MB-4476 - USA (California) - Workers Compensation Program Administration Services - Deadline September 18,2020

Product (RFP/RFQ/RFI/Solicitation/Tender/Bid Etc.) ID: MB-4476

Government Authority located in California; USA based organization looking for expert vendor for workers compensation program administration services.

[A] Budget: Looking for Proposal

[B] Scope of Service:

(1) Vendor needs to provide workers compensation program administration services.
1. Claims processing
- Establish a case management system for each case and review cases in accordance with the guidelines contained herein, at least, every 30 days, or more frequently, if directed by the agency.
- Make recommendations on funding of the workers’ compensation program in reserve account, taking into consideration all potential payments.
2. Payment of claims
3. File documentation
- Clearly document the basis for all initial reserves, reserve revisions, and payments in the case file.
- Establish specific direction on investigation and handling of all indemnity cases and clearly evidence same in the file. The extent of the direction of each investigation shall be based on the seriousness or complexity of the case at hand.
4. Claims management
- Where claims for benefits are adjudicated, the contractor shall vigorously defend such claims unless otherwise directed by the agency.
-In all questionable indemnity cases, contractor shall obtain informative statements from anyone who may have knowledge of the injury, including the claimant, witness(es), and/or supervisor of claimant.
5. Medical control
-Work with the agency’s director of human resources to identify “designated” medical facilities, provide a panel of physicians and specialists for the diagnosis and treatment of injured employees, and supervise the furnishing of medical treatment required under the workers’ compensation law of the state to injured employees.
6. Litigation management
- Legal counsel will be selected on the basis of needed expertise and subject to the prior written approval of the agency’s director of human resources. in matters related to the agency’s obligations as a self-insured agency, contractor shall direct the attorney(s) in ways consistent with the agency’s policies and instructions.
7. Reporting requirements
- For claims meeting the following criteria: a) reserved of $10,000 and above; or b) involving serious injury, including death, heart attack, back problems involving surgery, serious burns, disfigurement, paraplegia, quadriplegia, amputation, loss of sight or hearing, brain damage, alleged psychiatric disability, or any other extreme and permanent injury; or c) in litigation.
8. Communication
- Maintain open lines of communication with the agency on an ongoing basis. This will include, a minimum of, five (5) working days’ written notification prior to any deposition, pretrial, or workers’ compensation board hearing, which shall include the approach intended to be used by the contractor.
9. Brokerage services
- Contractor shall provide or engage a third party to provide brokerage services for placement of excess workers’ compensation insurance coverage (reinsurance) after receiving the agency's prior written authorization. The cost of such insurance and brokerage fees will be paid for by the agency.
10. Review procedures
- The agency’s right to exercise oversight of the workers’ compensation program shall not be abridged by the retention of a TPA.
11. Program management services
- In order to deliver a successful and efficient workers’ compensation program, program management services are important factors.
(2) All questions must be submitted no later than September 2, 2020.
(3) A pre-proposal conference will be held on August 26, 2020.
(4) 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, 18 September, 2020

Pre-proposal Conference Date : Wednesday, 26 August, 2020

Question Answer Deadline : Wednesday, 2 September, 2020

Category : Medical Billing and Coding

Country : USA

State : California

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