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MB-3878 - USA (Texas) - Claims Audit Services - Deadline February 19,2020

Product (RFP/RFQ/RFI/Solicitation/Tender/Bid Etc.) ID: MB-3878

Government authority located in Texas; USA based organization looking for expert vendor for claims audit services.

[A] Budget: Looking for Proposal

[B] Scope of Service:

(1) Vendor needs to provide self-insured workers’ compensation program to determine the efficiency, effectiveness, and the consistency of claims adjusting services and performance of the third-party administrator (TPA) per contractual performance standards.
- Determine the monthly adjuster claim workload, determine turnover rate for adjusters, supervisors and account management, Assess timeline of the initiation of weekly benefits, Assess compliance with contractual reporting requirements, Assess timeliness of the completion and documentation of contacts associated with the claim investigation, Assess documentation of claim file notes concerning prior claims history, Assess timeliness of the completion and documentation of recorded statements, Assess ongoing documentation of all statements and contacts, Assess maintenance of open claim diaries, to include Plan of Action and Reserves, Assess completion of supervisor claim reviews, Assess the completion of a comparison of actual lost time duration to MD Guidelines, Assess the completion of referrals for telephonic or field case management.
- To assess the efficiency and effectiveness of the present claims administrator; To review a reasonable sample of open and closed claim files; To evaluate the examiner's experience, competence, and staffing levels; To obtain suggestions for improvement in claims handling, reserving, and reporting; and to ensure that all provisions of the contract for services are met.
(2) All question must be submitted no later than February 17, 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 : Wednesday, 19 February, 2020

Question Answer Deadline : Monday, 17 February, 2020

Category : Medical Billing and Coding, Auditing, Finance and Accounting

Country : USA

State : Texas

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