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MB-3573 - USA (California) - Third Party Administrator for Workers Compensation Claims Administration and Managed Care Services - Deadline December 11,2019

Product (RFP/RFQ/RFI/Solicitation/Tender/Bid Etc.) ID: MB-3573

Government Authority located in California; USA based organization looking for expert vendor for third party administrator for workers compensation claims administration and managed care services.

[A] Budget: Looking for Proposal

[B] Scope of Service:

(1) Vendor needs to provide third party administrator for workers compensation claims administration and managed care services
- Contractor shall assume all claims administration services including transfer, conversion, installation and adjustment of all open claims records as of July 1, 2020, this will include maintenance of all closed claim records,
- Assign a claims manager to supervise the claims team, the claims manager will have a minimum of five years’ experience administering workers’ compensation claims, the claims manager will not carry a caseload,
- Assign claims examiners with a minimum of five years’ experience administering workers’ compensation claims,
- Ensure that all claims examiners, representatives and managers assigned to the county’s account possess a self-insured certificate in workers’ compensation, claims examiners shall participate in effective continuing education,
- The claims examiners assigned to the county shall not have a caseload of more than 125 open indemnity claims,
- Medical only claims shall be handled by a claims representative or claims examiner responsible for medical only and future medical cases. medical only and future medical claims will be counted on 2:1 basis,
- Make initial contact with the injured worker and establish an electronic claim file within 24 hours of receipt of the employers’ first report of injury,
- Coordinate arising out of employment and course of employment investigation of claims with county staff,
- Expedite the 5020 when the doctor’s first report of work injury is received,
- Provide ongoing communication on delayed claims and provide notice and explanation to the County upon recommendation of acceptance or denial of the claims,
- Close medical and indemnity claim within 30 days of the last benefit payment,
- Make all files available to the County for inspection, review, and claims audit without prior notice to the Contractor,
(2) Intent to propose must be submit no later than 12 November, 2019.
(3) All the questions must be submitted no later than November 20, 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 December, 2019

Question Answer Deadline : Wednesday, 20 November, 2019

Category : Medical Billing and Coding

Country : USA

State : California

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