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MB-2900 - USA (Idaho) - Worker Compensation TPA Services - Deadline April 1,2019

Product (RFP/RFQ/RFI/Solicitation/Tender/Bid Etc.) ID: MB-2900

Government Authority located in Idaho; USA based organization looking for expert vendor for worker compensation TPA services.

[A] Budget: Looking for Proposals

[B] Scope of Service:

(1) Vendor needs to provide worker compensation TPA services.
- Review and process all workers compensation claims in accordance with the requirements of the industrial commission and worker’s compensation law, including determinations of compensability of reported injuries and illnesses
- Authorize and coordinate medical treatment with the county’s selected primary care providers, or with a jointly approved provider network
- Authorize and manage any required vocational or medical rehabilitation in conjunction with the county risk management manager
- Determine eligibility for and issue payment for medical treatments as well as compensation for temporary and permanent disability
- Develop and maintain adequate individual claim reserve recommendations and provide continuous review of same to reflect changes. Make monthly reports or downloads of updated reserves and other significant claims information
- Establish and maintain a complete claim file for each reported accident and injury which shall be available for review by the county at any time
- File and assist the county with the filing of any and all reports, forms and documents as required by the industrial commission and other regulatory agencies
- Arrange for independent investigators, case managers, medical or other experts to the extent necessary in connection with the timely processing of any qualified claim;
- As requested, monitor treatment programs prescribed for employees by physicians or specialists by reviewing all reports prepared by treating physicians and by maintaining contact with treating physicians as may be appropriate
- Coordinate claims handling activities with the county’s risk management manager
- Seek subrogation recovery on claims involving a responsible third party, in coordination with county risk management and legal staff
- Provide a loss report in county summary form and by county departments which will assist the county in the analysis of claims by cost, type of injury, and type of action and occurrence to identify trends and developments in order to develop and maintain effective loss control programs. Provide on-line, or by periodic download access to data on claims payments and claim status
- Meet with risk management manager at county facility and service provider office for all current and open claims review at least four times a year; and as needed with the risk management manager, the county’s medical providers, and county department representatives on specific cases
- Submit or prepare necessary data for county
- Provide in digital format a monthly summary of workers compensation checking account, listing all checks, vouchers, voided checks, showing the date issued, claim number, claimant name, payee, amount, type of benefit paid and benefit service dates, and subtype of medical service (on medical claims payments)
- Prepare an annual loss report on losses paid for the preceding year for county, or alternatively provide download claims information from which such reports can be prepared, and other annual loss information as requested by the county’s risk management manager.
(2) All questions must be submitted no later than March 15, 2019.

[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 : Monday, 1 April, 2019

Question Answer Deadline : Friday, 15 March, 2019

Category : Medical Billing and Coding

Country : USA

State : Idaho

Cost to Download This RFP Document : $ 5

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