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MB-4014 - USA (California) - Worker Compensation Claims Administration Services - Deadline April 2,2020

Product (RFP/RFQ/RFI/Solicitation/Tender/Bid Etc.) ID: MB-4014

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:

(1) Vendor needs to provide worker compensation claims administration services for its self-insured workers’ compensation program including medical provider network management and bill review
- The claim file shall be available to City representatives, claims auditors, and agents for inspection,
and contain all medical and factual information on each claim reported within two business
days,
- The City requires that the TPA provide exceptional customer service to all injured workers.
TPA shall reply to all inquiries made by injured workers in a timely, accurate and professional manner,
- Provide on-site claim file reviews on a quarterly and annual basis. Other periodic on-site claim file reviews will be scheduled based upon the needs of the City,
- The TPA shall first obtain authority from the City to delay or deny a claim,
- The city’s authorization shall be clearly documented in the applicable claim file or in the computer
System, the compensability determination (accept claim, deny claim, or delay acceptance pending the results of additional investigation) and the reasons for such determination will be made and clearly documented in the file,
- The City shall be notified of all claims involving potential fraud and must authorize the TPA
to initiate fraud investigation activities when such activities are determined necessary,
- The TPA will provide other special reports including, but not limited to, loss trend reports, claim abstract reports, reports required by actuaries, excess insurance carriers, bill review fees, etc., provided that such reports do not require data elements that have not previously been collected by the TPA.
(2) All the questions must be submitted no later than March 25, 2020.

[C] Eligibility:

- Onshore (USA Organization Only);

[D] Work Performance:

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

[E] Proposal Submission:

Response can be submitted either digitally (via Email or Online) or physically (courier or post).

Expiry Date : Thursday, 2 April, 2020

Question Answer Deadline : Wednesday, 25 March, 2020

Category : Medical Billing and Coding

Country : USA

State : California

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