Product (RFP/RFQ/RFI/Solicitation/Tender/Bid Etc.) ID: MB-6680

Government Authority located in North Carolina; USA based organization looking for expert vendor for worker compensation services for self-insured worker compensation fund.

[A] Budget: Looking for Proposals

[B] Scope of Service:

(1) Vendor needs to provide workers’ compensation services for self-insured workers’ compensation fund.
- Third party administrator (TPA): Claims reporting and management, medical compensation, pharmacy benefit management, and medical bill review
- Medical (nurse) and vocational rehabilitation
- Physical therapy and functional capacity evaluation (FCE)
- Diagnostic radiology
- Home health and durable medical equipment (DME)
- Transportation and translation
- Vendor shall maintain an information management system that serves as a repository for open and closed claim data with internet-based user portal with customizable individual authorized end-user access levels for state agency and staff based upon agency mapping and need to perform certain functions (i.e., claim reporting, viewing claim files, generating claim reports, access location specific claim files, or run location specific reports).
- Vendor shall provide claim database for all transferred open and closed claim files and all newly filed open and closed claims filed during contract period.
- Vendor shall provide claim database system with the capability for multiple end users to access the same individual claim file at the same time.
- Vendor shall provide claim database system including all claim information transferred, added, or generated until contract termination with no purging of any information for any reason.
- Vendor shall provide mechanism for search for individual claims using any of the following claim elements: first name and last name, date of birth, employing agency name, TPA claim file number, incident calendar year, incident fiscal year, date of injury, and social security number.
- Vendor shall provide individual claim file set-up including record of first notice of loss, return to work status, maximum medical improvement (MMI) status, medical provider visits records, submitted medical bills, and documentation of medical bill review, categorized financial information including records of all payments made and claim reserves, document storage, pharmacy information and adjuster notes.
- Vendor shall provide individual claim file set-up that allows Vendor to restrict access to an individual claim file or adjuster notes as necessary i.e., such as when a state agency employee with access to claim files has an open or closed claim.
- Vendor shall provide end user access to data in all open and closed claim files in the claim database based on their authorized access level as determined by the end user’s employing state agency.
- Vendor shall provide that end user can view, print, and transmit any individual part or all of a claim file.
(2) All questions must be submitted no later than August 15, 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 : Friday, 30 September, 2022

Question Answer Deadline : Monday, 15 August, 2022

Category : Medical Billing and Coding

Country : USA

State : North Carolina

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