MB-6672 - USA (New Jersey) - Third Party Administrator Services - Deadline September 14,2022

Product (RFP/RFQ/RFI/Solicitation/Tender/Bid Etc.) ID: MB-6672

Government Authority located in New Jersey, USA; based organization looking for expert vendor for third party administrator services.

[A] Budget: Looking for Proposal

[B] Scope of Service:

(1) Vendor needs to provide workers’ compensation and automobile third party administrator services include but is not limited to tasks such as preparation of comprehensive medical history and factual reports to accompany the file, inclusive of medical records.
- pre-approved legal defense counsel associated with the workers’ compensation program as well as Auto claims
- own electronic claims management system with initial training and ongoing in-service for all designated UH staff on the claims submission process, electronic claims management systems and any forms to be utilized
- customization of all client handling instructions and claim funding
- A dedicated Claims Service Coordinator/Supervisor will be required to ensure claims service is being performed with excellence
- Quarterly onsite comprehensive claim review meetings
- responsible for advising liability excess carriers in accordance with policy provisions
- allow UH or its designee the ability to audit all files.
- perform concurrent and continual review of all claims assessing treatment recommendations by physicians to determine if it is medically necessary
- carefully monitor and assess treatment plans for injured employees to ensure that they receive proper care and to avoid over treatment and ensure timely and appropriate discharge
- Robust investigations are to be ongoing to evaluate questionable claims with the consent, coordination and assistance
- Proactive review of claims for appropriate timing of Functional Capacity Exams with close follow up, communications and resolutions
- recommend reserves for unpaid reported claims and unpaid claim expenses
- Allocated Claim expenses include all expenses incurred in connection with the investigation, adjustment, settlement or defense of Client claims
- Destroy claim records by shredding.
(2) All questions must be submitted no later than August 12, 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 : Wednesday, 14 September, 2022

Question Answer Deadline : Friday, 12 August, 2022

Category : Medical Billing and Coding

Country : USA

State : New Jersey

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