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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 available <br />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 />104 <br />