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MB-5252 - USA (Arizona) - Workers Compensation Claims Administration Services - Deadline May 27,2021

Product (RFP/RFQ/RFI/Solicitation/Tender/Bid Etc.) ID: MB-5252

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

[A] Budget: Looking for Proposals

[B] Scope of Service:

(1) Vendor needs to provide workers compensation claims administration services
- Create a Workers’ Compensation Claims Manual, with input from the County, for the program, outlining roles and responsibilities for all involved in the program within the first six (6) months,
- Contractor will provide third party administration services required for the management of the County’s workers’ compensation program. Contractor will process worker compensation claims and manage claims and related services, including but not limited to the management of:
- Claim adjusting services to include initial and ongoing contact, investigations, recorded statements, reserves levels, action plans, closing claims, payments and financial/accounting.
- Subrogation.
- Filing reports with the State, County Finance and Risk Management and excess insurance providers.
- Negotiations and settlement of claims for amounts pre-approved by the County.
- Litigation support/management.
- Independent medical exams and rehabilitation services.
- Claims data administration, maintenance and reporting.
- Claims related data and document transfer to and from Contractor’s system o the County’ s RMIS (Origami),
- Claims Classifications:
- Claims with lost time paid or anticipated loss time.
- Occupational disease and/or accidents.
- Cumulative trauma/repetitive motion upper extremity injuries.
- High-severity/catastrophic/death claims.
- Specific claims such as:
- Questionable injuries-including claims that initially may be medical only.
- Red flags when identified by PCHR: spinal injuries, knee injuries and shoulder injuries to name the most common.
- Other red flags include but are not limited to: multiple prior claims, late reported claims and claims with factual disputes,
- Claims that nurses (telephonic or field) are assigned to the claim to assist the claims adjuster in the medical management of the injury.
- Claims with possible subrogation recovery.
- Adjuster must be ready to discuss with PCHR the claims identified in advance for the weekly telephonic claims meetings
- Non-complex claims will include:
- Claims anticipated not to have any lost time paid (medical claims only).
- Minor injuries.
- Exposures,
- Low severity claims.
- First aid claims.
- Maintenance claims,
- Maintenance claims will include:
- Resolved fatality claims.
- Maintenance claims are counted in the non-complex adjuster’s case load,
- Claim Investigation:
- A claim investigation will be conducted and substantially completed on all claims within seven (7) days of the receipt of the claim by the Contractor,
- The extent of the claim investigation will be equivalent to the complexity of the case; however, all claims investigations will include a minimum of the following:
- Review of accident, injury and claim documentation for the incident.
- Review of the coverage of the claim including documentation of self-insured
- Claims adjuster will obtain reports on all Industrial Commission prior claims.
(2) A pre-proposal meeting will be held on May 12, 2021.

[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 : Thursday, 27 May, 2021

Pre-proposal Conference Date : Wednesday, 12 May, 2021

Category : Medical Billing and Coding

Country : USA

State : Arizona

Cost to Download This RFP Document : $ 5

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