MB-4277 - USA (Michigan) - Workers Compensation Third Party Administration, Loss Control and Medical Utilization Bill Review Services - Deadline July 10,2020

Product (RFP/RFQ/RFI/Solicitation/Tender/Bid Etc.) ID: MB-4277

Government Authority located in Michigan; USA based organization looking for expert vendor for workers compensation third party administration, loss control and medical utilization bill review services.

[A] Budget: Looking for proposal

[B] Scope of Service:

(1) Vendor needs to provide workers compensation third party administration, loss control and medical utilization bill review services who has experience in public and private sector employee self-insured worker compensation lost time and medical only claims, return to work/light duty and loss control programs.
- The Contractor will need to be available for consultations with personnel and other related departments relating to handling of worker compensation claims and safety and loss control. The Contractor will work daily with the Airport Authority’s Human Resource staff to ensure continuity of the Airport Authority’s current customer service levels for claimants and departments.
- The Airport Authority exercises its option to transfer open claim files to the Contractor at its discretion. The Airport Authority will determine who will handle the tail claims. A list of these claims will be provided during the transition period.
- The Contractor shall process all claims or losses transferred from the previous Contractor remaining open on the effective date of the contract or at the discretion of the Airport Authority. The Airport Authority retains the option to finalize any claim and to not transfer certain claims to the Contractor.
- File / Data Ownership: Contractor agrees that the claim files and claim and statistical data shall remain the property of the Airport Authority.
- The Contractor shall coordinate service strategies with Human Resources, including but not limited to, performing accident investigations, training, audits, and quarterly meetings.
- The Contractor shall provide a method or methods for agencies to report claims and indicate if their system is capable of receiving claims, particularly first reports of workers’ compensation injury, electronically.
- Correspondence and other documents shall be date-stamped on the day it is received and shall be documented in the file within 48 hours. The Contractor shall document all statements and each contact with employees, witnesses, claimant, staff, physicians, attorneys, the Airport Authority and any other investigative efforts in the file. The Contractor’s database should have the capability for designated Airport Authority staff to view the progression of any claim
- The Contractor shall provide on-line access to the Human Resources Department that includes all required software at no additional cost. The online access shall include, but is not limited to, access by claim to the claim historical data, financial data, supervisory and adjuster notes, diary information, all payment information. Preferably the online access shall provide the Human Resources Department the ability to run management reports on the Authority’s claims as needed.
- The Contractor shall conduct a thorough investigation of each reported claim to the extent necessary, which may include but is not limited to statements, photographs, diagrams and police reports from involved parties.
- Investigations and the hiring of all independent subcontractors, experts and vendors, including, but not limited to nurse case management; vocational rehabilitation, investigators, independent medical examiners; Sington/Stokes evaluations, Durable Medical Equipment and Pharmacy must be approved by the Airport Authority within the Human Resources staff prior to retaining services. The Contractor must provide the Airport Authority with a copy of all written reports.
- The Contractor shall make all payments of benefits, losses and expenses as necessary including but not limited to wage loss, medical, vocational rehabilitation, medical management, mileage, funeral, and death benefits.
- The adjuster will represent the Airport Authority at mediation at the Bureau of Workers’ Disability Compensation to handle lost time and medical only claims or claims where the claimant is in proper. The Airport Authority retains the right to determine who will appear to represent the Airport Authority. If the adjuster is absent, the Contractor must receive approval from Human Resources as to who will represent the Airport Authority at the medication hearings
- The Contractor shall assist the approved defense counsel with the litigation of Airport Authority claims including but not limited to supplying detailed claim documentation in the format required by defense counsel, provide medical organization and analysis, evaluation and discussion of exposure, settlement value, and participation as needed in hearings, settlement or trial. The Contractor shall continue to update defense counsel on any received documents and evaluations.
- Medical bills shall be reviewed for processing within three (3) working days upon receipt of same at the lowest possible rate (fee schedule and any applicable cost containment programs)
- For more information describe in documents.
(2) A pre-pr

[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, 10 July, 2020

Category : Medical Billing and Coding

Country : USA

State : Michigan

Cost to Download This RFP Document : $ 5

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