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MB-6564 - USA (California) - Third Party Administration of Worker Compensation Program Services - Deadline July 12,2022

Product (RFP/RFQ/RFI/Solicitation/Tender/Bid Etc.) ID: MB-6564

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

[A] Budget: Looking for Proposals

[B] Scope of Service:

(1) Vendor needs to provide third party administration (TPA) of worker compensation program services.
- The TPA contract includes reporting injuries; employee contact; providing lost time and salary information; training for managers, supervisors, and employees; assisting with early return to work program; claimant service evaluation and maintenance of the City’s workers compensation claim files.
- The successful Administrator shall have at a minimum the following qualifications:
i. Must be licensed by the state as a third-party administrator (TPA).
ii. Have a claim administration office within reasonable proximity to the San Francisco Bay Area.
iii. Will render uninterrupted services during the business hours Pacific Standard Time (PST) zone.
iv. Have a minimum of five (5) years’ experience administering claims as a claim administrator for a public entity.
v. Have sufficient means and resources to conduct field investigations, provide prompt reporting and adjudication of medical and indemnity payments.
vi. Have an electronic database capable of producing specialized and ad hoc reports in addition to those required by the State.
vii. Have not received sanctions for nonconforming performance by the Department of Industrial Relations (DIR) in the past three years.
1. Records
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.
2. Dedicated Claims Unit and Assigned Personnel
The respondent shall establish a dedicated claims office, or a segregated unit whose sole responsibility is the handling of the City’s workers’ compensation claims.
3. Program Administration
i. 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.
ii. Inform the City of current changes or proposed changes in statutes, rules and regulations and case law affecting the workers’ compensation program.
iii. Represent City in all matters related to the set-up, investigation, adjustment, processing, negotiation, and resolution of workers’ compensation claims against the City.
4. Medical Bill Review
A bill for any type of medical treatment (physician, pharmacy, hospital, therapist, etc.) received by the Administrator shall be reviewed for correctness and accuracy; approved for payment; and paid within sixty (60) working days of receipt.
(2) All question must be submitted no later than June 28, 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 location.

Expiry Date : Tuesday, 12 July, 2022

Question Answer Deadline : Tuesday, 28 June, 2022

Category : Medical Billing and Coding

Country : USA

State : California

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