Product (RFP/RFQ/RFI/Solicitation/Tender/Bid Etc.) ID: MB-7224

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

[*] Budget: Looking for Proposal

[*] Scope of Service:

(1) Vendor needs to provide third party workers compensation claims administration service.
- Administer workers’ compensation benefits in accordance with the labor code.
- Make initial contact with the employee and establish a claims file within 24 hours of receipt of the employer’s first report of injury for the city. Claim files will be available for review by the city at any time during the TPA’s regular business hours.
- The TPA must resolve city issues immediately to the city’s satisfaction. This may include reassignment of claims examiner staff.
- The compensability determination (accept claim, deny claim or delay acceptance pending the results of additional investigation) and the reasons for such determination.
- Provide guidance and information regarding workers’ compensation benefits to city employees.
- Respond to city staff inquiries within twenty four hours and critical issues on the same day.
- Monitor treatment programs for injured employees to ensure that they receive proper care and to avoid over treatment situations.
- Establish claim reserves and provide a continual review and update of reserves to reflect changes during the life of the claim.
- The TPA should pursue actions of abuse of the workers’ compensation system or suspected fraud.
- Investigate and recommend special, outside independent investigations for questionable claims with the consent, coordination and assistance of the city.
- The claims examiner shall obtain the city’s authorization on all claim settlements.
- All penalties incurred because of failure of the TPA to comply with statutory laws or reimbursement should be brought to the city’s attention and shall be the sole responsibility of the third party administrator and reimbursement shall be made on a quarterly basis.
- The claim’s management software should provide a claim description, financial data and ad hoc reports on claims using criteria such as reserves, paid, indemnity, etc.
- The claims management system must be read-only accessible to city risk management with licensing allowing a minimum of three individual computers to access claim information simultaneously.
- The selected firm will be required to provide training to risk management staff on report generation and the use of software.
(2) All question must be submitted no later than March 29, 2023.

[*] Eligibility:

- Onshore (USA Organization Only);

[*] Work Performance:

Performance of the work will be Onsite and Offsite.

Expiry Date : Monday, 17 April, 2023

Question Answer Deadline : Wednesday, 29 March, 2023

Category : Medical Billing and Coding, Software, System and Application

Country : USA

State : California

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