Product (RFP/RFQ/RFI/Solicitation/Tender/Bid Etc.) ID: MB-7493

Government Authority located in Texas; USA based organization looking for expert vendor for property casualty and workers compensation service.

[*] Budget: Looking for Proposals

[*] Scope of Service:

(1) Vendor needs to provide property casualty and workers compensation service.
- County is currently fully insured for workers compensation but is considering the creation of a self-funded program and is seeking quotes for a third-party administrator with network and peripheral options to run the program.
- Assist the County in procuring network facilities and doctors approved to provide workers compensation services within the state of Texas.
- Review and process all workers' compensation claim in accordance with the requirements of the division of workers' compensation and the state's workers' compensation law, including determination of compensability of reported injuries and illnesses, including covid source exposure.
- Determine eligibility for and authorize payment of medical benefits, as well as compensation for temporary and permanent disability, utilizing any medical sources or advisory boards, as may be deemed necessary and desirable.
- Develop and maintain adequate claim reserves and provide continuous review of same to reflect changes. Note: The reserving formulas and practices are subject to review and approval of the County.
- Maintain a complete claim file for each reported accident and injury that shall be available for web-based review by the County at any time.
- File all reports, forms and documents as required by the Texas Department of Insurance, CMS and other regulatory agencies in a timely and accurate manner. The County does file the required self-insured annual reports.
- Report all qualifying claims to the appropriate excess carriers, monitoring claims for potential reporting qualifications.
- Coordinate investigations of litigated claims with attorneys approved by the County and, where appropriate, with adjusters and attorneys of the excess insurance carrier.
- With approval of the County, arrange for independent investigators or other experts to the extent deemed necessary in connection with processing the qualified claim or loss.
10. Monitor the treatment programs recommended for employees by physicians, specialists and other health care providers by reviewing all reports prepared by them and maintaining such contact with these providers as may be appropriate.
- Provide narrative or analytical reports of major litigated cases whenever requested by the County.
- Coordinate claims handling activities with the County’s Risk Management Department. Note: The County’s involvement is significant and may exceed that of other clients, therefore, respondents should take this into consideration when considering staffing requirements.
- Assist the County in the analysis of claims to prevent similar occurrences, providing periodic reports identifying trends and major developments.
- In cooperation with any managed care firm(s) the County may contract, provide monitoring of treatment programs recommended for employees by physicians or specialist by reviewing all reports prepared by treating physicians and by maintaining contact with medical case managers or treating physicians as may be appropriate.
- Submit monthly claim and expense summary reports in a manner and format mutually agreed upon by the County and the successful respondent.
- Issue payments on all claims. Auto/general liability and workers’ compensation settlements must be reviewed and approved by the Office of General Counsel. At such time as the County determines, limited settlement authority may be granted and may be increased periodically.
- Limit the number of lost time claims handled by any one adjuster to a maximum of 115 claims.
- Assist the County in processing damage claims against other parties where the County is not at fault.
- Be fully qualified and competent with proper license, knowledge, experience, and personnel.
- Adjusters to be available for visits to the County prior to beginning date and as required thereafter.
- Members of the dedicated adjusting unit should be immediately adjacent to each other in a cluster or similar arrangement. The County reserves the right to approve staff assigned to service this account for the duration of the contract.
- County reserves the right to audit and approve office practices pertaining to this account.
- Provide telephone or email responses to employees and Coordinators inquiries within 24 hours of receipt.
(2) A Non-Mandatory pre-bid meeting will be held on June 13, 2023.
(3) All questions must be submitted no later than June 23, 2023.

[*] Eligibility:

- Onshore (USA Only)

[*] Work Performance:

- Performance of the work will be Onsite and Offsite.

Expiry Date : Monday, 26 June, 2023

Pre-proposal Conference Date : Tuesday, 13 June, 2023

Question Answer Deadline : Friday, 23 June, 2023

Category : Medical Billing and Coding

Country : USA

State : Texas

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