MB-7213 - USA (California) - Third Party Administration Managed Care Services - Deadline April 11,2023

Product (RFP/RFQ/RFI/Solicitation/Tender/Bid Etc.) ID: MB-7213

Government Authority located in California; USA based organization looking for expert vendor for third party administration managed care services.

[*] Budget: Looking for Proposals

[*] Scope of Service:

(1) Vendor needs to provide third party administration managed care services
- Contractor and Contractors’ dedicated staff shall be prepared and ready to commence the annual claims administration, as a Third-Party Administrator, of all County Workers Compensation claims as of July 1, 2024
- The Contractor must have an electronic database capable of producing specialized and ad-hoc reports in a timely and accurate manner in addition to those required by the State,
- Claims Administration:
- The Contractor shall maintain adequate internal controls over all phases of claims handling to ensure accurate and timely program information. Adequate internal control shall be construed to include at a minimum, the definite assignment of responsibilities for performing established Claims Management procedures, documentation of the performance of required procedures and sufficient supervisory review to ensure that
individuals are in fact performing their assigned tasks
- The Contractor shall prepare and file all legally required forms and reports with the appropriate State agency and interested parties.
- The Contractor shall promptly accept all claims wherein the compensability is immediately evident as arising out of or being caused by work-related activities
- Financial Controls:
- The Contractor shall maintain current estimated future of the cost of all anticipated benefits on each claim and maintain procedures for reviewing and adjusting reserve adequacy no less frequently than every 90 days. The County shall be notified of all original or revised estimated future costs exceeding $50,000 and $100,000
- Consultation:
- The County has developed and implemented a return to work (RTW) program. The contractor shall assist the County with clarifying work restrictions, assisting with developing job and task banks as needed, assisting with job analyses and ergonomic evaluations for County positions.
(2) All the questions must be submitted no later than March 22, 2023.

[*] Eligibility:

Onshore (USA Organization Only);

[*] Work Performance:

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

Expiry Date : Tuesday, 11 April, 2023

Question Answer Deadline : Wednesday, 22 March, 2023

Category : Medical Billing and Coding

Country : USA

State : California

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