Product (RFP/RFQ/RFI/Solicitation/Tender/Bid Etc.) ID: MB-6532

Government Authority located in Iowa; USA based organization looking for expert vendor for third party administrative services for workers compensation claims medical bill review and pharmacy benefit management.

[A] Budget: Looking for Proposals

[B] Scope of Service:

Vendor needs to provide third party administrative services for workers compensation claims medical bill review and pharmacy benefit management to adjust and administer its workers’ compensation claims in a way that provides a high level of customer service while simultaneously reducing the overall cost of the City’s Workers’ Compensation Program through efficient use of cost containment practices, procedures and protocols.
O Documentation of each workers’ compensation case for tracking purposes.
O Transfer of past and present claims and information.
O Hosting and secured maintenance of all Workers’ Compensation claims.
O Provide strategy for the effective management of each claim through closure
O Process claims in an efficient manner.
• Review all medical reports and medical bills related to the claims for appropriateness, as well as verify that the medical treatment provided is consistent with what is required and billed and negotiate modifications as appropriate.
• Monitor medical treatment and arrange examinations by specialists where appropriate.
• Establish claims reserves; provide a continuous review and update to reflect changes in exposure.
• Participate in claims review and action plan meetings with the City on a quarterly basis, or more frequently if required.
• Maintain financial claim records for all reported incidents and provide the City with these reports monthly.
• Make all payments to claimants and providers required but not limited to: payment of medical bills, lost time, and settlements.
- Pharmacy Bill Management: -
• We strongly prefer a web-based management program with online access for the City.
• We prefer to work with a paperless system and require electronic invoicing.
• Please explain how the pharmacy bill management process works for your company, including details on electronic pharmacy bill management software program that enables automated   auditing, review, and re-pricing for bills related to worker’s compensation

[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 : Friday, 1 July, 2022

Category : Medical Billing and Coding

Country : USA

State : Iowa

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