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MB-3260 - USA (New York) - Professional Claims Administration Services - Deadline July 25,2019

Product (RFP/RFQ/RFI/Solicitation/Tender/Bid Etc.) ID: MB-3260

Government Authority Located in New York; USA based organization looking for expert vendor for professional claims administration services.

[A] Budget: Looking for Proposal

[B] Scope of Service:

(1) Vendor needs to provide professional claims administration services for the Authority’s self-insured workers’ compensation program.
1. Upon receipt of the First Report of Injury, the TPA shall begin the administration process with the establishment of a claims file that should include automatic completion, and statutory filing, of a New Claim Summary Report with a copy sent to the Authority including the assigned claim number. All claim files, within the laws regarding medical information, are to be made available for review by the Authority anytime during the TPA’s regular business hours.
2. The Authority must be notified immediately, via telephone and e-mail, of all newly reported catastrophic claims (threshold to be determined) upon receipt of the first notice of loss.
3. The adjusters will perform and provide: (i) three-point contact within 24 hours of report with the injured worker, employer and treating physician; obtain recorded statements of the injured worker (other civilians, witnesses, supervisors and doctors, as needed), all possible reports, photographs and diagrams of the scene, and use video when appropriate; (ii) in-depth claims investigations on all lost-time claims and are required to complete an initial investigation within 7 days from date of receipt of the claim. All final lost-time investigations will include a compensability determination plan of action within 14 days of receipt of the claim, or earlier; (iii) third-party investigations; (iv) prior loss history and medical records; (v) diligent monitoring of lost time; (vi) aggressive use of Independent Medical Evaluations and Functional Capacity Evaluations; (vii) offset, lien and credit analysis; and (viii) proper notification to excess carriers of potential claims in accordance with the terms of the carrier’s service agreement.
4. Complete a thorough analysis of relevant factors to determine compensability and coordinate recommendations with the Authority for settlement/disposition of claims. Settlement
evaluations will be made promptly based on coverage, liability, damages and available defenses and will be documented in the claim file. Final settlement authority shall rest with the Authority. Claim Petitions must be forwarded to the Authority for timely assignment of counsel.
5. All claim-related phone conversations, discussions, meetings, supervisory directives and action plans must be clearly detailed and documented in the claim file. All Action Plans must be comprehensive, list specific steps to bring each claim to closure as expeditiously as possible at the lowest possible cost and must be updated every 90 days or sooner as needed.
6. Assess and evaluate the nature and extent of each claim for purposes of establishing claim reserves at ultimate probable cost for medical, indemnity and legal expenses within 90 days
from the first notice of loss in accordance with the Authority’s best practices. All indemnity claims are to be reported to the Index Bureau upon receipt of first report and re-indexed every six (6) months for the life of the claim. All first aid claims must be flagged with notice to the Authority and identified as first aid on all loss run reports. Invoice payments for first aid claims shall be determined by the Authority.
(2) Contract period 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 : Thursday, 25 July, 2019

Category : Medical Billing and Coding

Country : USA

State : New York

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