MB-3960 - USA (New York) - Third Party Administration Services for Workers Compensation - Deadline March 27,2020

Product (RFP/RFQ/RFI/Solicitation/Tender/Bid Etc.) ID: MB-3960

Government Authority located in New York; USA based organization looking for expert vendor for third party administration services for workers compensation.

[A] Budget: Looking for Proposal

[B] Scope of Service:

(1) Vendor needs to provide third party administration services for workers compensation to provide appropriate benefits and services in a timely, cost effective manner focusing on communication, quality care and prompt return-to-work when conditions warrant.
- Recommend and implement a system of early intervention, risk management, loss control, and employee assistance which will include any necessary training for city employees and for city employees charged with workers compensation administrative duties.
- Develop a team approach to pro-active claim management.
- Focus on stay-at-work and prompt return-to-work from first report of injury.
- Establish an effective relationship with the local medical community.
- Maintain a current and pro-active system of claim strategy, action planning, diary action and follow through that expedites claim resolution and minimizes cost.
- Examine all claims submitted and create and maintain a file on each, including the setting of reserves or total estimated cost of the claim by expense area.
- Within 48-hours of receipt, conduct an accident investigation (including the 3-point contact) surrounding the issues of compensability and disability.
- Monitor the treatment programs recommended for claimants by the treating physicians, specialists and health care providers for appropriateness and compliance by reviewing all reports prepared by them and maintaining such contact with these providers as may be appropriate.
- Implement and manage return to duty and fitness for duty process to determine employee’s ability to function in the job and title and to ensure the safety of the public, colleagues and employee upon return to duty.
- Review all medical bills regarding appropriateness of treatment and compliance with the state workers’ compensation fee schedule.
- Assign and monitor medical case management when appropriate and upon authorization.
- Review claims to determine if investigation and surveillance is necessary; and
1) Obtain City approvals (required for field, scene, or fraud investigations; signed statements; police reports; etc.); and
2) Arrange for and manage investigations.
- Prepare and file all forms required by workers compensation law and any other applicable state or federal laws, such as public goods pool.
- Review, audit, prepare, and issue checks for payment, in a timely manner, for medical, indemnity, and loss use awards as well as miscellaneous or travel expenses related to claims.
- Arrange medical exams with the city’s independent medical examiners as necessary.
- Provide monthly reports as required.
- Prepare all files and records necessary for hearings, defense of claims, and other litigation or proceedings (such as actions for subrogation); be available as witnesses at hearings and trials; and assign to the designated legal firm.
(2) An optional non-mandatory pre-proposal conference will be held on March 10, 2020.
(3) All question must be submitted no later than March 13, 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.

[E] Proposal Submission:

Response should be submitted physically (courier or post).

Expiry Date : Friday, 27 March, 2020

Pre-proposal Conference Date : Tuesday, 10 March, 2020

Question Answer Deadline : Friday, 13 March, 2020

Category : Medical Billing and Coding

Country : USA

State : New York

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