Specifications include, but are not limited to: provide all core workers’ compensation program services including medical management and claims administration without subcontracting to or partnering with other vendors. Workers’ compensation core services include claims administration/adjudication, medical management, medical bill review and repricing, physician peer to peer services, and utilization review nurse services. Other services include collaborating with Roane County’s manager of workers’ compensation services to reach settlement of claims in appropriate circumstances to assist in selection of defense counsel and assistance with required state reporting. Responders much agree to provide all of the following services: Administrative services. Claims services. First notice of injury services. Loss statistic services. Medical management services to include: Network access and development services. Triage Electronic case management and site case management when appropriate and agreed upon. Pharmaceutical benefit management services. Communicable disease management program services. Utilization review including: Medical bill review and audit services. Precertification. Concurrent and retrospective review. Peer to peer review.
