Worker's Compensation Medical Management Service

The Vendor is required to provide to administer an exclusive 504 Physician Panel, provide workers compensation medical cost containment, case management, pharmacy benefits management, information systems, and all other services.
- Provide Workers’ Compensation (WC) medical cost containment (i.e. bill review, utilization review, peer review, etc.), case management, pharmacy benefits management, information system, and all other services identified in this work and associated with the City’s WC self-insured program.
- Ensure all correspondence with injured employees includes a reference of representation on behalf of the City.
- Develop a process to work with third-party vendors to ensure seamless timely communication and effective claims and Physician Panel management processes.
- Agree to work with any other third parties associated with furthering the effectiveness and efficiency of the City’s WC program as requested by the City.
- Agree to provide electronic read only claim file access capability to all 3rd parties the City requests.
- Pay third party vendors within 60 days of invoice receipt and be responsible for payment if invoices are not paid timely.
- Forward copies of all correspondence pertaining to the City and received from any Federal or State agency within two business days of receipt to City Risk Management that references: Data Calls, Notice of Violations, Sanctions, Warnings, agency complaints against City or Contractor.
- A 504 Panel website shall be online and operational with sorting and printing functionality.
- Develop and administer a healthcare Panel of quality medical providers located in the central state area that has the depth to ensure access to superior care for City employees who have an on-the job injury or job-related disease.