Laserfiche WebLink
(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 <br />the 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 <br />pharmacies with agreed upon discounted prices for drugs. Provide IRC injured workers <br />with 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 <br />between 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 />