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MB-3361 - USA (Arizona) - Workers Compensation Cost Containment, Claim Management and Administration Services - Deadline September 2,2019

Product (RFP/RFQ/RFI/Solicitation/Tender/Bid Etc.) ID: MB-3361

Government Authority located in Arizona; USA based organization looking for expert vendor for workers compensation cost containment, claim management and administration services.

[A] Budget: Looking for Proposal

[B] Scope of Service:

(1) Vendor needs to provide workers compensation cost containment, claim management and administration services,
- Maintain a toll-free dedicated Nurse Triage and Third-Party Administration (TPA) telephone numbers for the reporting of new workers’ compensation claims twenty-four hours per day seven days a week (24/7) including weekends and holidays,
- Ensure that the phone number is re-routed in the event of any disasters in order to provide 24/7 availability,
- Capable to accommodate a warm transfer to 24/7 nurse triage and telemedicine programs if medically appropriate,
- 24/7 Nurse Triage Services: Provide a separate toll-free number for employees in need of triage services available to accept direct call from employees 24/7,
- Establish the process for nurse triage including but not limited to: providing triage on all calls regarding occupational injuries and illnesses that are received,
- Establish and maintain adequate network of hospitals, physicians, laboratories and other appropriate facilities, available 24 hours a day, seven days a week,
- Establish the Bill review process, including but not limited to:
- Receiving, imaging, uploading, reviewing and make recommendations for provider bills,
- Adjudicate medical bills for accepted medical conditions and body parts and notify the State adjusters of questionable medical bills for their review and approval within two business days from receipt of the invoice,
- Rule based bill review and network application to validate medical services were claim-related, approved and payable based on retrospective, concurrent or prospective review and assigned to the appropriate claim,
- Third party administration (TPA) services:
- Provide a separate toll-free number for employees in need of triage services available to accept direct call from employees,
- In Origami Risk manage workers’ compensation claims (time loss, no time loss, scheduled unscheduled, supportive care, subrogation, litigation etc.),
- File Employer’s Report of Injury,
- Respond to all communications, notices, awards, decision and orders,
- Be responsible for paying benefits,
- Comply with MRO process as required by law,
- Be responsible to issue notices,
- Send Annual Report of Income and Notice of Intent,
- CMS Reporting, as required by law.

[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 : Monday, 2 September, 2019

Category : Medical Billing and Coding

Country : USA

State : Arizona

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