MB-3075 - USA (Arizona) - Third Party Administrator Workers Compensation Claims Administration and Medical Management Services - Deadline May 29,2019

Product (RFP/RFQ/RFI/Solicitation/Tender/Bid Etc.) ID: MB-3075

Government Authority located in Arizona; USA based organization looking for expert vendor for third party administrator workers compensation claims administration and medical management services.

[A] Budget: Looking for Proposal

[B] Scope of Service:

Vendor needs to provide third party administrator workers compensation claims administration and medical management services to review all claims made by the city of personal injury, sickness or disease incurred by an employee in the course of employment during the term of the agreement, and of death resulting at any time from any of the foregoing to determine validity and  compensability, conduct an investigation of each reported claim to the extent deemed necessary or at the request of the city, guarantee timely delivery of all benefits and related expenses, to include but not limited to investigations, rehabilitation, job analysis, medical services and reports, independent medical/hospital bill review fees, maintain a computerized diary in the claims adjustors notes for each city claim, to include appropriate documentation regarding action and timing, develop, implement and maintain a claim-specific plan of action to include a meaningful resolution plan for each claim incurred, to include claims which do not result in lost time or permanent disability; and address any issues that arise to be accessible through the computerized diary, conduct and/or assist in conducting on-going orientation and educational meetings for city personnel involved directly or indirectly with the reporting of injuries and the processing of
claims, provide complete claims handling and adjustment services of all assigned losses, to include initial and ongoing investigation, medical and litigation direction, and ongoing supervisory oversight, to include all cost control efforts through final claim resolution and/or closure, promptly establish, monitor, and periodically adjust claim-specific reserves through the life of each claim, to include adequate and appropriate analysis of all reserve changes in a format meeting with the city’s approval, provide utilization review and approval for all consults, diagnostics, physical therapy pharmaceuticals, and other employer controlled medical services.
- Telephonic case management, to include client managed care procedures observance, hospital bill pre-screening, development of treatment/return to work plans, precertification of outpatient treatment plans, direction, monitoring and support of case managers, life-care plans, utilization management services, medical provider network (MPN), pharmaceutical product plan and physician peer review services.
- Third Party Administrator will provide information on changes or proposed changes in legislation, rules and regulations which may affect the city, access to claims management system to view claims notes, status, payments, and other information deemed necessary for the city to adequately monitor management of claims.

[C] Eligibility:

- Onshore (USA Only);

[D] Work Performance:

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

Expiry Date : Wednesday, 29 May, 2019

Category : Medical Billing and Coding

Country : USA

State : Arizona

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