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MB-4603 - USA (New Jersey) - Third Party Insurance Administrator and Medical Bill Re-Pricing and Intake Services - Deadline October 20,2020

Product (RFP/RFQ/RFI/Solicitation/Tender/Bid Etc.) ID: MB-4603

Government Authority located in New Jersey; USA based organization looking for expert vendor for third party insurance administrator and medical bill re-pricing and intake services.

[A] Budget: Looking for Proposals

[B] Scope of Service:

Vendor needs to provide third party insurance administrator and medical bill re-pricing and intake services.
- The Fund seeks a partnership through innovative services, solutions and technology that addresses the County’s self-insured liability, workers’ compensation and automobile claim management issues and needs. The Fund desires a collaborative effort yielding custom designed programs, constantly finding ways to strengthen and improve relationships among claim management, provider network, the County and the employee. Communication among all parties is critical and shall be maintained when providing timely and comprehensive claims handling.  
- Services provided shall include investigation, evaluation and administrative handling of all general, employment related practices and automobile liability claims as well as all workers’ compensation claims. The TPA is responsible for maintaining computerized claim data, setting appropriate loss reserves, monitoring all litigation and maintaining communication with the attorneys, obtaining necessary case- specific client authority, required reporting to excess insurance carriers, making claim settlement and  expense payments, pursuing subrogation opportunities, attending regular Fund meetings, and complying with Fund claim handling and reporting requirements. The TPA shall be responsible for the above while performing the following minimum duties as well as those prescribed by applicable law, subject to the review and approval of the Fund.
The bidder must establish a secure electronic data interface (EDI), between the TPA and bill-repricing agency for the purpose of transmitting all claim processing in HIPAA compliant 837 formats. The frequency of the feed between the contractor and the TPA shall be no less than one time per week; daily is the preferred method. In addition, they must provide on-line access to all claim information and to Network Providers. Web based sites must be secure and use the HTTPS protocol.  The site must be compatible with all browsers.
1. Third Party Administrator (“TPA”) and
2. Bill Re-pricing and Intake Services
- The Fund has an in-house Nurse Case Manager and maintains a Special County Counsel list to handle legal services. The Division of Risk Management currently:
o Utilizes a company to provide Intake Services on all initial work-related injuries.
o Utilizes a third-party claims administrator to:
• Issue payment for claim expenses in a timely manner.
• Provide decisions on such matters as compensability based on workers’ compensation law.
• Assist with voluntary offers determined by the value of cases in court.
• Participate in the Insurance Fund Committee meetings, twice monthly.
• Establish a network of primary care facilities, physicians, etc., for work-related injuries/accidents.
• Provide claims reporting in areas such as: check registers, frequency losses, types of losses, total claims costs, etc.
• Utilizes a secondary organization for:
• Provision of a PPO Network to encourage greater discounts
• Re-pricing of bills for providers
A.) Establish a secure electronic data interface (EDI), between the TPA and bill-repricing agency for the purpose of transmitting all claim processing in HIPAA compliant 837 formats.
B.) Commit to servicing the County with at least one designated claim adjuster assigned to handle all County of Morris workers’ compensation claims and at least one dedicated adjuster to handle indemnity claims.
C.) Review all workers compensation claim forms and petitions submitted by Fund members and investigate each in order to determine the Fund’s obligation to pay or provide other benefits in accordance with applicable law.
D.) Review all tort notice claim forms submitted by Fund members and investigate each in order to assess the Fund’s obligation to reimburse third parties in accordance with applicable law.
E.) Establish, maintain and revise (where reasonably necessary) estimated reserve figures for all claims.
F.) Proceed with the payment or denial, as appropriate, pursuant to applicable law and where authorized by the Fund, all claims received
G.) Maintain and provide to the Fund upon its request statistical evaluations of all claims, including by way of example and not limitation, monthly amounts paid on each open claim, claim experience for all Fund operating years, etc.
H.) Notify the Fund and excess carrier where there is reason to believe that a claim will exceed the Fund’s claim retention and/or 50% of reserve of SIR ($500,000)
I.) Respond to inquiries by the Fund’s Administrator, General Counsel or Risk Manager.
J.) Serve lien letters on all potentially responsible third parties and coordinate

[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

Category : Medical Billing and Coding

Country : USA

State : New Jersey

RFP Expired

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