MB-4561 - USA (Pennsylvania) - Third-Party Claims Administration Services - Deadline October 20,2020

Product (RFP/RFQ/RFI/Solicitation/Tender/Bid Etc.) ID: MB-4561

Government Authority located in Pennsylvania; USA based organization looking for expert vendor for third-party claims administration services.

[A] Budget: Looking for Proposal

[B] Scope of Service:

(1) Vendor needs to provide third-party claims administration services
- To initiate Third-Party Administration (TPA) to provide Workers’ Compensation and Automobile Liability Claims Administration (TPA) for the City’s Self-Insured General Liability Program
- All Payments and Claims must be processed through our online system using the City of Allentown claim number,
- Ensuring Medicare compliance and coordination,
- First aid claims are to be flagged with notice to the City and shall be identified as first aid on all loss run reports. Bill payments for first aid claims shall be determined by the City,
- Troubleshooting and providing effective solutions to resolve technological issues or problems with the service agreement and/or deliverables,
- Identify key outcome-based measurements that are tracked and deliver program improvements and cost reduction results,
- Monitor claim trends and audit claim handling procedures to ensure a high level of customer service and best in class claim service deliverables,
- Coordinate annual or as needed stewardship meeting to present service performance metrics, benchmarking and claim trending/loss analysis reports,
- Clearly document the initial plan of action in the claim file within 14 days from receipt of the claim and it should be updated every 30‐60 days,
- Communicate and discuss reserve increases of $10,000 or more on any one claim with the City,
- Prior to the denial of compensability of any claim, the adjuster must discuss the case with the City of Allentown for mutual agreement on the denial,
- The claim adjuster must notify the City anytime there are changes to the claimant’s work restrictions and at the time of any permanent work restrictions,
- Transitional/modified duty must be documented in the claim file and should include the medical diagnosis, work restrictions and estimated duration of disability,
- Review medical provider bills for appropriateness of fees charged utilizing the Pennsylvania Fee Schedule for WC claims; handle all medical bill discounts and re-pricing,
- Explain the safeguards to prevent bills unrelated to a claim but submitted for payment, including prescriptions and provider services, from being paid, and if erroneous payment is made, how the claim will be credited,
- Litigation management and defense are controlled and closely monitored by Risk Management, City Solicitor’s Office, and City’s Legal Counsel,
- TPA shall maintain an open case file and ensure loss runs accurately report claims that become litigated including legal fees, legal costs, settlements, and judgements,
- The TPA will provide the City with monthly risk management information reports, including a loss run, check register, bank statement and account reconciliation. Claim payments are made daily or as needed by the TPA using a positive pay system. The TPA will provide a notice of payments to be issued, and the City Risk Management will approve them prior to issuance.
(2) All questions must be submitted no later than October 6, 2020.

[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 : Tuesday, 20 October, 2020

Question Answer Deadline : Tuesday, 6 October, 2020

Category : Medical Billing and Coding

Country : USA

State : Pennsylvania

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