No charge for W.C.A.B. Expert Witness appearances on LOM reviewed bills ONLY. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 PROFESSIONAL SERVICES CONTRACT BETWEEN THE CITY OF HUNTINGTON BEACH AND LIEN ON ME FOR WORKERS' COMPENSATION MEDICAL BILL REVIEW Table of Contents Scope of Services CityStaff Assistance................................................................................................2 Term; Time of Performance.....................................................................................2 Compensation..........................................................................................................2 ExtraWork...............................................................................................................2 Methodof Payment..................................................................................................3 Disposition of Plans, Estimates and Other Documents...........................................3 HoldHarmless.........................................................................................................3 Professional Liability Insurance.............................................................................4 Certificate of Insurance............................................................................................5 Independent Contractor............................................................................................6 Termination of Agreement.......................................................................................6 Assignment and Delegation......................................................................................6 Copyrights/Patents...................................................................................................7 City Employees and Officials..................................................................................7 Notices......................................................................................... 7 Consent....................................................................................................................8 Modification.............................................................................................................8 SectionHeadings.....................................................................................................8 Interpretation of this Agreement..............................................................................8 DuplicateOriginal....................................................................................................9 Immigration...............................................................................................................9 Legal Services Subcontracting Prohibited................................................................9 Attorney's Fees..........................................................................................................10 Survival.....................................................................................................................10 GoverningLaw.........................................................................................................10 Signatories.................................................................................................................10 Entirety......................................................................................................................10 EffectiveDate.................................................................................I 1 ACORN® CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDD/YYYY) 9/28/2018 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 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 policy(ies) must have ADDITIONAL INSURED provisions or 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 Andreini & Company -Oxnard 500 Esplanade Drive, Suite 900 Oxnard CA 93036 CONTACT NAME: LOrena Fahl PHONE FAx AIC N Ex : 805 981-6250 A/c No : 650-378 4361 E MA ADDRESS: lfahl@andreini.com INSURERS AFFORDING COVERAGE NAIC X INSURER A: Sentinel Insurance Company Ltd 11000 INSURED LIENO-1 Lien On Me, Inc. Janet Jacobs INSURERB: Peleus Insurance Company 34118 INSURERC: Oak River Insurance Company 34630 INSURER D : PO Box 91630 INSURER E : Pasadena CA 91109 INSURER F : COVERAGES CERTIFICATE NUMBER:924176104 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY Y 57SBAAG7645 8/15/2018 8/15/2019 EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE I —XI OCCUR DAMAGEO RENTED PREMISES Ea occurrence $ 1,000,000 MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 1,000,000 AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 GEN'L POLICY F7 PRO F5C] LOC JECT PRODUCTS - COMP/OP AGG $ 2.000.000 $ OTHER: A AUTOMOBILE LIABILITY 57SBAAG7645 8/15QO18 8/15/2019 COMBINED SINGLE LIMIT Ea accident $ 1,000,000 BODILY INJURY (Per person) $ ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ X HIRED X NON -OWNED AUTOS ONLY AUTOS ONLY AMOVED AS TO FORM A X UMBRELLA LIAB X OCCUR 57SBAAG7645 G 8 8/1512019 EACH OCCURRENCE $ 1,000,000 AGGREGATE $ 1,000,000 EXCESS LIAB CLAIMS -MADE BY. ✓ MiCMAft:• � �! tag DM X RETENTION$ $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANYPROPRIETOR/PARTNER/EXECUTIVE LIWC9104trff of HU1M llri " 6/1/2019 X STATUTE EERPER H E.L. EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? ❑ NIA (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ 1,000.000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $ 1,000.000 B Professional E042076090 3/25/2018 3/25/2019 Aggregate 2,000,000 Prvacy i Privacy 2,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) City of Huntington Beach, its officers, elected or appointed officials, employees. agents and volunteers are named as additional insured per the business liability coverage form #SS0008 04/05 attached to this policy per the signed contract. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Huntington Beach ACCORDANCE WITH THE POLICY PROVISIONS. Attn: Human Resources / Risk Management 2000 Main Street Huntington Beach CA 92648 AUTHORIZED REPRESENTATIVE � ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD City of Huntington Beach 2000 Main Street ♦ Huntington Beach, CA 92648 (714) 536-5227 • www.huntingtonbeachea.gov Office of the City Clerk Robin Estanislau, City Clerk December 27, 2018 Lien On Me 330 N. Brand Blvd., Suite 350 Glendale, CA 91203 To Whom It May Concern: Enclosed is a copy of the fully executed "Professional Services Contract between the City of Huntington Beach and Lien On Me for Workers' Compensation Medical Bill Review Services" approved by the Huntington Beach City Council on December 17, 2018. Sincerely, Robin Estanislau, CIVIC City Clerk RE:ds Enclosure Sister Cities: Anjo, Japan ♦ Waitakere, New Zealand ' PROFESSIONAL SERVICE AWARD ANALYSIS SERVICE: Medical Bill Review SERVICE DESCRIPTION: Cost containment firm specializing in Workers' Compensation medical bill review, focused on- achieving savings via extensive audits with defined processes and procedures for bill review activities. VENDOR: Lien On Me OVERALL RANKING: 1 SUBJECT MATTER EXPERTS/RATERS: 1. City of H.B. Risk Manager 2. City of H.B. Senior Risk Management Analyst 3. City of Fullerton Risk Management Analyst 4. City of Los Angeles Workers' Compensation Administrator 1. MINIMUM QUALIFICATIONS REVIEW • Written Proposal Score: 90% mien wM1022-M3n mum$flualiflcatrons ikRvj&WsFR ;. ,;.tea54 N. . Total Weighted Maximum Criteria Score Score Compliance with RFP 10% 10% Approach & Methodology 20% 25% Qualifications & Experience 20% 25% Partnership & Value Added Features 20% 20% Proposed Cost 20% 20% Total if. DUE DILIGENCE REVIEW • Interview Ranking: I • Excellent compliance with RFP, inclusion of required licenses and certifications. • Methodology is thorough/clear, creative approaches to finding hidden savings, and has state -of -the art technology to protect networks and data. • Very qualified, serviced.public agencies for over 26 years. • Value-added features include Lien Defense. + Excellent relationships with.public agencies, outstanding references from cities of Pasadena, Glendale, Costa Mesa, Monterey Park and Brea. • Very competitive bid of $173,0001yr to include flat rate fees (2"d lowest of 6 proposals submitted; lowest of "unbundled" bill review vendor. PROFESSIONAL SERVICE AWARD ANALYSIS SERVICE: Medical Bill Review SERVICE DESCRIPTION: Cost containment firm specializing in Workers' Compensation medical bill review, focused on achieving savings via extensive audits with defined processes and procedures for bill review activities. VENDOR: #2 OVERALL RANKING: 2 SUBJECT MATTER EXPERTS/RATERS: 1. City of H.B. Risk Manager. 2. City of H.B. Senior Risk Management Analyst 3. City of Fullerton Risk Management Analyst 4. City of Los Angeles Workers' Compensation Administrator MINIMUM QUALIFICATIONS REVIEW • Written Proposal Score: Criteria Compliance with RFP Approach & Methodology Qualifications & Experience Partnership & Value Added Features Proposed Cost Total Total Weiahted Maximum Score Score 10% 10% 20% 25% 20% 25% II. DUE DILIGENCE REVIEW • Interview Ranking: 2 16% 20% 16% 20% • Successful compliance with RFP, inclusion of required licenses and certifications. • Methodology is thorough/clear, and has physical and technological security safeguards to protect data. • Qualified: Serviced private sector and public agencies for 13 years. Good references from City of Bakersfield, Fresno Schools, and Sempra Energy. • No specific value added features. MM • Pricing at $311,408/yr (51h place of 6 proposals submitted Bidder's List for Workers' Compensation Medical Bill Review Company Name Phone Definiti 949-716-1890 Lien On Me 626-921-1120 Arissa Cost Strategies 714-259-1053 AIMS 916-563-1900 Athens 949-296-3951 Adminsure 909-396-5813 Hazelrigg 909-606-6373 PROFESSIONAL SERVICE AWARD ANALYSIS SERVICE: Medical Bill Review SERVICE DESCRIPTION: Cost containment firm specializing in Workers' Compensation medical bill review, focused on achieving savings via extensive audits with defined processes and procedures for bill review activities. VENDOR: Lien On Me OVERALL RANKING: 1 SUBJECT MATTER EXPERTS/RATERS: 1. City of H.B. Risk Manager 2. City of H.B. Senior Risk Management Analyst 3. City of Fullerton Risk Management Analyst 4. City of Los Angeles Workers' Compensation Administrator MINIMUM QUALIFICATIONS REVIEW 0 Written Proposal Score: 90% Lien On Me — Minimum Qualifications Review Total Weiqhted Maximum Criteria Score Score Compliance with RFP 10% 10% Approach & Methodology 20% 25% Qualifications & Experience 20% 25% Partnership & Value Added Features 20% 20% Proposed Cost 20% 20% Total II. DUE DILIGENCE REVIEW • Interview Ranking: 1 Lien On Me — Summary of Review • Excellent compliance with RFP, inclusion of required licenses and certifications. • Methodology is thorough/clear, creative approaches to finding hidden savings, and has state -of -the art technology to protect networks and data. • Very qualified, serviced public agencies for over 26 years. • Value-added features include Lien Defense. • Excellent relationships with public agencies, outstanding references from cities of Pasadena, Glendale, Costa Mesa, Monterey Park and Brea. Lien On Me — Pricing tit • Very competitive bid of $173,000/yr to include flat rateJees (2nd lowest of 6 proposals submitted; lowest of "unbundled" bill review vendor. PROFESSIONAL SERVICE AWARD ANALYSIS SERVICE: Medical Bill Review SERVICE DESCRIPTION: Cost containment firm specializing in Workers' Compensation medical bill review, focused on achieving savings via extensive audits with defined processes and procedures for bill review activities. VENDOR: #2 OVERALL RANKING: 2 SUBJECT MATTER EXPERTS/RATERS: 1. City of H.B. Risk Manager 2. City of H.B. Senior Risk Management Analyst 3. City of Fullerton Risk Management Analyst 4. City of Los Angeles Workers' Compensation Administrator I. MINIMUM QUALIFICATIONS REVIEW • Written Proposal Score: Criteria Compliance with RFP Approach & Methodology Qualifications & Experience Partnership & Value Added Features Proposed Cost Total Total Weiahted Maximum Score Score 10% 10% 20% 25% 20% 25% II. DUE DILIGENCE REVIEW • Interview Ranking: 2 16% 20% 16% 20% • Successful compliance with RFP, inclusion of required licenses and certifications. • Methodology is thorough/clear, and has physical and technological security safeguards to protect data. • Qualified: Serviced private sector and public agencies for 13 years. Good references from City of Bakersfield, Fresno Schools, and Sempra Energy. • No specific value added features. 1/endor#2 Pricing .... • Pricing at $311,408/yr (51h place of 6 proposals submitted 198 From: pacj <pacj_03@yahoo.com> Sent: Thursday, December 13, 2018 11:41 PM To: Estanislau, Robin <Robin.Estanislau@surfcity-hb.org> Subject: City Council agenda 12-17-18 Please share my note with city council and appropriate city staff. With respect to agenda items related to workers compensation/utilization review/medical bill review, please provide link to rfp(s) and list of those firms who responded to the rfp(s), those firms which were interviewed and their respective scores. How does the city monitor the tpa to ensure timely claims processing and benefit provision? Does the city hire an outside firm to audit the tpa? If so how is that firm selected? Thank you. Pat Quintana 915 California St HB 92648 N Im7 SUPPLEMENTAL '� tm a rn rn COMMUNICATION rn MeaftDate: .a n O c-n Estanislau, Robin From: Warren, Michele Sent: Friday, December 14, 2018 2:01 PM To: pacj_03@yahoo.com Cc: Estanislau, Robin Subject: City Council Agenda 12-17-18 Pat Quintana, This communication is in response to your e-mail related to the workers' compensation/utilization review/medical bill review item. All RFP information for the services referenced in the agenda item was obtained via Planet Bids (link here): https://www.planetbids.com/portal/portal.cfm?CompanylD=15340 There are multiple tabs related to the specific RFP results which provide information on various bidders. The staff report provides summary information on the review process and results (link here): file://cohb.net/files/UserDirs/warrenm/Downloads/Staff%20Report%20(3).pdf As well, each item has the review results as an attachment to the staff report (link here): file://cohb.net/files/UserDirs/warrenm/Downloads/Att2%2OProfessional%2OService%2OAward%2OAnalysis%20- %20 R a n k%201%20 a n d %202. p df The TPA is audited by Bickmore Risk Services to review compliance in 16 areas: • Caseload • Case Review and Documentation • Communication • Fiscal Handling • Medicare Reporting • Claim Creation • Payments & Benefit • Notices • Medical Treatment • Apportionment • Disability Management • Supplemental Job Displacement Benefits • Claims Reserving • Resolution of Claim • Settlement Authority • Litigated/Subrogation Cases • Excess Insurance Bickmore Risk Services is an independent consulting firm providing Risk Management consultation to public sector agencies (website link here): https://www.bickmore.net/ Hopefully this information effectively responds to your inquiry. Thank you. 1 Michele Warren Director of Human Resources City of Huntington Beach Estanislau, Robin From: Estanislau, Robin Sent: Monday, December 17, 2018 10:41 AM To: .pacj, Subject: RE: For Mayor Peterson Received. Robin Estanislau, CMC, City Clerk City of Huntington Beach 714-536-5405 Please consider the HB City Clerk's office for your passport needs! From: pacj <pacj_03@yahoo.com> Sent: Friday, December 14, 2018 4:53 PM To: Estanislau, Robin <Robin.Estanislau@surfcity-hb.org> Subject: For Mayor Peterson Robin, Can you please forward Ms Warren's response to Mayor Peterson as well as my note which follows: Dear Mayor Peterson I have been asking questions about the city's workers comp program since 2015. My questions are responded to but only partially answered. The subject of workers comp arises again on 12-17-18. When I read the council meeting agenda I asked about the workers comp rfp, about who responded, about who was interviewed and about the scoring of each vendor who was interviewed. I also asked who monitors the tpa chosen and if an outside firm how that vendor is selected. Robin has forwarded Ms Warren's response which includes a series of links which I cannot open and does not answer my questions. That is not government transparency. I would appreciate my questions being answered and it appears I need your intervention to have them answered. I have one additional concern. The council delves into a number of subjects. Considerable attention is given by the council on public pensions and unfunded liability. Attention should also be given to the city's workers comp program and its unfunded liability. My concern is that this important program which impacts the total unfunded liability for the city is not on the council's radar. Mayor Peterson, thank you for looking into this matter. Sincerely, Pat Quintana