Specifications include, but are not limited to: A. Vendor shall provide services as a third-party administrator (“TPA”) for workers’ compensation claims management services in connection with self-insurance of workers’ compensation risks through claims administration and program development for both LRWRA and CAW. 1.3 CLAIMS MANAGEMENT Vendor shall provide claims management services, including, but not limited to the following A. Reviewing all claims reported by LRWRA and CAW. 1. Accidental injuries, illnesses, or deaths sustained or alleged by employees as arising out of and in the course of their employment. 2. Process each claim or loss report in accordance with applicable statutory and administrative notification requirements to the Arkansas Workers’ Compensation Commission (“AWCC”). B. Providing proactive claims administration to facilitate the prompt delivery of quality medical care, fair and reasonable claims management, and to ensure fiscal responsibility C. Monitoring the medical treatment programs recommended for employees by physicians or specialists. D. Obtaining and reviewing the medical reports prepared by treating physicians. E. Maintain contact with treating physicians when appropriate in the judgment of LRWRA or CAW. F. Meeting with injured employees and maintain reasonable communication for the duration of the claim. G. Advising LRWRA or CAW, when necessary, the arrangement of rehabilitation or retraining of employees with costs to be borne by the entity. H. Establishing and maintaining an estimate of the anticipated ultimate cost for each qualified claim or loss. I. Ensuring vendor’s staff, as well as LRWRA and CAW, are kept abreast of rule changes, advisories, alerts, and code revisions. Vendor shall train staff prior to changes and revisions of any AWCC rules and regulations taking place at no cost to LRWRA or CAW. J. Determining compensability of injuries and illnesses in accordance with Arkansas Workers Compensation law. K. “Medical only” claims shall be managed in the same way as indemnity or lost time claims with respect to diary and medical management. A Notice of Claim Status (“NCS)” shall be issued on each claim notifying the employee of whether their claim is accepted or denied. L. Reviewing physician findings and consult with doctors to resolve medical questions.
