Product (RFP/RFQ/RFI/Solicitation/Tender/Bid Etc.) ID: MB-7159

Government Authority located in Colorado; USA, based organization looking for expert vendor for workers compensation third party administrator service.

[*] Budget: Looking for Proposals

[*] Scope of Service:

(1) Vendor needs to provide workers compensation third party administrator service.
- Review and process all workers’ compensation claims.
- Create files and conduct the necessary investigations in consultation with the district.
- Establish and maintain reserves on the basis of most probable final cost.
- Obtain medical reports and pay medical bills as required by statute. Monitor treatment for appropriateness.
- Admit or deny claims, with prior approval from the district, in accordance with statutory guidelines based on investigation and analyses of medial information.
- Pay disability benefits on admitted cases in timely manner. Obtain medical verification on continuing disability before payment.
- Outline claim strategy regarding defense and further claim handling in accordance with settlement authorization by the district.
- Refer claims to authorized counsel when necessary.
- Assist the District with defense of litigated cases when requested.
- Investigate and refer files for subrogation, where appropriate.
- Refer cases to vocational rehabilitation in accordance with the State requirements.
- Appropriately document all files.
- When requested, provide copies of all written correspondence to medical care providers, claimants, attorneys, rehabilitation counselors, investigators, State agencies and the district as their interests may require.
- Attend hearings, pre-hearings and settlement conferences as needed.
- Provide reports to excess insurer per policy requirements.
- Provide monthly cumulative check register, giving a summary of all medical, indemnity and other payments for that month.
- When requested, provide quarterly vendor reports.
- Provide 1099’s to vendors.
- Provide annual data for the calculation of the district’s experience modification factor.
- Provide analysis of claims data.
- Provide monthly performance and experience reporting to include trend analysis.
- Provide reports for annual self-insurance permit renewal and loss runs.
- Provide annual benchmarking report.
- Provide consultation on best practices including return to work program
- Provide updates, education, and recommendations on trends in workers’ compensation claims management.
- Assist with development of long-range goals, objectives and strategies including recommending innovative ideas and new products, proven programs and services to ensure a cost-effective workers’ compensation program.
- Provide telephone consultation as needed.
- Provide access for claim entry and ability to view claim information.
- Provide comprehensive range of services, including fee scheduling, pharmacy management, special network, diagnostic referrals, investigations, set asides and bill payment.
- Provide full transparency of all fees with specific details for services provided including.
- Provide the responsibility and background information on each member of the proposed account team including years of experience.
- List additional ways that your firm can assist with management of workers’ compensation, including preparation of claims activity reports; executive summary reports; annual financial projections for budgeting purposes analysis, etc
(2) All questions must be submitted no later than March 8, 2023

[*] Eligibility:

- Onshore (USA Only)

[*] Work Performance:

- Performance of the work will be Onsite and Offsite.

Expiry Date : Wednesday, 22 March, 2023

Question Answer Deadline : Wednesday, 8 March, 2023

Category : Medical Billing and Coding

Country : USA

State : Colorado

RFP Expired

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