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2. Reimburse IRC for any overpayments made in the bill review process within 30 days of <br /> identification of overpayment. Reimburse IRC for any penalties and/or interest associated <br /> with inaccurate payments. <br /> 3. For Medical Auditing Services: <br /> (a) Audit in-network and out-network hospital/provider bills <br /> (i) Exceeding $25,000 <br /> (ii) Others at TPA's discretion or specific request by IRC for accuracy and <br /> appropriateness <br /> (b) Develop and follow written policies on how late charges, no show charges and special <br /> payment arrangements are to be handled <br /> 4. Develop and provide communication materials to explain the policies and procedures of the <br /> Medical Bill Review and Audit Services to: <br /> (a) IRC <br /> (b) Medical providers <br /> 5. Develop and follow written grievance procedures for provider concerns. <br /> PHARMACEUTICAL MANAGEMENT SERVICES <br /> TPA shall recommend a prescription benefit management (PBM) vendor which: <br /> 1. Provide IRC injured workers access to a pharmacy network of local and national pharmacies <br /> with agreed upon discounted prices for drugs. Provide IRC injured workers with <br /> communication materials, including pharmacy cards, to assure proper information is <br /> available for prompt dispensing of and proper coding and billing of pharmaceuticals. <br /> 2. Provide IRC with pharmacy specific reporting on a quarterly basis of generic/brand <br /> utilization,network penetration,narcotic usage and other detailed reports as agreed between <br /> the parties. <br /> 3. Develop appropriate utilization review procedures in real time to assure dispensed drugs are <br /> appropriate for injury, timely dispensing and concurrent review for medical interactions. <br /> Page 18 <br />