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MB-4167 - USA (Texas) - Workers Compensation Administration and Related Services - Deadline June 18,2020

Product (RFP/RFQ/RFI/Solicitation/Tender/Bid Etc.) ID: MB-4167

Government Authority located in Texas; USA based organization looking for expert vendor for workers compensation administration and related services.

[A] Budget: Looking for Proposal

[B] Scope of Service:

(1) Vendor needs to provide workers compensation administration and related services in the event an employee is injured on the job.
- Workers’ compensation claims administration to include claims adjusting, claims investigations, claims payments, establishing reserves, and claims management reports.
- Medical case management to include field and telephonic case management and vocational case management.
- Medical cost containment to include field and telephonic case management, early intervention, medical bill auditing, preauthorization and reconsideration determinations, utilization review, and durable medical equipment management.
- Pharmacy benefits management to include developing and maintaining a drug formulary, contracting with pharmacies, negotiating discounts and rebates with drug manufacturers, processing and paying prescription drug claims, and working with city and proposer to maintain or reduce pharmacy expenditures and improving health care outcomes of city employees.
- 504 medical provider program - administration of the city’s “blackstone provider panel” to include provider credentialing, website maintenance, and maintenance of claimant and healthcare provider policies and procedures.
- Related Services, such as agency representative, actuarial services, claims auditing, private investigations, legal representation at hearings, and other such services.
- City is specifically looking for a third party administrator (TPA) that will deliver objective and measurable results to: reduce the duration and costs of workers’ compensation claims; provide claims handling and processing services in a professional, timely manner; actively pursue subrogation and contribution; proactively assist the city return-to-work coordinator and departmental workers’ compensation coordinators with returning injured employees to work as soon as medically feasible; and maintaining strong communications and relationships with injured workers, healthcare providers, and city department personnel.
- The successful proposer(s) will work closely with the city’s human resources department, risk management division and other city department managers and workers’ compensation coordinators to provide workers’ compensation administration and related services to the risk management division and city employees.
- Claims management is centralized within city’s human resources department, division of risk management. A professional workers’ compensation manager oversees the workers’ compensation program. Claims are reported by designated departmental workers’ compensation coordinators who electronically complete required state claim forms and submits them electronically to the TPA and city risk management.
- City will use the results of this RFP process to award a service agreement that will include the takeover of all existing workers’ compensation claims and all historical claims records and files. The anticipated inception of the professional service agreement is November 1, 2020.
- City is soliciting proposals for a third party claims administrator that is capable of providing a full range of claims adjusting and administration services for its self-insured, self-funded workers’ compensation program and to provide related workers’ compensation-related support services to city’s risk management program. Such services may include, but are not necessarily limited to:
 - Claims adjusting activities
 - Medical cost containment services
 - Pharmacy benefits management
 - Claims management system
 - Administration of the city’s “504 medical provider panel”
(2) All questions must be submitted no later than May 28, 2020.
(3) A pre-proposal conference will be held on May 26, 2020.
(4) Contract term will be two 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 : Thursday, 18 June, 2020

Pre-proposal Conference Date : Tuesday, 26 May, 2020

Question Answer Deadline : Thursday, 28 May, 2020

Category : Medical Billing and Coding

Country : USA

State : Texas

Cost to Download This RFP Document : $ 5

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