MB-5951 - USA (Nevada) - Third Party Claims Administrator Services for Self-Insured Workers’ Compensation Program - Deadline February 4,2022

Product (RFP/RFQ/RFI/Solicitation/Tender/Bid Etc.) ID: MB-5951

Government Authority located in Nevada; USA based organization looking for expert vendor for third party claims administrator services for self-insured workers’ compensation program.

[A] Budget: Looking for Proposals

[B] Scope of Service:

(1) Vendor needs to provide third party claims administrator services for self-insured workers’ compensation program
- Determine the acceptance or rejection of all workers’ compensation claims
- The successful proposer shall supply the following reports, annually, monthly, or as requested by the City:
- Monthly reports for all open claims with reserves, closed claims during the month, and a summary by fiscal year of all claims filed, open, closed, and rejected
- Annual report as required by the State, Department of Business & Industry, Division of Industrial Relations, and the Division of Insurance.
- Specialized reports as requested by the City.
- Provide referrals to the appropriate rehabilitation service agencies as required.
- Review permanent partial disability evaluations; determine permanent partial disability awards, and notify claimants of their options.
- Review and audit doctors’ bills and reports for accuracy and adjust payments accordingly.
- Work in coordination with the City Managed Care provider.
- Assist the City in returning injured workers to light duty.
- Approve all requests for surgery and refer claimants for second opinions, as needed on claims.
- Provide subrogation to recover any judgements from third parties
- Advise the City of Reno of claims resulting in major surgery, lost time, possible rehabilitation, and all claims concerning litigation
- Review with City’s representative’s program progress, including identification of problem areas and recommend solutions there to and provide consultative services as necessary
- Provide the City complete access to its claims data pertaining in any way to the workers’ compensation program referred to herein. Any system providing such information shall be secure
and shall contain the applications necessary to prohibit access by unauthorized individuals
- Claims Administration:
- Review and adjust all workers’ compensation claims in accordance with all applicable state laws as well as the terms of the contract
- Report all claims that might reach the excess layer of insurance coverage to the appropriate insurance carrier in accordance with their respective requirements
- Participate fully in on-site/virtual file reviews and audits and respond promptly to written Inquiries
- Provide copies in each claim file of all checks, vouchers, or warrants drawn to pay benefits and claims expenses on behalf of the City
- Adjustment Services:
- Maintain a claim file on each potential or actual claim reported to Proposer.
- Establish and maintain case reserves for workers’ compensation claims which accurately reflect the ultimate probable exposure of the claim.
- Act as a liaison between the excess insurance carrier(s) and the City on matters affecting the adjustment of claims.
- Provide a copy of your claims administration manual to the City as part of this proposal, marked as proprietary if appropriate.
- Maintain records on all claims and notify the City when the City is entitled to reimbursement for loss in excess of their retention.
(2) All the questions must be submitted no later than January 18, 2022.

[C] Eligibility:

Onshore (USA organization Only)

[D] Work Performance:

Performance of the work will be Offsite. Vendor needs to carry work in their office premises.

Expiry Date : Friday, 4 February, 2022

Question Answer Deadline : Tuesday, 18 January, 2022

Category : Medical Billing and Coding

Country : USA

State : Nevada

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