MB-6675 - USA (California) - Workers Compensation Nurse Case Management, Utilization or Peer Review, Medical Bill Review and Pharmaceutical Benefit Management Services - Deadline September 15,2022

Product (RFP/RFQ/RFI/Solicitation/Tender/Bid Etc.) ID: MB-6675

Government Authority located in California, USA; based organization looking for expert vendor for workers compensation nurse case management, utilization or peer review, medical bill review and pharmaceutical benefit management services.

[A] Budget: Looking for Proposal

[B] Scope of Service:

(1) Vendor needs to provide third-party administrator service for claims review, processing, and payment of benefits for its self-insured Workers’ Compensation program.
- setting up and maintaining the interfaces, including, but not limited to, implementation fees, electronic data interface, or scanning fees
- Nurse case managers shall actively coordinate health care services and ensure medical treatment requests are reviewed and authorized according to medical treatment utilization schedule (MTUS), provide case direction, and promote early resolution of the claim
- nurse must contact the injured worker, providers, and the claims adjuster to actively coordinate healthcare services, in compliance with the MTUS, and assist with the injured worker’s return-to-work
- providers (as necessary), and the claims adjuster to identify options for achieving optimal case resolution
- Mail intake operations, scanning, indexing, imaging and Optical Character Recognition (OCR) operations
- identify and correct fee schedule excesses, duplicate charges (full and partial), and billing infractions, and recognize and unbundle service codes as appropriate
- receives bills from the County’s TPA and within 24 hours, identifies bills by such fields as claim number, social security number and/or claimant name
- provide customer service and quality control personnel to manage and resolve medical provider re-evaluations, inquiries, and complaints.
(2) A bidder conference will be held on August 11, 2022.
(3) All questions must be submitted no later than August 12, 2022.
(4) Contract period 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 : Thursday, 15 September, 2022

Pre-proposal Conference Date : Thursday, 11 August, 2022

Question Answer Deadline : Friday, 12 August, 2022

Category : Medical Billing and Coding

Country : USA

State : California

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