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LOSS STATISTICS SERVICES <br /> TPA shall provide IRC with the ability to access comprehensive on-line,real-time electronic claim <br /> information data, including reporting capabilities, at no additional cost to IRC. TPA shall provide <br /> IRC with regular monthly reports, as agreed upon by the parties, in such a format as is acceptable to <br /> IRC. <br /> TPA agrees that IRC shall have real-time access to all claim files, including all adjuster notes, <br /> supervisory notes, field case management notes, diary items, payment records, medical bills and <br /> expense bills in an electronic manner with internet based access available to IRC. <br /> NETWORK ACCESS & DEVELOPMENT SERVICES <br /> TPA will provide the following network access and development services: <br /> 1. Provide IRC access to a provider network that contains appropriate providers. TPA must assure <br /> that high quality providers, particularly in key specialties, are encouraged to participate in the <br /> network. TPA will work with providers to 'develop contractual agreements which include <br /> preferred appointment setting criteria, reporting and standards to best address the medical and <br /> rehabilitative needs of IRC injured employees. Key specialties include internists, orthopedics, <br /> neurology, neurosurgery, occupational medicine specialties, pulmonology, infectious disease <br /> specialists,ear/nose/throat specialists,allergists,psychiatry and psychology. On an annual basis, <br /> the TPA and IRC will meet and agree upon discounts,types of specialists and key providers to be <br /> added to the network. <br /> MEDICAL BILL REVIEW AND AUDIT SERVICES <br /> TPA will provide the following medical bill review and audit services: <br /> I. For Medical Bill Review: <br /> (a) Promptly review medical/surgical bills(in and out of network)for accuracy including,but not <br /> limited to, as they relate to the following: <br /> (i) Duplicate billings <br /> (ii) Unbundling of charges <br /> (iii) Upcoding of charges <br /> (iv) Approval and appropriate precertification. <br /> (b) Review all medical bills that: <br /> (i) Are not subject to fee schedule coding <br /> (ii) Are for services not specifically addressed in the fee schedule <br /> (iii) Need an in-depth medical interpretation of the rules and regulations <br /> (iv) In the exercise of professional judgment, specifically warrant review. <br /> (c) Process, pay and mail bills within 45 days of receipt. <br /> Page 17 <br />