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MB-3583 - USA (Ohio) - Third-Party Administration and Consultant Service for Insured Worker Compensation Claims - Deadline November 20,2019

Product (RFP/RFQ/RFI/Solicitation/Tender/Bid Etc.) ID: MB-3583

Government Authority located in Ohio; USA based organization looking for expert vendor for third-party administration and consultant service for insured worker compensation claims.

[A] Budget: Looking for proposal

[B] Scope of Service:

(1) Vendor needs to provide third-party administration and consultant service for insured worker compensation claims.
- Responsibility for claims processing is assigned to a specifically designated individual, the claims investigator, within the city's employ. This individual will serve as the third-party administrator and consultant's administration of claims contact in the daily
- It is anticipated that the claims investigator will consult as needed with the consultant to perform the following tasks: (1) certifying or rejecting claims; (2) investigating claims and documenting and maintaining claim files; and (3) securing medical records, communicating with health providers, scheduling independent medical examinations and all other aspects of claims, management and administration.
- As requested, the consultant shall review all claims where the injured worker is receiving injured-on-duty benefits and advise and assist the claims investigator on effective management of those claims.
- It is anticipated that the consultant will prepare claims for administrative hearings. The consultant shall provide weekly notification (e-mail) of all hearing dockets.
- At the city's request, the consultant shall review and evaluate new worker's compensation claim applications presented for verification as to validity and course of action.
- Where appropriate, the consultant shall review city and industrial commission files of claimants to determine grounds for rejection of claims based on previous conditions or percentages of disability allowed.
- At the request of the city, the consultant shall review accident reports promptly to obtain facts pertaining to cause of accident and the determine if further investigation is necessary to prepare a defense of a claim.
- As needed, the consultant shall confer with the city's managed care provider to ensure that claims are being effectively managed by the MCO, particularly those claims where rehabilitation or return to transitional work is appropriate.
- The consultant shall provide lists and assist the claims investigator in selecting physicians to provide independent medical examinations.
- Consultant shall review individual claims reports of injured employees to establish control over all awards of compensation and payment of medical expense chargeable to the city.
- The consultant shall review city's calculation of premium rates to determine accuracy.
- The consultant shall protest any inaccuracies in rate calculations, reserves, medical payments and compensation.
- The consultant shall individually examine and verify reserves set by the bureau of workers' compensation to determine accuracy in accordance with facts of the claim.
- The consultant shall track award of benefits and lost time for individual injured employees to ensure that medical reviews and hearings to terminate benefits, where appropriate, are being scheduled per statutory requirements.
- The consultant shall prepare and follow procedures for handicap reimbursement on all cases where injury causes aggravation to a pre-existing condition recognized in a claim.
- The consultant shall meet with and advise the law department, or its designee, as to all outstanding workers' compensation matters on a periodic basis in the city's offices. Timely and consistent contact with the city's designee must be maintained at all times.
- The consultant shall present a written report to the city on a quarterly basis of the number and type of hearings attended.
- weekly claims review via conference call with MCO and claims investigator.
- Attendance at quarterly safety steering meetings. Provide quarterly activity reports by departments.
- The consultant shall pursue non-at-fault vehicle accident (AC-28) applications.
(2) The contract period will be for two 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 : Wednesday, 20 November, 2019

Category : Medical Billing and Coding

Country : USA

State : Ohio

Cost to Download This RFP Document : $ 5

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