MB-3193 - USA (Texas) - Workers Compensation TPA, Support Services and 504 Network Services - Deadline July 9,2019

Product (RFP/RFQ/RFI/Solicitation/Tender/Bid Etc.) ID: MB-3193

Government Authority located in Texas; USA based organization looking for expert vendor for workers compensation TPA, support services and 504 network services.

[A] Budget: Looking for proposal

[B] Scope of Service:

(1) Vendor needs to provide workers compensation TPA, support services and 504 network services.
1. Claims Administration – including, but not limited to: payments and adjusting of claims, claims self-audits, medical reviews, maintenance of reserves, management reports, etc.
2. 504 Program Management –, which includes administration and providing a panel of medical providers contracted to provide quality care in accordance with ODG/MDA guidelines, with appropriate utilization and return to work.
3. Cost Containment – including, but not limited to, bill review, telephonic case management, bill negotiation, utilization review (which includes concurrent, pre-authorization, retrospective, peer review, drug utilization review and independent medical exams), Pharmacy Benefit Management, ISO claim searches, subrogation, field case management, surveillance and investigation, transportation and translation.
- Including, but not limited to; adequate on-site staffing, claims self-audits, payments and adjusting, compliance monitoring to ensure claims are adjusted timely and properly, maintaining the HISD High Tier performer rating by the Texas Department of Insurance and maintaining adequate reserves throughout each claim to ensure adequate funding etc. In order to administer workers’ compensation claims in a prompt, proficient and cost-effective manner, HISD’s third party administrative (TPA) staff is currently located in the Workers’ Compensation Department in the Teledyne Building, located at 5827 Chimney Rock Road. Should HISD relocate the on-site staff, HISD agrees to pay all reasonably appropriate moving costs, but reserve the right to designate its own staff or contractors related to the move, except that the Provider agrees to cover the cost to move their phone lines and T-1 line (or other direct Internet connection).
1. Provider will be responsible for an annual review of open indemnity and medical only claims. This should also include a review of closed indemnity and medical only claims. It is estimated that up to 50 claims will be reviewed annually.
2. Every three months or on an as-needed basis there shall be held accountability claims review meeting. The accountability claims review meeting shall be a roundtable discussion whereby
the Provider discusses a selected number of claims for issues, concerns, action plans and resolution.
(2) All questions must be submitted no later than June 25, 2019.
(3) Contract period 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 premises.

Expiry Date : Tuesday, 9 July, 2019

Question Answer Deadline : Tuesday, 25 June, 2019

Category : Medical Billing and Coding

Country : USA

State : Texas

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