Claims Administration. The following is a summary of claims administration services that the chosen Respondent will be responsible for performing. Receive all First Report of Injuries (FROI) electronically and receive hard copy supporting claims documentation and convert into a paperless environment. The Respondent will meet all reporting standards of DAS for management reports and for Electronic Data Interchange (EDI) with Iowa Workforce Development‐Division of Workers’ Compensation. Claims investigation. Claims adjudication. Litigation management including, but not limited to, coordination with the Iowa Attorney General’s Office, arranging mediation and attendance at all mediations and hearings. Setting and revising reserves. Arranging Field Case Management by Registered Nurses which require travel and on‐site meetings with claimants and providers. Timely and accurate claims processing by the Contractor. Coordination with the State’s staff and agencies on the resolution of cases and return‐to‐ work. Development, maintenance and steerage to the occupational health and pharmacy network. Administration of medical provider network and monitoring its performance, as well as securing the discounts and pricing will be the responsibility of the TPA. Timely processing of payments of benefits to claimants, medical providers and other miscellaneous vendors according to state mandated guidelines. Responsible for the review of medical, pharmacy and hospital bills and applying the Iowa fee schedule as well as any network negotiated discounts. Data Management. DAS is expecting the chosen Respondent to be the manager and data processor of all workers’ compensation information and data. All workers’ compensation data will reside with the Respondent.
