Specifications include, but are not limited to: The proposer shall review medical bills from health care providers submitted to DIR for their treatment of or for services provided to injured workers who are entitled to workers’ compensation benefits. Health care providers include, but are not limited to, physicians, hospitals, pharmacies, interpreters, copy services, transportation services, and home health care services. The proposer shall make available for use a health care provider bill review tracking system (BRTS) that provides bill reviews, explanation of reviews, medical reports. In addition, the BRTS shall include information such as submission of requests by each adjuster, pending transactions, and other information. The proposer’s BRTS shall be capable of interfacing with the system that is providing Utilization Review services for DIR such that it can electronically capture physician’s Request for Authorizations (RFAs) that were approved, modified, or denied.
