A. Claim Administration; Provide investigation, administration and ongoing monitoring of all claims referred to the UEF. Prepare reserves on all UEF claims. Assist Special Counsel in investigating, planning discovery, suggesting strategy and in preparation for UEF hearings, seeking Review and taking Appeals including the preparation of Hearing Memoranda. Process and pay all indemnity and medical benefits on compensable claims. Make suggestions and recommendations to the Special Counsel when information in file supports a change in condition application or other legal pleading or process. The Contractor will have the technical proficiency and flexibility to interact and exchange information with the Commission through automated systems in a mutually agreed format. The Contractor will receive and review all Special Counsel invoices for legal fees. The contractor will approve the invoices for payment or make suggestions for reductions and remit the invoices to the Administrator. Quarterly, the Contractor will report to the Administrator on the number of case referrals to each Special Counsel. B. Provider Bill Review: Provide medical provider bill review based upon CPT Codes of medical procedures and the diagnostic codes to assure that reasonable and customary charges are being paid by the Uninsured Employer’s Fund and in accordance with Virginia’s Medical Fee Schedule (Code of Virginia 65.2-605) The Fund would have advantage of preferred provider agreements between the selected contractor and medical providers whenever possible. C. Utilization Review: Provide a Utilization Review Program for the determination of the need for inpatient hospital stays, approving pre-surgical lengths of stay and controlling the length of inpatient stay. D. Drugs, Supplies and Apparatuses: Provide a mechanism for claimants to receive prescription drugs, medical supplies and apparatus at a discount utilizing generic drugs whenever possible.
