Product (RFP/RFQ/RFI/Solicitation/Tender/Bid Etc.) ID: MB-7167

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

[*] Budget: Looking for Proposal

[*] Scope of Service:

(1) Vendor needs to provide self-insured workers compensation claims administration services.
- Review of its self-administered worker’s compensation claims program and considering possible options for contracting out all or a portion of the claims administration responsibilities.
- Implement a plan to facilitate full program implementation.
- Establish the required reporting capabilities within Administrator’s claims information system.
- Establish access to and training on the Administrator’s claims information system to all designated City staff members meeting City cyber security standards.
- Establish a process for timely payment of benefits and billing related to the administration of the claims program.
- Establish working relationships with all City service providers related to the operation of the self-insured claims program including but not limited to occupational medical facilities and providers, medical bill review and utilization review providers, nurse case managers and defense attorneys.
- Obtain copies of necessary hard copy documents for all open claims necessary for the accurate and efficient transfer of responsibility for handling of such claims.
- Review all open files, determine claim status, and establish or confirm existing monetary reserves consistent with accepted claims management practices.
- Conduct in-person orientation and introductory meetings with all stakeholders identified by the City, which may include Risk Management staff, department representatives, and bargaining unit representatives.
- Administrator shall dedicate the agreed number of qualified, experienced Claims Manager, Claims Examiners, Claims Assistants and other staff positions to exclusively be assigned to the City account.
- Administrator shall be solely responsible for ensuring all staff members maintain certification requirements and are provided necessary training to keep abreast of changes in the law and current best practices in claims handling.
- Administrator shall ensure that staff member caseloads stay within agreed limits – generally to be set to industry best practices.
- Administrator shall alert City immediately upon discovery of any breach or possible breach of City data maintained by the Administrator.
- Administrator shall establish and maintain an agreed system for efficient, accurate and timely payment of benefits to claimants and payment to providers of all related services and products.
- Provide Administrator’s Claims Management Manual for review by the appropriate City staff or representative.
- Create a claim file and establish contact with claimant within twenty-four (24) hours after receipt of notice of the claim.
- Promptly communicate with the City, not longer than twenty-four (24) hours after receipt, any return to work letters, any determination of or changes to a claimant’s temporary work restrictions, and any determination of permanent work restrictions.
(2) All questions must be submitted no later than March 10, 2023.
(3) The contract period will be for three years.

[*] Eligibility:

Onshore (USA Organizations Only)

[*] Work Performance:

Performance of the work will be Offsite. Vendor needs to carry work in their office location.

Expiry Date : Friday, 31 March, 2023

Question Answer Deadline : Friday, 10 March, 2023

Category : Medical Billing and Coding

Country : USA

State : California

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