Exhibit F_Scope of Work.docx

Exhibit F - Scope of Work

1. Purpose Vendor shall provide Medical Invoice Review Services for WSDOT's medical invoices for WSDOT's Human Resources (HR) Office.

2. Scope of Work and Deliverables Vendor shall provide Services and staff, and otherwise do all things necessary for or incidental to the performance of work, as set forth below:

a. Invoice Review and Repricing

i. WSDOT Responsibilities

· WSDOT will upload a .pdf file containing Health Insurance Claim invoices, or similar, to the FTP site along with an Excel Spreadsheet listing each billing’s information.

· WSDOT will then email Vendor to inform them of uploaded documents.

ii. Vendor Responsibilities

· Review individual invoice medical procedures codes, re-price each invoice to reflect a reasonable rate for the services provided.

· Upon completion of each review, Vendor will upload to WSDOT's File Transfer Protocol (FTP) site the provider invoice and corresponding Explanation of Review indicating date of service, procedure codes, diagnosis codes original charge, reduction amount and recommended payment, along with review explanation for each provided invoice.

· Add pertinent information to the Excel spreadsheet and send back to WSDOT. This information includes but may not be limited to: Vendor recommended pricing, Vendor fee, amount discounted, duplicate submissions, bill number, and potentially other pertinent information.

· Work Expectation Schedule:

· Completed reviews must be electronically uploaded to WSDOT FTP site within ten (10) business days of original receipt of a Clean Claim. Upon receipt of payment recommendations from Vendor, WSDOT will issue payments to providers directly.

· Vendor will provide WSDOT with an itemized invoice for billed service fees on a monthly basis, or per batch.

· Vendor will also identify medical provider billing duplication.

· If Medical Providers appeal discounts recommended by Vendor, the Vendor will resolve disputes and appeals within 60 days. However, WSDOT reserves the right to assume negotiations of appeals directly with providers and will notify Vendor in writing, if that is WSDOT's intent.

· Vendor may be required to provide legal testimony on behalf of WSDOT.

b. Pre-Negotiation of Fees for Surgeries and Complex Procedures When specifically requested by WSDOT, vendor will negotiate costs of facility fees, surgeries and procedure with providers prior to treatment being authorized by WSDOT.

Vendor Work Expectations Schedule:

· Pre-Negotiations must be successfully completed and submitted to WSDOT within 72 hours of request.

· If Vendor is not able to successfully negotiate costs with Employee's medical provider and/or facility of choice within 48 hours, Vendor will identify an alternate medical provider and/or facility in the same geographical area that can provide identical services for a discounted rate. This information will be provided to WSDOT.

· Vendor will communicate via email or phone call to WSDOT Project Manager, or designee, progress of pre-negotiations with WSDOT staff each Business Day until pre -negotiations are complete.

· Vendor will provide WSDOT with an itemized invoice for billed services on a monthly basis, or per Batch.

· WSDOT must be able to reach Vendor during normal business hours. If Vendor is unavailable, Vendor must return phone calls and emails within 24 hours