Product (RFP/RFQ/RFI/Solicitation/Tender/Bid Etc.) ID: MB-7822

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

[*] Budget: Looking for Proposal

[*] Scope of Service:

(1) Vendor needs to provide workers compensation program third party claims administration service.
- Provide a detailed transition plan, which will ensure uninterrupted services to the CSURMA members and their employees. Plan should include details regarding:
• The Claims Administrator’s primary and alternate contact person(s)
• The data conversion
• File retrieval from current locations to the proposed locations
• Storage of closed files and retrieval procedures
• The timeframes for each phase
• Initiation of the trust account
• The necessary resources and associated costs that are in addition to your bid for claims administration costs
- Review all applications for adjudication of claim and all claim or loss reports made by CSURMA, or its designee, to TPA with regard to personal injury, sickness, disease or death that is alleged to have resulted from an employee’s work-related activity and which is first reported during the term of this agreement.
- Process each such claim or loss report in accordance with applicable statutory and administrative notification requirements.
- Conduct a timely investigation of each reported claim or loss under subparagraph to determine compensability.
- Engage independent investigators or medical or other experts as reasonably required by the circumstances in connection with processing any reported claim or loss.
- Perform reasonable and necessary administrative and clerical work in connection with the processing of reported claims or losses, including the preparation of checks or drafts bearing the name of CSURMA and drawn on the account established.
- Maintain a file for each reported claim or loss, which shall be available for review by CSURMA at any reasonable time.
- Notify excess carriers in accordance with such carrier’s reporting guidelines, provided that TPA has been advised in writing of same.
- Monitor the treatment programs recommended for employees by physicians or specialists by reviewing all initial reports prepared by treating physicians or specialists and maintaining contact with treating physicians or specialists managing the medical treatment as appropriate to effect optimum conclusion.
- Assist CSURMA in determining the circumstances under which an ill or injured employee could return to work in the shortest period of time.
- Assist in arranging for rehabilitation or retraining of employees where indicated.
- Maintain a current estimate of the cost of all anticipated losses on each qualified claim or loss.
(2) All question must be submitted no later than November 03, 2023.
(3) A contract period will be for five years.

[*] Eligibility:

- Onshore (USA Organization Only);

[*] Work Performance:

Performance of the work will be Onsite and Offsite.

Expiry Date : Friday, 17 November, 2023

Question Answer Deadline : Friday, 3 November, 2023

Category : Medical Billing and Coding

Country : USA

State : California

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