Specifications include, but are not limited to: A. Contractor shall assist the LTD administration team with determinations for complex LTD claims. B. Contractor shall provide consultation through credentialed clinical, vocational, and behavioral health independent medical experts. C. As requested by the City’s LTD administration team, the clinical consults shall consist of the following (in part and in total depending on the claim): 1. One or more experts to review LTD claim(s) based upon a. Evidence based clinical guidelines; b. Attending Physician return to work guidelines. c. Other nationally recognized disability management resources. 2. Expert opinions regarding regular and appropriate care; care improvement recommendations through appropriate treatment tests, diagnosis reassessment, , and therapy; ability to return to work assessments; and possible job accommodations. 3. Upon request by the City’s LTD Administration team, the clinical consult expert shall conduct a peer to peer review with the treating provider to ensure an appropriate treatment/action plan. 4. Contractor shall provide upon request, recommendations for ongoing strategic LTD claim(s) management analysis. D. Contractor shall prepare reports clearly documenting recommendations and analysis from each clinical, behavioral and vocational consultation provided, including the rationale for each case management recommendation, including a description of industry standard guidelines and source materials upon which Contractor relied on rendering recommendation and/or assessment. E. Contractor shall provide professional services for this Agreement that are objective, fair, equitable, evidence-based, and consistent. F. Contractor shall meet at least annually with the City’s LTD Administration team virtually or inperson, as needed, to evaluate the quality of the program and discuss opportunities for improvement. G. Contractor shall at the request of the City, coordinate evaluation services to include but not limited to, functional capacity evaluations, independent medical evaluations, and independent psychiatric evaluations. H. Contractor shall, at the request of the City coordinate surveillance services related to LTD case management.
