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MB-3178 - USA (California) - Workers Compensation Claims Third Party Administration Services - Deadline June 25,2019

Product (RFP/RFQ/RFI/Solicitation/Tender/Bid Etc.) ID: MB-3178

Government Authority located in California; USA based organization looking for expert vendors for Workers Compensation Claims Third Party Administration Services.

[A] Budget: Looking for proposal

[B] Scope of Service:

(1) Vendor needs to provide workers compensation claims third party administration services that all Proposers adhere to generally accepted workers' compensation claim administration processes and industry standard practices.  In addition, Proposers must conform to RTD's Health and Safety Program and agree to conduct their claims management activities, include a job description for each staff classification and applicable resume for proposed staff personnel, The TPA will be responsible for ensuring the efficiency and quality of service provided to RTD.  It is the expectation of RTD that the selected TPA provide the following services:
-  Claims Management include:
- Investigation of all workers’ compensation claims
- Provide a toll free (800) number for employees to contact claims examiner
- Determine the compensability of claimed injuries and illnesses in accordance with the State of Workers’ Compensation laws.
- Medical bill evaluation
- Payment and denial of workers’ compensation claims in accordance with state regulatory statutes
- Coordination of loss adjustment services include:
-  Surveillance
- Medical case management
- Vocational rehabilitation
- Independent medical evaluation
- Utilization Review
- Impairment rating evaluation
- Excess insurance reporting requirement
- Medical Cost-Containment include:
- Comprehensive medical network
- Physical therapy and rehabilitation networks
- Pharmacy benefit management and customized formulary
- Proactive coordination and monitoring of the medical portion of a claim
- Assistance in restoring employees to appropriate gainful employment
- Escalated case review
- Workers' Compensation Appeals Board appearances
- Strategic plan of action meetings
- Litigation referrals
- Return-to-work program development
-  claim management plan of action for each claim.  Critical claim information and key elements of the plan of action shall be accessible at all times by designated RTD staff.
- The TPA shall at all times, have one or more of the examiners assigned to RTD’s dedicated unit, or in their absence, the supervisor or account manager available by telephone for emergencies through a 24- hour emergency telephone number.
- The TPA shall ensure at least one or more of the examiners assigned to RTD’s dedicated unit are on-site and available to RTD every business day throughout the term of the contract period.
- The TPA shall ensure each claims examiner handling RTD’s claims will receive continuing education training each year.  The TPA shall annually certify this in writing Caseload.
(2) All question must be submitted no later than June 4, 2019.
(3) The contract term will be for 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, 25 June, 2019

Question Answer Deadline : Tuesday, 4 June, 2019

Category : Medical Billing and Coding

Country : USA

State : California

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