MB-3962 - USA (New York) - Third Party Administration Service for Workers Compensation and General Municipal Law 207A & 207C Self-Insured Programs - Deadline March 27,2020

Product (RFP/RFQ/RFI/Solicitation/Tender/Bid Etc.) ID: MB-3962

Government Authority located in New York; USA based organization looking for expert vendor for third party administration service for workers compensation and general municipal law 207A & 207C self-insured programs.

[A] Budget: Looking for proposal

[B] Scope of Service:

(1) Vendor needs to provide claims administration for workers compensation and New York state general municipal law 207a and 207c. The quality of claims administration is important to the City and the development of a strong working relationship with the City will be an essential component of servicing this contract.
- The primary goal in purchasing the services of the Workers' Compensation Claims Administrator is 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.
- Provide supervisory, administrative, and adjustment services on claims, including advising the City with regard to actions, procedures, etc. that could result in controlling claims and controlling or reducing the growth of overall program costs.
- Place all appropriate carriers on notice of loss and conduct investigations as requested by the carrier. The third-party Administrator must comply with the excess carrier’s conditions with regard to reporting claims.
- One full-time, dedicated project manager who will act as the vendor’s supervisor for claims staff, as well as the point of contact for all communications related to the city’s program; and
- Dedicated claims administrators sufficient to handle city’s claims volume
- Work in cooperation with the city to develop policies and procedures to efficiently and economically process and settle program claims, including both new and historical claims.
- Examine new claims and return to duty cases
- 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.
- Review claims to determine if investigation and surveillance is necessary
- Review, audit, prepare, and issue checks for payment, in a timely manner, for medical, indemnity, and loss use awards as well as miscellaneous and travel expenses related to claims.
- The vendor will close claims with 5-day approval after the 5 days have elapsed;
- Vendors will reopen claims only if a 207a application is received from the City
- Claims are set up for payment only and closed immediately afterward
- Vendor may be required to schedule IME visits and act as the coordinating entity in accordance to the city’s claims process.
- A monthly open claims statement that contains the following data elements: claimant's name, claim number, claim type, date of incident, claim status (open, closed), amount paid by type of expense, (medical, indemnity, other), reserves, and estimated total cost of claim by expense type.
(2) All the questions must be submitted no later than March 13, 2020
(3) The contract period will be for one year.
(4) Non-mandatory pre-bid conference will be held on March 10, 2020  

[C] Eligibility:

Onshore (USA Only)

[D] Work Performance:

Performance of the work will be Offsite. Vendor needs to carry work in their office premises.

[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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