Preferred Provider Disclosure
In order to provide a wide array of quality services to control customer loss costs, Risk Enterprise Management Limited (REM) has developed preferred vendor networks to provide certain specialty services. These specialty services include: early intervention, telephonic and field nurse case management, utilization review, medical bill review, PPO network access, Specialty Carve-out PPO networks for Diagnostic Services, and Durable Medical Equipment (collectively “Managed Care Services”), claim reporting (telephonic, electronic, fax or internet), Special Investigation (SIU), and index bureau reporting. Managed Care Services are generally provided or coordinated by Zurich Services Corp. (ZSC), with considerable Managed Care expertise and volume-based buying power.
In order to provide specialty services that are both efficient and fully integrated with its overall Best Practices claims management, REM has established an operations model in cooperation with the preferred providers that includes customized workflows, constantly maintained system interfaces and uniform billing procedures. REM’s field staff is regularly trained in the utilization of the specialty services.
Fees and expenses for these specialty services will be charged to customers’ loss fund accounts as Allocated Loss Adjustment Expenses (or Loss where required by state law) according to REM's preferred provider price list, which will be adjusted from time to time. In recognition of the additional costs to REM and the value to its customers in coordinating and delivering these specialty services, REM may receive compensation, either by retaining a portion of the fees and expenses charged to customers' loss fund accounts, or by receiving fees from preferred providers. The amount REM retains or receives will vary depending upon the preferred provider, and may be calculated based on percentage of savings, percentage of revenue to the provider, or REM's mark-up of provider fees. The amounts retained or received by REM are in addition to any fees paid to REM by the customer under the services agreement.