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MB-4495 - USA (Texas) - Third Party Claims Administration Service for Workers Comp Program - Deadline September 17,2020

Product (RFP/RFQ/RFI/Solicitation/Tender/Bid Etc.) ID: MB-4495

Government Authority located in Texas; USA based organization looking for expert vendor for third party claims administration service for workers comp program.

[A] Budget: Looking for proposal

[B] Scope of Service:

(1) Vendor needs to provide party claims administration partnership which deliver objective and measurable results that will reduce the cost and duration of Worker's Compensation claims, provide claims processing in a timely and professional manner, actively pursue subrogation, assist in returning injured employees back to work and maintain strong communication with injured workers and the County.
- TPA shall administer Workers Compensation Claims in accordance with laws, rules, and regulation of the State of Texas.
- TPA shall comply with statutory constraints regarding the state filings for administrative, medical and indemnity payments.
- TPA shall handle, and monitor all claims, make payments, adjustments, and investigate claims on behalf of Dallas County.
- TPA must discuss all reasons of denial with the County's Risk Manager.
- All claims will be documented regarding compensability.
- All medical only claims involving work restrictions will be handled the same as lost time claims as respects diary, medical management and release to regular duty
- TPA will submit a status report (including reasons) to County's Risk Manager prior to all case reserve increases. Currently, claims are funded through an lmprest Account. The County initially funds the account with six weeks anticipated payments (medical, indemnity and expense) and reimburses the account as check registers representing claim payments are presently weekly. Large medical and lump sum payments (over $10,000.00) are prefunded on an as needed basis.
- All open files will be reviewed at a minimum of every thirty days. These open files will be maintained on a regular diary and the claim files will be documented regarding current status and action plan to bring file to closure (keep computer notes current).
- Reserves, including reserve worksheets, must be reviewed upon diary and reserve analysis must be documented in the reflecting of all reserve changes
- All telephone conversations, discussions, correspondence and medical reports will be documented in the claim file on all claims and computer files.
- Account Manager and/or Supervisor shall create a claim file workflow to ensure timely claim processing and handling.
- TPA will perform all work on claims.
- Maintaining and documenting regular contact with treating physicians. In situations where contact is not made document the reason for lack of contact.
- TPA will exhibit sound and timely file notes documentation practice.
- TPA will submit status reports to the county on all open files with an incurred reserve of $10, 000 or more every three (3) months or as requested by the County.
(2) All the questions must be submitted no later than September 2, 2020
(3) The contract period will be for three year.  

[C] Eligibility:

Onshore (US organization Only)

[D] Work Performance:

Performance of the work will be Offsite. Vendor needs to carry work in their office premises.

Expiry Date : Thursday, 17 September, 2020

Question Answer Deadline : Wednesday, 2 September, 2020

Category : Medical Billing and Coding

Country : USA

State : Texas

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