Audit and Consultation Services for Managed Care Cost Containment of theCounty’s Workers' Compensation Claims *RE-BID*

Provide audit and consultation services for managed care cost containment of the county's workers' compensation claims; examine monthly, quarterly semi-annual or annual reports for bill review to include independent bill review; utilization review to include independent medical review, medical provider network, telephonic/field nurse case management and ancillary services. Following review, the contractor will provide the county and tpa with the recommended selection of items to be audited at least two (2) weeks prior to beginning the actual managed care audit. ; contractor shall review the managed care provider s policies, procedures and client service instructions pertaining to managed care cost containment services, as well as the pertinent computer system(s) business rules and fee structure; based on audit results, the contractor shall identify opportunities to reduce costs through changes in claims management and cost containment practices. See outside link.