MB-5869 - USA (Maryland) - Third Party Claim Administrative Services - Deadline December 16,2021

Product (RFP/RFQ/RFI/Solicitation/Tender/Bid Etc.) ID: MB-5869

Government Authority located in Maryland; USA based organization looking for expert vendor for third party claim administrative services.

[A] Budget: Looking for Proposals

[B] Scope of Service:

Vendor needs to provide third party claim administrative services
A. Claim Intake and Set Up Requirements:
- On-line internet-based reporting available
- Acknowledgement of new claims back to client representative
- Ability to report via email
- Electronic acknowledgement of new claims back to reporting party and client representative
- Claims Service Provider may not accept new WC claim reports received directly from any claimant, attorney, or other party not a responsible management representative
B. Medical Management:
- Telephonic Case Management capabilities available
- Field Case management and Rehabilitation Management capabilities available
- 24-7 Nurse Triage available
- Telemedicine/Telehealth available
- Review and re-pricing of all medical and bills required
- Preferred Provider Organization (PPO) networks and customization options available
- Quarterly reporting of expenses and savings on all aspects of medical management required
- All medical management expense must be billed directly to the claim file
- Prescription Benefit Management Program available
- Utilization review, peer review, IME/QME capabilities available
- Claim Service Provider must be willing to utilize County-preferred vendors or unbundle Non-Bill Review ancillary medical management services
C. Legal Management:
- Claim Service Provider shall utilize the County’s designated Counsel. For states where no Panel Counsel is specified, Claim Service Provider should recommend carrier approved counsel to the County for approval before assignment on any case
- Claim Service Provider must have written litigation management program that includes written litigation plans and reports provided to the County, including legal budget on a monthly basis
D. Data System and Reporting:
- Able to interface with clients external Risk Management System and/or Safety Systems (Client RMIS/Safety System Name)
- Mobile applications for claim reporting and claim management capability
- All claim files must be in electronic format and all documents must be imaged and available for review by the Risk Management Office (RMO), where applicable by state laws. Claim Service Provider will arrange training for its employees to ensure the claims management system is used efficiently, effectively and to its fullest capabilities. (RMIS must be flexible in coding and mandatory data fields).
- Ability to add unique claim coding for the purposes of tracking claim cost paid under the Initial Treatment Policy

[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, 16 December, 2021

Category : Medical Billing and Coding

Country : USA

State : Maryland

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