Specifications include, but are not limited to: Medical bill review services to ensure appropriate payment and recovery for our self-insured Workers’ Compensation Program for Maine State Government employees. The Department will send facility bills via a secure confidential email including but not limited to, hospitals, inpatient or outpatient clinics, and surgery centers, as well as professional fees associated with these services, to the Bidder to down code in accordance with the current Maine Medical Fee Schedule. https://www.maine.gov/wcb/Departments/omrs/medfeesched.html The Bidder will review the bill and return it via a secure confidential email to the Department with the down coded amount due along with the savings due to the audit and the invoice for payment. The Bidder will apply the Medical Fee Schedule mandated by the Workers’ Compensation Board with review/audit of the bills and an evaluation of the appropriateness of codes, modifiers and charges along with the recommendations for payment. The Bidder will provide direction to the Department regarding billing, coding and modifiers. The Bidder will provide in-person or virtual training quarterly to the Department staff relative to billing issues and new billing information provided by the Workers’ Compensation Board. The Bidder will negotiate fees for specific medical services as requested by the Department including but not limited to the following: Surgical procedures, Assisted living arrangements, Durable equipment supplies, Home health care services, And out of State Providers not willing to accept payment in accordance with the Maine Medical Fee Schedule.
