MB-4131 - USA (Massachusetts) - Third-Party Administration Services of Worker Compensation - Deadline May 11,2020

Product (RFP/RFQ/RFI/Solicitation/Tender/Bid Etc.) ID: MB-4131

Government Authority located in Massachusetts; USA based organization looking for expert vendor for third-party administration services of worker compensation.

[A] Budget: Looking For Proposal

[B] Scope of Service:

(1) Vendor needs to provide third-party administration services of worker compensation
-  Includes third party management of all claims, but specifically excludes the appearance of counsel before the Department of Industrial Accidents and Superior Court,
- Third-party administration services shall consist of claims administration, claims monitoring, medical case management, utilization review (UR), and case management to and through resolution of all active past, current and future claims and cases,
- The services shall include:
- Receipt, processing, filing and maintenance of all claim-related forms, reports and notices as required by state law for controlling losses,
- Utilization review (UR) and verification of all medical services billings, including medications and durable medical equipment,
- Determination of lowest state authorized rate for payments, including claimants granted accidental disability retirement (ADR),
- Timely follow-up with doctors and claimants and investigation of cases, when necessary, to reduce exposure and cost; and
- Calculations of indemnity payments for lost time claims and status for final decision by the Town,
- Administration should also include the incorporation of the appropriate number of nurse case managers to effectively provide advice and assistance in monitoring injured employees’ medical care and treatment and to issue reports to claims handlers assigned,
- Administration of claims shall include receipt, processing, filing, and maintenance of all relevant claims, all contact with claimant employees and their legal representatives, all parties involved in treatment and rehabilitation, excluding legal representation,
- The contractor will review each claim for facts, consistency, completeness and clarity and make the initial determination of compensability under the respective statutes and provide advice and guidance to the Town on all matters relative to workers’ compensation; injured on duty; and accidental disability retirement claims,
- Handling of all workers compensation claims, including the following:
- Develop and recommend a case management action plan for all new cases,
- Confirm claim as lost time or no lost time,
- Establish liability reserve for compensation and medical services for each claim,
- Establish claim status for payment or non-payment pending further review,
- Review all no lost time claims for potential medical liability,
- Request up to date medical reports from providers,
- Investigate all claims for concurrent employment wages, and
- Assure medical appointments are kept and reports submitted are timely and complete.
(2) All questions must be submitted no later than May 6, 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.

Expiry Date : Monday, 11 May, 2020

Question Answer Deadline : Wednesday, 6 May, 2020

Category : Medical Billing and Coding

Country : USA

State : Massachusetts

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