MB-4011 - USA (California) - Worker Compensation Claims Administration Services - Deadline April 17,2020

Product (RFP/RFQ/RFI/Solicitation/Tender/Bid Etc.) ID: MB-4011

Government authority located in California; USA based organization looking for expert vendor for worker compensation claims administration services.

[A] Budget: Looking for Proposal

[B] Scope of Service:

Vendor needs to provide worker compensation claims, provide claims processing in a timely and professional manner, actively pursue subrogation, assist in returning injured employees back to work and maintain strong communications with the injured worker.
A. Claims Management Services
1. All Claims Examiner(s) assigned and designated to the CITY will each have a minimum of five {5) years' experience administering Workers' Compensation claims, which includes benefits for public safety employees {LC 4850 benefits). The Claims Examiner(s) will be designated to the CITY's account and will not have a caseload exceeding 150 open indemnity claims. Medical Only claims will be handled by a Claim Representative responsible for both Medical Only and Future Medical cases which will be counted on a 2:1 basis.
2. All Workers' Compensation Claims Examiners shall be certified under California State rules administered by the Department of Insurance (DOl).
3. CONTRACTOR will assign a Claims Supervisor to oversee the Claims Examiner.
4. CONTRACTOR will make initial contact with the injured worker and establish the claim file within 24 hours of receipt of the Employer's First Report of Injury {5020) from the CITY. All files will be available to the CITY or its representative at any time during CONTRACTOR's business hours.
5. The CITY may report claims to CONTRACTOR through mail, fax, toll-free telephone, or electronically through Internet access.
6. CONTRACTOR shall comply with all of the regulations as mandated by the California Labor Code.
CONTRACTOR will send all required benefits and informational notices to employees within the
statutory time period. Temporary disability benefits would be paid upon clarification of lost time with the CITY and if the medical treatment provider supports the lost time as being related to the injury.
7. CONTRACTOR shall comply with California Labor Code {LC) section 3823 regarding fraudulent claims, with a full understanding of what qualifies as a fraudulent claim.
8. CONTRACTOR shall have a Utilization Review {UR) program in place, and adhere to all ACOEM
9. CONTRACTOR will make every effort to provide benefits to injured employees in a timely fashion. In the event of a penalty, self-imposed or otherwise, CONTRACTOR shall analyze the reasons for the penalty payment, and immediately implement steps to prevent other occurrences of penalty payments owing or becoming due. If CONTRACTOR fails to comply with statutory laws and/or administrative regulations, any and all penalties incurred as a result shall be the sole responsibility of CONTRACTOR.
10. CONTRACTOR will maintain accurate and timely loss runs in a format and system acceptable to the CITY. In addition, CONTRACTOR will establish reserves and post indemnity, 4850, medical, vocational rehabilitation and loss adjustment expenses (allocated). All loss runs--requested by the CITY shall be provided no later than the 5th day of the following month (i.e. July's reports are due no later than the 5th of August, etc.).
B. Closing of Claims
1. Claims for which all medical and indemnity payments have been provided will be closed in accordance
with Rules and Plans of Workers' Compensation Laws, and in no case later than 30 days as allowed
under the Rules and Plans of the Workers' Compensation laws, at no additional claim handling expense.
2. CONTRACTOR will maintain closed files pursuant to State Labor Code Provisions.
3. All claim files will remain the property of the CITY and/or its members and will not be disposed of
without the CITY and/or its member prior authorization.
C. Additional Services
1. CONTRACTOR's Claims Examiners and Claims Supervisor will participate in quarterly claim reviews.
2. CONTRACTOR will provide at no cost, the required forms for the CITY to process claims mandated by the California Labor Code and the Administrative Director, including the 5020, DWC-1 and the Facts About Workers' Compensation brochure.
3. CONTRACTOR will prepare and file the Third-Party Administrator's portion of Self-Insured Annual Report.
4. CONTRACTOR will have a system and protocol that meets the requirements of the Secondary Payer Act (Medicare Set Aside), and may serve as the City's agent in meeting the Act's requirements relating to Workers' Compensation.
5. CONTRACTOR will report all claims that are required to the excess carrier according to the specific policy guidelines and will promptly respond to their inquiries.
6. CONTRACTOR will fully cooperate with, provide requested information to, and respond to
recommendations and findings of the CITY, its auditor and consultants.
D. Litigation
1. CONTRACTOR will work closely with the CITY in litigation management. CONTRAC

[C] Eligibility:

- Onshore (US Organization Only);

[D] Work Performance:

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

Expiry Date : Friday, 17 April, 2020

Category : Medical Billing and Coding

Country : USA

State : California

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