MB-6667 - USA (New Mexico) - Worker Compensation Third Party Administration Claims Service - Deadline August 23,2022

Product (RFP/RFQ/RFI/Solicitation/Tender/Bid Etc.) ID: MB-6667

Government Authority located in New Mexico; USA based organization looking for expert vendor for worker compensation third party administration claims service.

[A] Budget: Looking for Proposals

[B] Scope of Service:

(1) Vendor needs to provide worker compensation third party administration claims service.
a. Workers’ Compensation Third Party Claim Administration Services
b. Workers’ Compensation Managed Care Services
c. Return-to-Work Coordination Services
d. Workers’ Compensation Medical Bill Review Services
e. Workers’ Compensation Pharmacy Network
- Investigate all claims for compensability and monitor all claims for potential fraud. Evaluate each claim for potential subrogation and contact the District’s Director of Risk Management if any questions regarding liability arise before pursuing subrogation.
- Pay all benefits allowed by law on the claim and in accordance with State law. Avoid duplicate payments, but if they occur, actively collect any overpayment of benefits.
- Return all phone calls within one working day.
- The selected administrator will be expected to bear the cost of:
1. Installing any necessary automated claims administration systems and all hardware upgrades necessary to access the system.
2. Installing/converting historical data, including claim, payment and reserve information and transferring paper files and electronic files from the District.
3. Transferring records and systems to the succeeding TPA at the transition of the contract (if a different TPA is selected) with no additional cost or fee required.
4. Administrative fees should cover the cost of administrator’s staff; all office space; storage space for closed files; supplies; forms/posters/pamphlets and brochures for injured employees as required by the State Labor Code and the Administrative Director; standard management reports; telephone expenses; postage; laser check stock; computer hardware/software; transcription services (if utilized for claims examiner’s correspondence); and other equipment/supplies necessary for claims handling.
- Provide training and orientation of the District’s personnel who are directly or indirectly involved in the reporting and or processing of the claims or losses.
(2) A question must be submitted no later than August 10, 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, 23 August, 2022

Question Answer Deadline : Wednesday, 10 August, 2022

Category : Medical Billing and Coding

Country : USA

State : New Mexico

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