MB-2890 - USA (Virginia) - Managed Care and Claims Administration Service - Deadline April 2,2019

Product (RFP/RFQ/RFI/Solicitation/Tender/Bid Etc.) ID: MB-2890

Government Authority located in Virginia; USA based organization looking for expert vendor for managed care and claims administration service.

[A] Budget: Looking for Proposals

[B] Scope of Service:

(1) Vendor needs to provide managed care and claims administration service.
- Notification of injury and illness by telephone, an 800 number, internet, or by fax. The fax and phone must be monitored and answered 24 hours a day, 7 days a week.
- Make telephone contact with the employee within 24 hours of receiving the claim notice. In the event of a serious injury or illness, notification to risk manager must be made immediately.
- Recorded statements should be taken on all questionable claims. Provide a dedicated claim representative for all lost time and questionable claims.
- Produce a first report of injury and make telephone contact with the employee's supervisor and the treating physician within 48 hours of receiving the claim. Risk Management must be notified by telephone, fax, or e-mail within 24 hours of receipt of the claim.
- Provide a case management report to risk management within 5 days of the claim receipt. A detailed status report in the file notes is sufficient.
- Develop and review a treatment plan prescribed by the treating physician; develop a return to work plan and establish a target return to work date based on the treating physician's recommendations. Work with treating physicians and employer to return the employee to work. Obtain job descriptions to provide treating physician for approval.
- Provide a panel of network providers skilled in treating injured workers in conjunction with county's current providers. negotiate reasonable and customary or contracted fees for medical services rendered. These network providers shall be within the county and its surrounding jurisdictions.
- Process and review medical bills within 5 days of receipt on non-contested claims.
- Participate in the Quarterly Claims Committee Meeting and any additional meetings to discuss open cases, the need for vocational rehabilitation, etc.
- Provide monthly activity reports.
- Audit hospital bills to verify that services were rendered for the charges made.
- Communicate all issues with the contact person electronically and verbally.
- Provide a dedicated claim representative for lost time and questionable claims. Claims must be processed in accordance with workers' compensation act and all regulations and rules promulgated by the workers' compensation commission as well as other state and federal requirements.
- Tabulate, reserve, and approve for payment all medical, hospital, indemnity and other benefits required by law, which will be paid in a manner prescribed by the county.
- File all forms, notices, records, or any other documentation required by the workers' compensation act, or by the workers' compensation commission or the department of labor and industry. The employer's first report of injury and illness will be filed with the workers' compensation commission within two days of receipt.
- Attend hearings before the commission as required by the county attorney's office or the office of risk management.
- Investigate and adjust all claims presented.
(2) Contract term will be three years.

[C] Eligibility:

- Onshore (USA Only);

[D] Work Performance:

Performance of the work will be Offsite. Vendor needs to carry work in their office location.

Expiry Date : Tuesday, 2 April, 2019

Category : Medical Billing and Coding

Country : USA

State : Virginia

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