Utilization Reviews

Comprehensive Managed Care & Cost Containment Better Service, Better Results

Bruce Nash, President & COO

“As we continue to grow, we seek to innovate and evolve on the strength of the legacy we have built."

Longevity, Expertise & Innovation Welcome to First MCO, We are a full-service Managed Care Organization; the first to be licensed in New Jersey. We provide

comprehensive cost containment solutions that stand alone and can be tailored to meet any need.

For nearly 50 years, we have continually adapted our products and services to address our customers’ changing needs; and have worked side by side with them to stay ahead of industry trends and face any resulting challenges.

The key to our longevity, is our ability to be creative, reimagine what is possible and operate in a way that distinguishes us from the competition. Customer service is at the forefront of everything we do.

We have perfected the ‘white glove’ experience by getting to know our client’s goals, their business and how to best serve them both.

The Right People FMCO Senior Leadership possesses over 200 years of combined industry expertise.

Expert Providers Our Providers are highly ranked medical healthcare professionals, that are responsive, experts at treating workplace injuries and deliver excellent patient experiences.

Best Practices Core principles for operational excellence: Assure quality at the source, create value for the customer and start with the end in mind.

Exceptional Products We develop forward thinking solutions based on the best practices and the most advanced technology..

Company Road Map • • • • • • • •

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1977 First MCO opens its doors providing Field Case Management Services.

1979 Incorporates and introduces the first self-contained Occupational Assessment/Evaluation system.

1993 1st company to be licensed as a Managed Care Organization.

2002 Introduces WebMCO to the marketplace.

2010 Completes interfaces to over 50% of the national Bill Review Clearinghouses.

2011 Achieves SOC II Type 2 Certification.

2015 Establishes patient scheduling division for rehabilitative services.

2018 Begins development of proprietary, web-based scheduling platform, investing heavily in fortifying disaster recovery measures and makes major data security enhancements; including migrating to a hybrid cloud end to end solution.

2019 Becomes FedRamp and ISO 207001 certified and completes phase II of disaster recovery and soft IP phone deployment to enhance user mobility and unified communication platforms.

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2020 COVID-19 pandemic reaches United States.

Using our disaster recovery protocols, FMCO transitions entire user population to remote workforce within 24 hours.

2021 Upgrades imaging & data center to latest technology and fully integrates with EDI billing including a partnership with Jopari.

2022 • Major enhancements to Auto Injury modules to be completed.

• B Corporation Certification to be received.

• Cross region data/service protection & recovery projects will be completed ensuring maximum up time.

Confidential and proprietary information of First Managed Care Option, Inc. Not for redistribution. © 2023 First Managed Care Option, Inc. All rights reserved.

Clinical Oversight Controlled medical indemnity and litigation costs •

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Protection against fraud •

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“The main reason for stability in medical payments per claim in New Jersey was small changes in non-hospital prices paid and Utilization [Review]” – WCRI CompScope Medical Benchmarks for New Jersey 16th Edition First MCO consistently performs well below State Benchmarks

Preferred Providers Our competitive contracts are the result of years of valued partnership and mutual respect.

Our Providers • Are workers’ compensation treatment experts.

• Trusted partners with a genuine interest in getting our claimants back to work.

• Prioritize FMCO injured workers for appointments.

• Are responsive and prompt with medical documentation.

• Maintain open communication with nurses and clients.

Quality Assurance • Providers are vigorously re-credentialed every two years.

• Demographics are re-verified every 6 months.

• Our proprietary ranking system evaluates several indicators such as outcomes, comprehensiveness of documentation and patient experience.

“Even the best software is only as good as the security protecting it.”

Henry Yiin Chief Information Security Officer

Cyber Security Security Highlights • • • • •

• Scheduled security vulnerability scanning • Single Sign-on plus MFA Secured and Encrypted E-mail Access control - fingerprint scan to office space 24x7 Security Incident monitoring and management

Security Awareness • •

Security Enhancements

Mandatory bi-monthly training Monthly phishing testing

VPN Security Server application environment

Information Assurance • •

Business Continuity Plan Disaster Recovery Plan Enhancements

SOC 2 Type II Certification Processing Integrity

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Quality Assurance Process Monitoring

Availability

Security

Privacy

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Performance Monitoring Disaster Recovery Security Incident Handling

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Access Control Two-factor Authentication Encryption Server Application Environment

Confidentiality • •

Intrusion Detection Network/Application Firewalls

Evaluation Services • Independent Medical Exams (IME) • Medical Record Reviews (Peer Reviews) • Diagnostic Film Review • Occupational Assessments • Functional Capacity Exams (FCE) • Liability Exams • Permanency Exams • Medical Records Organization Reviews (MRO)

Medical Evaluations

Decision Point Review Our Auto Injury RNs have the industry knowledge and practical experience to stay ahead of deadlines and in control of the process.

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Seasoned professionals that average 15 years experience.

Their expertise translates into fewer needs to consult a Medical Director for a decision, which translates to lower costs for our clients.

If we do need an outside consult, our Medical Directors are among the best in the business and typically have been in practice 20 years or more.

Highlights: • 100% paperless • System-driven workflow increases efficiency • 100% compliant with DOBI utilization and casualty requirements • We return every APTP within 72 hours

Our providers are recruited based on the extent and level of experience, the comprehensiveness of their reports and their adherence to state regulated timelines.

We evaluate our Directors frequently and adjust as necessary.

Performance Technology Advanced, end-to-end, workflow guided software solution for managing the business and complexities of: Independent Medical Evaluations, Medical Record Reviews, Occupational Assessments, Third Party Service Management (i.e. transportation or translation vendors), state regulated time constraints/reporting requirements and customer SLA’s.

• Full

communications module including records management, and a document library of fully customizable correspondence, notifications and fax cover pages.

• Customized

workflows can automate correspondence including email messages, status updates and service requests.

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Issue quick notifications and faxes from communications module

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Secure web portal available to clients and service providers to access claim data, make referrals, or submit reports at any time

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Fully encrypted data and Multi-factor Authentication

“When we put our knowledge, experience, and expertise in service of our clients, we deliver better than anyone else.”

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• Begin with the end in mind • Respect individuals & their ideas • Think systematically • Assure quality from the start • Build customer value • Be accountable and close the loop

Operational Excellence At First MCO we are focused on exceeding customer expectations in every way possible.

Our core principles for Operational Excellence

Using Today’s Success to Prepare for Tomorrow’s Challenges • Constantly honing the principles, systems and tools in our charge to monitor and improve •

performance metrics.

Reshaping our outlook, tuning in to network results and heightened Business Intelligence.

We are updating WebMCOSM with a more robust module for managing Decision Point Reviews. We are enhancing structural and workflow designs to increase capacity and add functionality.

• Proprietary Contracts • Industry Specific • Pharmacy Benefits Management • Provider Lookup

Rules Engine

• Bill Review • Coding & Edits • NJ PIP Fee schedule/UCR • Recommend Penalties • Cost Projections • Duplicate Checking

PPO

• Patient and Provider Intake Interview • Pre-Certification • Utilization Review • IME’s • Medical Director Reviews

Cost Containment

• End to End Claims Management • SaaS • Real Time Claims Access 24/7 • Robust Reporting Capabilities • Monthly Performance Statistics

Clinical Oversight

SaaS

Custom Rules/Workflows Exception Based Processing

WebMCO®

Cloud based, end-to-end, proprietary, Claim/medical cost management platform and reporting suite.

Being fully owned and operated by First MCO allow us the flexibility to be more responsive to our client needs. In the last few years, we have added even more automations to increase efficiency and leverage economies of scale.

Our platform continues to evolve and grow based on client feedback and shifts in the market space.

WebMCO

SM

Provider lookup tool accessible from anywhere at anytime • Increase penetration • Maximize network savings Fully ASCX12 Compliant • Jopari PayerID: J3839 • Implemented for attachments

WebMCO

SM

Electronic Data Interchange Bridge • Able to receive bills and/or claims data electronically • Batch processing or web service

• Medical Bill Management and Utilization Review systems seamlessly integrated.

• Automated workflows driven by state regulations and customer requirements.

• Straight through processing of bills.

• Increased operational efficiencies through automation while allowing for manual controls.

• Any issues are managed directly or referred to the Nurse Case Manager from within the platform.

• Any claim notes or case information relevant to provider charges are instantly visible to the Bill Review team.

Better service. Better results.

Bruce Nash President, & COO 2740 Route 10 West, Suite 304 Morris Plains, NJ 07950 Confidential and proprietary information of First Managed Care Option, Inc. Not for redistribution. © 2023 First Managed Care Option, Inc. All rights reserved.