Product (RFP/RFQ/RFI/Solicitation/Tender/Bid Etc.) ID: MB-6957

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

[*] Budget: Looking for Proposals

[*] Scope of Service:

(1) Vendor needs to provide workers compensation third party claims administration services.
- Provide member agencies with on-line, facsimile, telephonic, and e-mail claim reporting
capabilities;
- Provide a process for rapid response and communication among the TPA’s adjuster, the provider, the claimant, the member agency, the OI staff, and other related parties in claims administration. Ensure telephone or written response to inquiries within forty-eight hours of receipt;
- Respond immediately to any inquiry, complaint or request received from a member agency, the board, OI, the workers’ compensation commission, other regulatory agency, a claimant, or other interested party;
- Review all incident, claim and loss reports received from member agencies, and process each such claim or loss report to conclusion in accordance with applicable statutory and administrative regulations;
- Establish an incident or suspense file for any event of which agency personnel becomes aware that may result in injury or property damage, but for which the employee involved has not claimed injury and a claim is not anticipated. This will be for reporting purposes only (RPO);
- Establish and reserve a file for each claim and code such claim in accordance with the TPA’s standard statistical data requirements;
- Maintain a current estimate of expected total cost of each claim or loss, and provide for reserve calculation tracking (including initial reserve establishment and all subsequent changes) within the claim files;
- Conduct a thorough investigation of each reported incident, claim or loss to the extent necessary, which may include but not be limited to photographs, diagrams, police reports, statements from involved parties and all witnesses to determine the Board’s liability, etc.;
- Process each claim in accordance with applicable statutory and administrative regulations. The Board shall have the right at its discretion to take over the handling of any claim and to direct the handling of any claim at any time during the life of the contract and the life of the claim, but with no expense or reduction in claim service fees or allocated claim expense incurred by the TPA with respect to such claims;
- Safety and loss personnel must make on-site contact within twenty-four hours of the notice to the TPA of the incident, claim, or loss, in the event of notification of an incident, claim, or loss involving death of an employee, or a catastrophic injury.
- Arrange for independent investigators, medical professionals, or other experts to the extent deemed necessary by the TPA in connection with processing any incident, claim, or loss. If it is mutually deemed necessary to assign an independent, third-party claims investigator (fee adjuster) to handle a portion of the investigation of a qualified claim or loss, the fee for services of such fee adjuster will be paid by the TPA, not out of the Trust’s funds, if those are services that the TPA staff is equally capable and qualified to handle.
- Cooperate with information and reporting requests from the Board’s actuary to facilitate actuarial analyses of the program;
- Comply with any and all claims administrative procedures of the Trust;
- Administer the litigation process and assist attorneys in accordance with instructions from any litigation assignment and management plan established by the Board.
(2) All the questions must be submitted no later than December 19, 2022
(3) The contract period will be for four years.

[*] Eligibility:

- Onshore (US Only);

[*] Work Performance:

- Performance of the work will be Offsite.

Expiry Date : Thursday, 5 January, 2023

Question Answer Deadline : Monday, 19 December, 2022

Category : Medical Billing and Coding

Country : USA

State : Mississippi

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