Description
The State Accident Fund of South Carolina is seeking a qualified vendor to provide comprehensive medical‑bill review services for workers’ compensation claims. The contractor will receive electronic claim files, apply the SC Workers’ Compensation fee schedule, perform clinical and administrative review, calculate reductions, and return reconciliation files. The work includes scanning, secure file transmission, training SAF staff, and regular reporting.
• Review and adjudicate medical bills in accordance with SC fee schedule and network discounts.
• Provide electronic EDI file ingestion, generate Explanation of Review (EOR) reports, and return reconciliation files.
• Maintain a secure portal, meet a ≤ 7‑day turnaround, and supply monthly/quarter‑based performance metrics.
• Supply scanning hardware (120‑150 bills per day capacity) and conduct at least two annual training sessions for SAF personnel.
• Retain records for three years, comply with HIPAA/FISMA security standards, and carry required insurance.