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MB-3388 - USA (New York) - Third Party Administration Service of worker compensation program - Deadline September 11,2019

Product (RFP/RFQ/RFI/Solicitation/Tender/Bid Etc.) ID: MB-3388

Government authority located in New York; USA based organization looking for expert vendor for third party administration service of worker compensation program

[A] Budget: Looking for Proposal

[B] Scope of Service:

(1) Vendor needs to provide third party administration service of worker compensation program.
1. General: Maintain file and records for all Claims files including adjuster claim notes.
- Provide necessary notification to all excess carriers on Claims that threaten the County’s
self-insured retention levels.
- Provide claim loss and management reports on a regular basis.
- Arrange for the services of legal counsel to appear on the behalf of the County at WC Board Hearings.
2. Claim Services: Examine and review all Claims that are submitted, create a file for each, and contact all claimants.
- Set the appropriate reserves or estimated value for each case and provide process used.
- Assign medical case management when necessary.
- Provide services of counsel to appear on the behalf of the County at WC Board Hearings.
- Provide monthly and other regular and ad hoc reports as requested by the County’s Risk Manager, County Attorney, or the Commissioner of Finance.
- The Offeror must also be prepared to provide recommendations to the County, including, where appropriate, financial and actuarial analyses for lump-sum settlements of Claims. Offeror’s offer must include a plan for the review of Claims to determine where a lump-sum settlement of an individual case would be in the best interests of the County.
3. Claims Management System: Permit secure online access to the Offeror’s Claim Management System by designated County representatives for Claim file review, case research, case financials, ad hoc reporting, and specified monthly reports;
- Provide secure access for the County’s investigative units for the purpose of conducting investigations, inputting commentary and reviewing case histories;
- Provide various levels of authorized access;
- Meet all security requirements established by the County’s Finance Department, Information Technology Department, Office of Risk Management, and County Attorney’s office.
- Provide scheduled monthly export file or download of specified data elements of all files to the County’s Risk Management Information System.
- Track and report medical expenses and savings by Claim and aggregate totals. Comply with State and County medical fee schedules and treatment guidelines.
- Track and manage Tail Claims.
- Track and manage all Claims that are medical only, medical and lost time, and those cases with no medical expenses or lost time.
- In order to ensure consistency of data between Offeror’s system(s) and the County’s system(s), the Offeror will store the County’s department coding, employee name and responsibility center codes and provide the ability to filter and sort reports based on these elements.
4. Investigative Services: Conduct investigations on all Claims to determine their validity.
5. Reporting Requirements All reports shall be current, accurate, and provided on a timely basis. Reports that will be required include, without limitation, include the following, and will be deliverable at such times as requested by the County’s Risk Manager Closed Claims, Claims Pending, New Claims Reported, Reopened Claims, Paid Loss Report, Case Reserves, Cause of Loss, Expense Reports, Day of Loss Report, Claims by type, E-Forms, E-Case (County Attorney Legal Application), Payment Reports.
6. Miscellaneous: Offerors shall provide training for County employees who are granted access to its
system. Training should include, but not be limited to, inquiries, notes, documentation, report generation, and diary maintenance.
7. Staffing: Engage the services a minimum of three (3) attorneys as in-house counsel; two (2) of which must have at least five (5) years’ experience in representing self-insured municipals employers in the State.
8. Claims Management and Administration Description: Provide a summary of how a Claim is handled during the first forty-eight (48) hours after receipt.
- Describe the procedures employed for disability retirements
(2) All question must be submitted no later than August 28, 2019.

[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 : Wednesday, 11 September, 2019

Question Answer Deadline : Wednesday, 28 August, 2019

Category : Medical Billing and Coding

Country : USA

State : New York

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