Workers' Compensation Bill Auditing Services

The Vendor is required to provide to perform workers' compensation bill auditing services for division.
- Medical Bill Handling, Auditing and Adjustments
•    Receive, review, process, and track medical bills to validate appropriateness of charges, and medical documentation to ensure appropriate coding and fees are applied in accordance with the state workers’ compensation medical fee schedule and medicare standards.
•    Amend and provide medical cost adjustments to bills audited under the audit process.
•    Utilize certified professional coders to perform all coding, audit, and bill audit functions in accordance with CPT, HAR, HRS, and applicable laws and rules.
•    Perform data entry and procedural coding.
•    Apply client overrides, as necessary.
•    Conduct resubmittals and re-audits due to changes in diagnosis or procedure codes.
- Operations and Client Management
•    Manage and perform all administrative, operational, and procedural functions necessary to process, review, audit, and track medical bills, in compliance with section i and as required under this work.
•    Respond to provider inquiries and conduct provider calls.
•    Maintain, update, and archive software files related to the services.
•    Print audit reports and provide client access to electronic audit reports.
•    Perform and prepare reports on annual assessment of costs through statistical annotations.
•    Submit monthly billing reports detailing costs for bill audits by individual claim, including a summary of total charges.
•    Prepare and submit quarterly reports summarizing bill audit activities and outcomes. Reports shall include, at a minimum, total volume of bills audited, total dollar value reviewed, total savings achieved, and any trends or patterns identified in billing practices.
•    Prepare and provide other ad hoc reports as requested.