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<br />. <br /> <br />. <br /> <br />Yes. The LOM software includes the NDC (National Drug Code) <br />database through MediSpan which identifies the wholesale cost of <br />drugs. This standard of reduction has been found reasonable in <br />the courts and is universally accepted by pharmacy providers. <br /> <br />6. <br /> <br />Do you provide durable medical equipment review services? <br />no, are you committed to doing this in the future? <br /> <br />If <br /> <br />Although there is no fee schedule allowance for durable medical <br />equipment. California employers are required to pay "reasonable" <br />costs for medical treatment. LOM recommends that any amount <br />charged for durable goods in excess of twice wholesale be <br />disallowed. <br /> <br />7. What in-patient hospital PPO agreements do you have in Orange <br />County? <br /> <br />Every in-patient hospital in Orange County has PPO agreements <br />with at least one of the networks to which we have access. <br />The PPO reductions, if lower than fee schedule. will either be a <br />"per diem" contract or a range of 20% to 25% below billing. <br /> <br />8. Do you own or have interest in other services? i.e.: Utilization <br />Review, TPA. Case Management. Describe them briefly. <br /> <br />No. Please refer to answer #4. <br /> <br />FUI'IICTIONAL <br /> <br />9. What is your turn-around time? Do you have any guarantees? If <br />so describe. <br /> <br />LOM has a strict standard of 48-hour turnaround time (two <br />business days). Most bills are returned on the same day of <br />receipt. Any bill returned late will be reviewed at NO CHARGE <br />to the City (PPO contract rates excepted.) <br /> <br />10. <br /> <br />Describe your internal audit processes, if any. <br />back-up or duplicate audit process? Describe. <br /> <br />Do you have a <br /> <br />When a batch of bills is received. it is maintained as a unit <br />throughout the bill review process. The bills are counted and <br />given a batch-identifier before processing. After the initial audit, <br />the batch is given to a second auditor for re-review to ensure <br />accuracy. All bills receive a double audit. <br /> <br />11. What percentage of re-evaluationsjprovider inquiries result in <br />additional allowances? <br /> <br />2 <br />