MB-6559 - USA (Massachusetts) - Third Party Claims Administration Services for Workers Compensation and Injury on Duty Claims - Deadline July 6,2022

Product (RFP/RFQ/RFI/Solicitation/Tender/Bid Etc.) ID: MB-6559

Government Authority located in Massachusetts; USA based organization looking for expert vendor for third party claims administration services for workers compensation and injury on duty claims.

[A] Budget: Looking for Proposals

[B] Scope of Service:

(1) Vendor needs to provide third party claims administration services for workers compensation and injury on duty claims.
• Provide comprehensive claims administration services focused on medical, claims management and legal guidance for all claims.
• Review all medicals bills, prescriptions and apply payment in accordance to the rate setting commission.
• Negotiate fees for injury related treatment and surgery.
• TPA will issue checks or vouchers for all payments.
• TPA will work closely with the city; occupational nurse to ensure the medical management of each claim is handled appropriate to reach an end medical result for all claims.
• TPA may be requested to recommend policies and procedures for injured on duty and injured on duty retired.
• TPA will be responsible for any and all compliance reporting, changes to or amendments to CH41 Section 100 & 111.
• TPA will as appropriate file liens against third party related any injured-on duty case.
• TPA will prepare claim file to the designated law firm agreed on by the city.
• The TPA Administrator will review procedures and reporting to ensure compliance with state CH 152.
• The TPA will ensure all claims reported are in compliance with division of industrial accidents reporting guidelines.
• TPA will coordinate all litigation.
• TPA will coordinate controverted claims and notifications.
• TPA will investigate all claims to determine compensability.
• The TPA will within 24 hours make the standard “three-point contact”.
• The TPA will issue the 180 days pay without prejudice and 180-day extension.
• Medical bills submitted must be reviewed for reasonably related treatment.
• TPA will negotiate medical and surgical treatment plans maintaining a high quality of medical care for all injured employees.
• All bills reviewed should be in paid pursuant to the state divisional of industrial accidents.
• TPA will be responsible to issue all checks.
• TPA will arrange the necessary utilization review set forth by the divisional of industrial accidents.
• TPA will work with the city occupational health nurse to coordinate high quality medical management plans for all injured employees.
• TPA will manage any disputed medical service or medical bill received by the city.
• TPA will index all workers compensation claims.
• Quarterly reports will be required to include total financial exposure and claim plan to close each claim.
• Quarterly trend and analysis reports to include leading accidents cause, cost of claims by department, frequency and severity.
• Monthly detail loss reports will be sent to the city workers compensation administrator by the 7th of the month.
(2) All questions must be submitted no later than June 30, 2022.
(3) Contract term will be three years.

[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 : Wednesday, 6 July, 2022

Question Answer Deadline : Thursday, 30 June, 2022

Category : Medical Billing and Coding

Country : USA

State : Massachusetts

Cost to Download This RFP Document : $ 5

You can either pay for Single RFP/Bid document or Subscribe with Monthly Subscription for whole Medical Billing and Coding Category/Categories.

If you will obtain monthly subscription for Medical Billing and Codingcategory/categories, you will be able to access all the RFPs from that Category. Here are the Monthly Subscription offers. So, subscribe for Monthly offers and get rid of Individual RFP payment.

*No commitment =
(1) There is no minimum commitment.
(2) You can subscribe for as less as 1 month and cancel it any time. If you subscribe for annual offer, you can cancel it any time within year.
(3) There is no partial refund policy after Monthly or Annual subscription. You will be required to use services for a Month (Or Year since you have availed discounted pricing).
(4) You can cancel your subscription any-time directly from your PayPal account to stop further recurring charges before next due date.
(5) You will be able to download all RFPs for subscribed Category or Location without any extra cost.

Similar RFPs