CVS CARESIDE

Health care cost management services for healthcare benefit plans of others and risk-bearing provider organizations being medical cost management services; Medical cost management; healthcare utilization and review services; managed care services, namely, utilization review and pre-certification services

Insurance claims administration; Medical insurance case and utilization review and insurance claims adjustment services for healthcare purchasers and payors and providers and beneficiaries of health plans; administration of healthcare benefit plans for Medicare and Medicaid-eligible individuals; Administration of health insurance plans in the nature of managed health care plans; insurance services, namely, administration of healthcare benefit insurance plans; Medical claims and utilization management services for health care organizations, health care plans and healthcare providers, namely, professional and institutional medical claim payment processing, processing of paper and electronic claims, claim adjudication in the nature of assessing insurance claims and distribution of funds to providers, insurance claims processing services utilizing complex reimbursement methodologies, issuing insurance claim denials, assessments of insurance claim appeals and claim reconsiderations, and reviewing claims for compliance with payments integrity protocols, insurance claims processing services, namely, generating of claim letters, explanation of benefits (EOB) letters and explanations of payments (EOP) letters, insurance claims processing services featuring compliance with local and federal claims processing regulations and guidelines; utilization management services for healthcare organizations and healthcare providers, namely, medical insurance case reviews and utilization review of services rendered, insurance claims management of referrals and authorizations ensuring the proper use of industry accepted and internally defined clinical criteria, medical insurance eligibility review of cases for level of appropriateness and medical necessity, insurance risk and cost management services, providing insurance claims assessments utilizing medical loss ratios, outlier reporting, peer to peer reviews in the nature of insurance claims reviews, insurance claims review and insurance claims adjustment services for health care plans and providers, claim payments and distribution of funds to providers

Providing healthcare services through an integrated, risk-bearing health care provider network; Medical services and managed healthcare services; Health care services offered through a network of health care providers in all health care fields; Medical services; Nursing services; Home health care services; Providing in-home and ambulatory infusion therapy services; Telemedicine services; Telehealth services; Virtual medical care services; Health care services, namely, primary care clinics