• Workers’ compensation claims investigation and determination of compensability; • A 24/7 Nurse Triage Call Center for the filing of workers’ compensation claims over the telephone and electronically, which service shall be available twenty-four (24) hours each day, seven (7) days a week; • Financial and operational loss control services, as further described in Sections A.3, A.4, and A.5 of RFP Attachment 6.6., Pro Forma Contract; • User friendly Claims Management System as further described in Section A.15 of RFP Attachment 6.6., Pro Forma Contract; • A state-wide workers’ compensation managed disability preferred provider network (PPN) through which state workers will receive needed medical care that focuses on positive medical outcomes, and transforming the larger available network into a narrower system by regional areas through initial physician panels; • State-mandated fee schedule medical bill review/re-pricing services; • Utilization review and case management, and/or other managed care services as described in Section A.4 of RFP Attachment 6.6., Pro Forma Contract; and • All other ancillary services such as fraud investigations, home health, rehabilitation, physical therapy, durable medical equipment, etc.
