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MB-5511 - USA (Texas) - Worker Compensation Third Party Administration Services - Deadline August 4,2021

Product (RFP/RFQ/RFI/Solicitation/Tender/Bid Etc.) ID: MB-5511

Government Authority located in Texas; USA based organization looking for expert vendor for worker compensation third party administration services.

[A] Budget: Looking for Proposals

[B] Scope of Service:

Vendor needs to provide worker compensation third party administration services.
- The TPA shall examine, investigate and administer all instances of job-related injury and illness reported.
- The TPA shall coordinate and consult with the agency on all medical cost containment issues. All reports on medical bill audit savings, physician peer reviews, rehabilitation nurse interventions, and pre-certification procedures shall be made available to agency upon request.
- The TPA shall provide all forms necessary for the efficient operation of the program; prepare and file all forms, documents and papers necessary in defense of the claim.
- The TPA shall provide monthly loss runs to the agency and their broker. These loss runs, at a minimum, shall clearly show detail and status on each claim filed, group claims by department, separated by program year, and show financial summaries by department and program year (paid to date, total reserves, and total incurred). Quarterly risk management reports revealing injury trends related to physical location of the injury, type of injury, body part involved, and apparent cause of accident will also be required.
- In all cases involving the subrogation of a loss due to the apparent responsibility of a third party the TPA shall place the third party on Notice of Subrogation and this service shall be without additional cost.
- The TPA shall not assign adjusters to the agency workers' compensation claims whose lost time case -load exceeds 125 files per adjuster.
- The proposer and the TPA shall be required to hold quarterly meetings with the agency to review existing issues and open claims should agency deem necessary.
- The agency desires that the TPA show proof of potential to provide on-line access inquiry and print capabilities for loss data related to its workers' compensation program.
- Agency desires that the TPA notify the excess carrier on all claims that meet the reporting requirements of the excess carrier.
- Agency desires that the TPA notify them prior to any surgery for their employees and change in status of claim from closed to reopen or medical only to lost time.

[C] Eligibility:

- Onshore (USA Organization Only);

[D] Work Performance:

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

Expiry Date : Wednesday, 4 August, 2021

Category : Medical Billing and Coding

Country : USA

State : Texas

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