Specifications include, but are not limited to: Third Party Administrator Services: 3.1.1 The Contractor’s adjusters shall be licensed by the State of Alaska Division of Insurance. 3.1.2 The Contractor shall utilize Claim Pilot, owned by Quick Internet Software Solutions, as the software to assist with the adjusting of MOA claims. 3.1.3 The Contractor shall provide adjusting services from claim initiation to claim resolution, including medical only claims, time loss claims/complicated medical only claims, litigated claims, claims involving Second Injury Fund, claims involving excess worker’s compensation insurance recovery, and vocational rehabilitation claims. 3.1.4 The Contractor shall utilize licensed Nurse Case Managers on all appropriate or necessary claims. The Contractor will obtain MOA approval prior to the NCM assignment. 3.1.5 The Contractor shall use Meshke, Paddock & Budzinski, PC. as the sole worker’s compensation attorney firm on all claims which would benefit from legal advice or defense pursuant to its contract with the Municipality of Anchorage. 3.1.6 The Contractor shall be capable of and willing to complete the Annual Report submitted to the State of Alaska, Bureau of Labor, Worker’s Compensation Division for each year the contract is in force. The submission of this report shall be in compliance with the current bulletin published by the Department of Labor, Division of Worker’s Compensation and al statutory requirements. Individual claim SIF payments will be completed by Contractor. 3.1.7 The contractor shall use PacBlu pursuant with its contract with the Municipality, or currently contracted vendor, as the provider of all medical bill auditing services. 3.1.8 The Contractor shall use Optum pursuant with its contract with the Municipality, or currently contracted vendor, as the provider of all pharmacy prescriptions auditing/payment services. 3.1.9 The contractor shall communicate with the designated point of MOA contact on all matters that fall outside standard adjusting practices within 48 hours of knowledge of the circumstances which created concern. 3.1.10 The Contractor shall meet with the Municipality of Anchorage Risk Management designee on all claims with an incurred value of $100,000 or higher every 90 days in the form of a File Review. 3.1.11 the Contractor will obtain prior approval from the Municipality of Anchorage Risk Management designee on any one claim payment That equals or exceeds $25,000.
