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MB-3130 - USA (Texas) - Workers Compensation Third Party Administrator and Medical Cost Containment Management Services - Deadline June 13,2019

Product (RFP/RFQ/RFI/Solicitation/Tender/Bid Etc.) ID: MB-3130

Government Authority located in Texas; USA based organization looking for expert vendor for workers compensation third party administrator and medical cost containment management services.

[A] Budget: Looking for Proposals

[B] Scope of Service:

(1) Vendor needs to provide workers compensation third party administrator and medical cost containment management services.  
- Provide, through the placement of an individual approved by the district within the district office, bill review, utilization review (prospective, concurrent, retrospective, preprocedural), peer review, pre-authorization, case management, vocational and rehabilitation evaluation, discharge planning, return to work program, identification of catastrophic illnesses or injury, and other workers' compensation medical cost management related services.
- Correspondence date stamped, sorted and checked for auditing, utilization review etc., services and assigned to staff promptly.
- Check all medical bills, including hospital bills for TDI-DWC fee guidelines or contracted rates via the 504 Physician Panel.
- Review and return bills promptly for payment to the assigned TPA contractor or the district.
- Monthly and fiscal reports must be received outlining gross billings, number of bills audited, cost of audit, net amount, appropriate application of ANSI Codes.
- Provide any other ad hoc reports or any other information as requested by the district. Electronically transfer required information to TDI-DWC per TDI-DWC requirements, and to the TPA, and other involved parties.
- Electronically transfer all bills and fees to designated TPA.
- Maintain contact with physicians, injured employees, and adjusters, and provide information to the parties promptly as requested and required.
- Provide services through experienced, qualified, licensed professional staff. Services of a medical director may be needed from time to time basis. The case managers should have appropriate required designations. Contractors are requested to provide detailed information on the qualifications and experience of their staff, including numbers and types of staff.
- Vocational evaluation for job analysis and return to work programs to be performed by properly certified vocational staff.
- Approach to containing workers' compensation costs must be comprehensive, fair, and in compliance with Texas Workers' Compensation Act rules, regulations etc.
- Case management program should use proactive approach, and coordinate activities with the claims adjusters, and supervisory staff.
- Facilitate and coordinate the district's return-to-work program activities with injured worker, physician, claims adjuster supervisor and any other related party.
- Case managers and utilization review staff must be available to treating physicians during normal working hours. Treating physicians will receive timely notification of decisions.
- All analysis and recommendations, reviews, provided by case managers, preauthorization etc. must be properly documented in the files. Documentation must show due diligence and reasonableness for any recommendations made, should these be challenged through administrative or judicial channels.
- The Company will be responsible for monitoring of appropriateness of treatment, necessity and continuation of medical treatment in relation to on-the-job injury and illness. Utilization review will include review of excessive costs of medical treatment, days of hospitalization, hospital bill screening.
- Screen charges for any overlapping dates of service or any unrelated fees, up coding, unbundling, a provider may submit.
- Provide one contact representative to interface with the district's adjuster and providers as problems may arise.
- Meet full compliance with the TDI-DWC guidelines and give updates on any changes to the district's adjuster and assigned personnel.
- Furnish copies of all memorandum and notices etc. by the TDI-DWC regarding rule changes, and revisions to the law.
- Obtain pre-approval from the District for use of subcontractor for any services.
(2) All questions must be submitted no later than May 28, 2019.
(3) Contract term will be 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 : Thursday, 13 June, 2019

Question Answer Deadline : Tuesday, 28 May, 2019

Category : Medical Billing and Coding

Country : USA

State : Texas

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