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MB-4162 - USA (New York) - Worker Compensation and No Fault Commercial Automobile Claims Administration Service - Deadline May 29,2020

Product (RFP/RFQ/RFI/Solicitation/Tender/Bid Etc.) ID: MB-4162

Government Authority located in New York; USA based organization looking for expert vendor for worker compensation and no fault commercial automobile claims administration service.

[A] Budget: Looking for Proposal

[B] Scope of Service:

(1) Vendor needs to provide worker compensation and no fault commercial automobile claims administration service.
- Provide claims administration services for workers’ compensation cases and no fault commercial automobile claims.
- Maintain files and records for all claims files including adjuster claim notes.
- Maintain records necessary for the defense of the claims at workers’ compensation board hearings.
- Aggressively pursue relief from the special funds and identify, and conduct, subrogation activities and pursue third party liens.
- Provide necessary notification to all excess carriers on claims which threaten the self-insured retention levels.
- Provide claim loss and management reports on a monthly, quarterly and annual basis. These reports must be issued on both a paid and incurred basis.
1. Claims Services for workers’ compensation claims: - Examine and review all workers’ compensation claims submitted. Create and maintain a file for each claim. Determine, analyze and evaluate the claim, determine validity and compensability, and advise the town of your findings.
- Estimated value for each case and set the appropriate reserve.
- Conduct early intervention and preliminary investigations on all claims to determine their validity.
- Ensure that all submitted claims for medical services and medications meet authorized WCL fee schedules.
- Utilize appropriate medical personnel to review claimant’s treatment plans and ensure that the treatments are related to the claimed injury.
- Review all prescription medications claimed by the employee or former employee to ensure that the prescriptions paid by the town are related to the claimed injury.
- Prepare the files for the defense of the claim at workers’ compensation board hearings.
- Schedule independent medical exams when necessary and assign medical case management when necessary.
- Review claims to determine if additional investigations such as surveillance are necessary and assign such investigation with Town approval.
- Provide monthly quarterly and annual reports as requested by the town comptroller’s office and department of human resources and include executive summaries.
- Provide the town with budgetary projections on the cost of the workers’ compensation program as needed.
- The vendor must submit a proposal for the review of all existing cases to design a comprehensive plan for lump sum settlements in appropriate cases. Such proposal’s cost should be included in an addendum to the price proposal sheet.
- Act as training agent to town personnel, providing periodic meetings to discuss town claims as well as direction and recommendations for reducing losses supervisor training and operational safety recommendations.
- Providing loss control and safety audits, as well as periodic stewardship reports notating problem areas requiring command attention.
2. Claims Services for no fault commercial automobile claims:
- Examine and review all no fault commercial automobile claims submitted. Create and maintain a file for each claim. Determine, analyze and evaluate the claim, determine validity and compensability, and advise the town of your findings.
- Conduct early intervention and preliminary investigations on all claims to determine their validity.
- Ensure that all submitted claims for medical services and medications meet authorized fee schedules.
- Utilize appropriate medical personnel to review claimant’s treatment plans and ensure that the treatments are related to the claimed injury.
- Schedule independent medical exams when necessary and assign medical case management when necessary.
- Provide monthly quarterly and annual reports as requested by the town comptroller’s office and town attorney’s office.
(2) Contract term will be five years.

[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 : Friday, 29 May, 2020

Category : Medical Billing and Coding

Country : USA

State : New York

Cost to Download This RFP Document : $ 5

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