Specifications include, but are not limited to: 4.1. Maintain a toll free dedicated Nurse Triage and Third Party Administration (TPA) telephone
numbers for the reporting of new workers’ compensation claims twenty-four (24) hours per day
seven (7) days a week (24/7) including weekends and holidays.
4.1.1. Ensure that the phone number is re-routed in the event of any disasters in order to
provide 24/7 availability: and
4.1.2. Capable to accommodate a warm transfer to 24/7 nurse triage and telemedicine
programs if medically appropriate.
4.2. Ensure that all communication is acknowledged within a four (4) hour business window, except
for request for copies of claim file.
4.3. Address and mail claim file copies within seven (7) business days from the date of request.
4.4. Provide exceptional customer service to all injured workers and respond to all inquire within one
4.5. Develop a workers’ compensation claim manual that includes:
4.5.1. Standard Work,
4.5.2. Work flows and
4.5.3. EDI processes.