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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 />1. 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) <br />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 />