MB-6956 - USA (California) - Workers Compensation Third-Party Claims Administration Services - Deadline January 9,2023

Product (RFP/RFQ/RFI/Solicitation/Tender/Bid Etc.) ID: MB-6956

Government Authority located in California; USA based organization looking for expert vendor for workers compensation third-party claims administration services.

[A] Budget: Looking for Proposal

[B] Scope of Service:

(1) Vendor needs to provide workers compensation third-party claims administration services. Claim notification, claim management, reporting, online Risk Management Information System (RMIS) access, and other vendor management functions will be coordinated through this division.
- The proposals shall include claims management services in the following areas: Reserving, Investigation, Subrogation, Medical Management, Disability Management (return-to-work issues), Litigation Management, Settlement Negotiation, Client Communication, RMIS, Claims Administration, Loss Control and Safety, Check Production, Audits, and Claim File Retention.
A. General Claims Management: - The TPA will record, establish, and maintain a claim file, and analyze and provide complete claims adjustment services, including fraud identification for all claim files against City. The TPA will be required to interact daily with Risk Management staff.
B. Reserving Practices
The TPA shall establish a reserve for each claim and review claims on a diary system (45 days) for adequacy of reserves based on the file facts. Reserves must be accurate, complete, and documented to reflect City’s full potential exposure.
C. Investigation Procedures
The TPA is responsible for investigation of all claims, including field investigation, statements, fraud investigation, and obtaining Police reports and any other investigation methods as appropriate.
D. Subrogation and Contribution/Excess Insurance Procedures
The TPA shall promptly recognize, investigate, and collect subrogation and contribution possibilities for all claims.
E. Medical Management
The TPA is responsible for effective medical management of all claims by maintaining medical control within the first thirty (30) days unless appropriate physician preselection is on file. Claim causality must be verified regarding medical plausibility.
F. Disability Management (Return-to-Work Issues)
The TPA shall establish and manage an effective disability management program by documenting a return-to-work plan and proposed disability duration.
G. Litigation Management
The TPA is responsible for cost-effective litigation management. The claims examiner will make every effort to settle claims in the early stages of the claim, avoiding the need for legal representation. Examiners will attend Workers’ Compensation Appeals Board (WCAB) hearings and handle disputed noncomplex claims. Risk Management Information System (RMIS)
H. The TPA will provide a RMIS developed and prepared to interact online with a compatible personal computer operating system. This database shall be supplied for City’s utilization, capable of, but not limited to, producing ad hoc reports online, producing loss information, and the ability to review claims information online, including examiner file notes Check Production
I. City will maintain a trust account and fund it monthly for the sole purpose of the TPA to provide benefits to City employees, payments to various providers and to pay allocated loss-adjustment expenses. All funds in the trust account belong to City and the TPA shall have authority to issue checks from the trust account.
(2) All question must be submitted no later than December 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 : Monday, 9 January, 2023

Category : Medical Billing and Coding

Country : USA

State : California

RFP Expired

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