Specifications include, but are not limited to: 1. Claims Administration - the plan should include but not be limited to: a. Data entry b. Coding c. Setting up files from notice of injury d. Assignment of the files e. Determination of compensability f. Setting of reserves g. Diary systems h. Supervisory controls i. Investigation Process j. Payments of medical, indemnity, expenses, and other related charges k. IAB, CCH, Appeals, and Legal defense of claims l. Coordination with Medical Providers, and Occupation Network m. Coordination with Cost Containment companies n. Compliance with TWCC rules, regulations, filings etc. o. Training and Education provided to staff p. Interaction with the client, and client involvement q. Cost Control strategies 2. Special Presentations a. Pre-Hearing Conferences b. Special Formal Hearings c. WCC appearances in Austin d. Special Board Filings e. Court Appearances 3. Surveillance Services Reports on claims suspected to be fraudulent, exaggerated or suspicious. Include a sample copy. 4. Risk Management Information Systems a. Standard Reports b. Ad HOC Reports c. On Line Capabilities 5. Workers Compensation Medical Cost Management Services a. Medical Bill Review b. Hospital Bill Review c. Utilization Review d. Case Management e. Pre-authorization process f. Peer Review g. Return to Work Coordination with parties involved h. Rehabilitation Services
