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MB-3086 - USA (South Carolina) - Workers Compensation Third Party Administration Services - Deadline June 7,2019

Product (RFP/RFQ/RFI/Solicitation/Tender/Bid Etc.) ID: MB-3086

Government Authority located in South Carolina; USA based organization looking for expert vendors for Workers Compensation Third Party Administration Services

[A] Budget: Looking for proposal

[B] Scope of Service:

(1) Vendor needs to provide workers compensation third party administration services
- Provide high quality, efficient third-party administration and claims adjudication of the City’s workers’ compensation self-insured program.
- Correctly adjudicate claims in accordance with the South Carolina Workers’ Compensation Act and Regulations.
- Manage the administration and ensure that the City is in compliance with all applicable laws
- Compile and file notices, reports and any forms required for the City by the Workers’ Compensation Act and Regulations.
- Receive and record first reports of injury and investigations to determine the validity and compensability of any accidents or injuries claimed by City employees to be a workers’ compensation claim and to accept or deny such claims;
- Determine all benefits due City employees on all compensable cases and to make payments of all benefits due under SC Workers’ Compensation Regulations through use of City funds in such a manner to be directed by the City.
- Determine all benefits due City employees on all compensable cases and to make payments of all benefits due under SC Workers’ Compensation Regulations through use of City funds in such a manner to be directed by the City.
- To direct choice of medical care for all City employees under the SC Workers’ Compensation Act and Regulations using negotiated fee schedules or fee schedules as established by the SC Workers’ Compensation Commission. If possible negotiating range discounts for physicians, hospitals, pharmacies, and medical providers.
- Utilize external bill review services, if deemed prudent by the City
- Negotiate workers’ compensation claims including but not limited to:
a. Determine compensability of claims
b. Negotiate settlements with claimants and or their attorneys within parameters set by the City
c. Attend all hearings and appeals (formal and informal)
- Compile all information necessary for the City to calculate and pay self-insurance taxes, Second Injury Fund assessment and premiums for excess insurance coverage and prepare the self-insurance tax form and Second Injury Fund assessment forms;
- Provide toll free telephone access for City employees to report claims or otherwise contact the Offeror’s personnel.
- Assign primary adjusters (both medical only and lost time) to oversee the City’s claims and provide a direct contact for the City’s Management and Legal Department by establishing a dedicated telephone line to the primary adjuster; Protect and/or pursue the City’s rights to subrogation in third party and second injury fund reimbursements.
- Provide managed care/case management for large claims.
- Initiate Medical Bill Savings Programs.
- Obtain from the current third-party administrator all records and data generated, created or received by the current third-party administrator which the successor Offeror deems necessary to perform the services requested by the City. The successor Offeror will store and maintain all records as required under state statutes.
- Allow claim audits as required by the City. The City reserves the right to review and audit, with appropriate notice, all claim files, claim data, related financial accounting and claim systems and procedures to assure that claims are processed appropriately and examiners are exercising sound claim judgment. Audits may be performed by authorized City personnel or, alternatively, outside professionals/consultants selected by the City.
- Provide a claims procedures manual to the City to assist in the proper and timely reporting and monitoring of claims. Provide training regarding WC filing procedures to designated Safety employees.
(2) All question must be submitted no later than May 20, 2019.
(3) The contract term will be for one year.

[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 : Friday, 7 June, 2019

Question Answer Deadline : Monday, 20 May, 2019

Category : Medical Billing and Coding

Country : USA

State : South Carolina

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