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MB-5922 - USA (California) - Third Party Administration of Worker Compensation Benefits Services - Deadline January 26,2022

Product (RFP/RFQ/RFI/Solicitation/Tender/Bid Etc.) ID: MB-5922

Government authority located in California; USA based organization looking for expert vendor for third party administration of worker compensation benefits services.

[A] Budget: Looking for Proposal

[B] Scope of Service:

(1) Vendor needs to provide third party administration of worker compensation benefits services to provide effective and efficient claims administration services and to provide the city’s employees with appropriate benefits and medical treatment in a prompt and efficient manner.
- The administrator shall maintain complete and accurate records with respect to costs, expenses, receipts, and other such information required by the city that relates to the performance of services under this agreement.
- The administrator shall maintain adequate records of services provided in sufficient detail to permit an evaluation of services.
- The administrator shall provide free access to the representatives of the city or its designees at all proper times to such books and records, and give the city the right to examine and audit same, and to make transcripts there from as necessary, and to allow inspection of all work, data, documents, proceedings and activities related to this agreement.
- The administrator shall designate a full-time claims supervisor to be assigned to this account that will act as the primary contact for the city and will be selected with the concurrence of the city.
- Develop policies and procedures relating to the workers’ compensation claims program, as well as provide information and guidance regarding the workers’ compensation program and specified claims.
- Inform the city of current changes or proposed changes in statutes, rules and regulations and case law affecting the workers’ compensation program.
- Investigate any questionable claim; recommend special, outside independent investigation for a questionable claim with the consent, coordination and assistance of the city.
- Provide information and guidance to an injured employee about the workers' compensation benefits available according to state law and established city policies.
- Develop and recommend a panel of physicians for the initial treatment of an industrial injury or illness.
- Review all billings for reasonableness using the state medical fee schedules and submit for medical auditing as necessary to a city-approved bill review service.
- Provide information and guidance to injured employees regarding the benefits they will receive in accordance with city policies.
- Maintain a litigation management budget for each litigated file and provide litigation status reports on a regular basis for each litigation file.
- Manage the impress account in a reasonable and prudent manner and in compliance with city directives and accepted accounting principles.
- Establish procedures and necessary documentation enabling the TPA to draw checks for payment of benefits on an appropriate imprest account of the city.
(2) All questions must be submitted no later than January 5, 2022.

[C] Eligibility:

- Onshore (US Organization Only);

[D] Work Performance:

Performance of the work will be Offsite.

Expiry Date : Wednesday, 26 January, 2022

Question Answer Deadline : Wednesday, 5 January, 2022

Category : Medical Billing and Coding

Country : USA

State : California

Cost to Download This RFP Document : $ 5

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