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MB-3706 - USA (Ohio) - Workers Compensation Third Party Administrator and Actuarial Service - Deadline January 24,2020

Product (RFP/RFQ/RFI/Solicitation/Tender/Bid Etc.) ID: MB-3706

Government Authority located in Ohio; USA based organization looking for workers compensation third party administrator and actuarial service.

[A] Budget: Looking for Proposals

[B] Scope of Service:

(1) Vendor needs to provide workers compensation third party administrator and actuarial service investigate alternative methods of cost management, increasing employee awareness regarding industrial safety, and providing a strong safety program focused on accident prevention. management is committed to providing a safe work environment and assisting employees in the expedient and efficient processing of workers’ compensation claims in the event of an industrial accident.
1. Upon receipt of notice of claim filing, evaluate the new claim and make contact with within 24 hours to confirm receipt of claim and discuss compensability. provide notice of certification or denial in writing to the injured worker,
2. Maintain complete records (hard copy or computerized) on all reported claims on behalf of and as custodian of the records per Bureau authorization,
3. Prepare and deliver all appropriate benefit payments (indemnity and medical) utilizing a payment method agreed upon with the account will be in the name,
4. Remain in contact with physicians and other involved medical personnel as required to maintain a current perspective on the claimants’ progress toward a timely return to work. Keep current on the claimant’s treatment plan and on any barriers to the expected Return to Work date established by the physician of record,
5. Claims adjuster will make recommendations for telephonic or nurse case management, vocational rehabilitation, job assistance, etc. upon approval, adjuster will make referrals as needed on a case by case basis will also approve any field case manager, vocational rehabilitation case worker, as well as any other vendor selected with discussion with the claim’s adjuster,
6. Maintain contact with the injured worker and document contact in the claims system,
7. Schedule medical appointments as necessary for the injured worker pertaining to return to work, independent medical examinations, medical reviews, etc.,
8. Agency shall be notified regarding any change in claims adjuster and have final approval on any changes,
9. Prepare letters to physicians regarding independent medical evaluations, medical opinions, or any other medical issues requiring a medical perspective,
10. Prepare and file necessary responses, appeals, motions, etc. with all involved parties within the time constraints required by the bureau of workers compensation,
11. Prepare and deliver all file documents as requested in writing by legal counsel, injured workers, etc.
12. Prepare claims status reports, loss run reports, etc. as required by agency for presentation at quarterly claims reviews. conduct quarterly claims reviews as requested by agency.
13. Provide hearing representation at all industrial commission hearings. all representatives representing must be certified attorneys knowledgeable in workers’ compensation rules and guidelines. shall be notified regarding all attorneys, attorney changes and have final approval on all assignments.
14. Work closely with selected legal counsel on workers’ compensation claims currently in litigation to provide oversight on strategy and expenses related to the file,
15. Document in a clear, concise, easily understood language all legal, general, medical and other claims note in the claims system,
16. Provide access to computer-based claims system to the agency safety and human resources departments and other staff as designated by the safety department.
17. Work with safety department to track and monitor trends relating to types of injuries, locations of injuries, length or severity of injuries in order to provide statistical data which will be used to improve the safety and health of our employees,
18. Review and process all medical bills in accordance with Ohio BWC guidelines and fee schedule,
19. Provide assistance, as requested by agency in preparation of annual or semi-annual or other required bureau of workers’ compensation reports and filings,
20. Provide assistance, as requested with Ohio BWC audits,
21. Set reserves in conjunction with agency safety department based on the most probable claim outcome. reserves must be monitored and updated (both indemnity and medical) as required by history and reserve protocols,
22. Review each file for subrogation potential and provide meaningful documentation regarding same, including letter to injured worker preserving our subrogation rights, calculations ongoing of our costs and amounts owed in subrogation and providing meaningful documentation of the results.
23. Review each file for potential fraud and keep agency alerted to any findings,
(2) Pre-proposal conference will be held on January 9,2020.
(3) All question must be submitted no later than January 14,2020.

[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 : Friday, 24 January, 2020

Pre-proposal Conference Date : Thursday, 9 January, 2020

Question Answer Deadline : Tuesday, 14 January, 2020

Category : Medical Billing and Coding

Country : USA

State : Ohio

Cost to Download This RFP Document : $ 5

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