13-Exhibit E - Performance Measures and Liquidated Damages - FINAL.pdf

EXHIBIT E | Performance Measures and Liquidated Damages | RLI 25003JD

EXHIBIT E - PERFORMANCE MEASURES AND LIQUIDATED DAMAGES

The PROPOSER must agree to the following minimum performance standards and applicable liquidated damages. At the Broward County Sheriff’s Office discretion, an audit of the accuracy of the PROPOSER’s results will be performed via a randomly selected, statistically verifiable sample of claims by a qualified, independent third party. The results of the audit after appropriate review and comment by the PROPOSER will be the final determinant of performance standard compliance. When sampling methods are used to estimate performance for the universe of claims, audit samples will be large enough to ensure a confidence interval whose deviation is no greater than plus or minus three percent (3%) and whose confidence level is at least ninety-five percent (95%). The Broward County Sheriff’s Office will consider the point estimate for the sample as the PROPOSER’s performance level in calculating liquidated damages.

The Broward County Sheriff’s Office’s reserves the right to reduce or waive any liquidated damages if, in the Broward County Sheriff’s Office’s sole discretion, failure to meet a performance standard was due to extraordinary circumstances.

PERFORMANCE GUARANTEES

It is the intent of the Broward County Sheriff’s Office to assess liquidated damages to any PROPOSER vendor who fails to meet the minimum performance standards listed below. The final contract between the Broward County Sheriff’s Office and the PROPOSER vendor will incorporate the specific terms and conditions under which such damages may be assessed, including the measurement methodology, amounts, and recovery provisions. Unless otherwise agreed to in writing, the Broward County Sheriff’s Office will evaluate the PROPOSER’S compliance with these standards by way of: (i) conducting its own auditing with its own personnel; or (ii) an independent claim reviewer/performance auditor contracted with by the Broward County Sheriff’s Office.

The following performance standards and discount guarantees will apply separately to each year of the resulting contract:

Performance

Standard Topic Description of Standard Guarantee Liquidated Damage Amount (based on that applicable year’s Claims Administration Fees)

1.

Three-point

Contact on all Medical and Lost Time

Claims

Telephone or written contact with all injured workers, the medical provider, and the State Agency (Member) contact within 3 working days of claim knowledge.

Measurement and Assessment Period:

Annually based on claims and performance review.

> 95% 5% of Claims Administration

Fees

2.

Reserve

Worksheets

Detailed and completed reserve calculation worksheets on all lost time files over $50,000 in incurred value; The worksheets are required for initial and subsequent reserve changes when the total incurred value is $50,000 or more.

Measurement and Assessment Period:

> 95% 3% of Claims Administration Fees

3.

Medical Bill

Payment

All (non-controverted) medical bills paid within thirty (45) days of receipt.

Measurement and Assessment Period:

> 95% 3% of Claims

4.

Indemnity Payment

Processing

All indemnity (Temporary Total Disability) payments made in accordance with Florida Worker’s Compensation Statute.

Measurement and Assessment Period: Annually based on claims and performance review.

> 95% 1% of Claims

5.

Supervisor

Review – New Lost Time

Claim Files

All new lost time files will be reviewed by the supervisor/manager within 10 days from date claim is opened.

Measurement and Assessment Period:

> 95% 4% of Claims

6.

Supervisor

Review – Open Lost Time

Claim Files

All open lost time claims valued over $15,000 will be reviewed by the supervisor/manager at least every 90 days.

Measurement and Assessment Period:

> 95% 4% of Claims

Performance Standard Topic

Description of Standard Guarantee Liquidated Damage Amount

7.

FL State Forms

Submission

All Fl State required filling filed timely and accurately.

Measurement and Assessment Period:

> 95% 1% of Claims

8. File Closing

Files closed within sixty (60) days of last activity.

Measurement and Assessment Period:

> 95% 2% of Claims

9.

Adjuster

Claims Load

Limit the number of open lost time files to maximum of 150 per adjuster.

Measurement and Assessment Period:

> 95%

2% of Claims Administration

Fees

10.

Comprehensive

Bill Review

Review and reduce all medical bills in accordance with the fee schedule.

Measurement and Assessment Period:

Annually based on PROPOSER-provided reports; The PROPOSER will provide a monthly report showing at a minimum all medical bills with number of lines billed, total billed charges, total allowed by fee schedule, and the amount and percentage discount achieved through fee schedule reduction.

> 28% average discount off billed charges

$2 per each medical bill reviewed

11.

Preferred Provider

Organization (PPO) and

Other Network Services

Review and reduce medical bills in accordance with PPO network pricing

Measurement and Assessment Period:

Annually based on PROPOSER-provided reports; The PROPOSER will provide a monthly report showing at a minimum all medical bills, total billed charges, total allowed by fee schedule, and the amount and percentage discount achieved through PPO network re-pricing.

> 2% average discount off Florida fee schedule

$2 per each medical bill reviewed

As indicated in the aforementioned table, compliance with the performance standards 1 through 9 will be measured and determined based on an annual claims and performance review to be conducted by, at the Broward County Sheriff’s Office’s option by way of: (i) conducting its own auditing with its own personnel; or (ii) an independent claim reviewer/performance auditor contracted with by the Broward County Sheriff’s Office, while compliance with standards 10 through 11 will be measured annually by performance reports provided by the PROPOSER. For the purpose of determining performance compliance with the standards 1 through 9, the claims and performance review will utilize statistically valid, random samples, and will be conducted no more frequently than once per contract year. The PROPOSER agrees to cooperate with this process and make available the requested records and the necessary system access to the reviewer at no cost to the Broward County Sheriff’s Office or reviewer. The reviewer will make his/her workpapers available to the PROPOSER and the Broward County Sheriff’s Office, and either will have the opportunity to respond to the review report before it is finalized. Unless one of the parties can conclusively demonstrate that the results of the review are incorrect, such results will be accepted and will become the basis for determining if liquidated damages should apply. The PROPOSER’s reports and/or any data supporting the PROPOSER’s reports relative to the performance standards 10 through 14 herein may also be review to be conducted by, at the Broward County Sheriff’s Office’s option by way of: (i) conducting its own auditing with its own personnel; or (ii) an independent claim reviewer/performance auditor contracted with by the Broward County Sheriff’s Office. If so reviewed, the report and determination of the claims and performance review professional shall be final, binding and conclusive; provided however, that before a final report and determination is issued, the Broward County Sheriff’s Office and the PROPOSER shall each have a reasonable opportunity to review the non-proprietary supporting documentation and proposed report and to provide any comments to the claims and performance review professional.

Any liquidated damages assessed as the result of documented noncompliance with any of the aforementioned performance standards and/or discount guarantees will become due and payable within 30 days after the PROPOSER receives written notification of same by either: 1) Broward County Sheriff’s Office elects to take a credit on the next PROPOSER’S monthly invoice; or 2) Broward County Sheriff’s Office accepts such payments that become due may be made directly to the Broward County Sheriff’s Office by the PROPOSER.

The cost for each annual audit, if elected by the Broward County Sheriff’s Office, will be paid equally by both parties.

PERFORMANCE GUARANTEES