MB-3558 - USA (Florida) - Workers Compensation and Third-Party Liability Claims Administrative Services - Deadline December 2,2019

Product (RFP/RFQ/RFI/Solicitation/Tender/Bid Etc.) ID: MB-3558

Government Authority located in Florida; USA based organization looking for expert vendor for workers compensation and third-party liability claims administrative services.

[A] Budget: Looking for Proposal

[B] Scope of Service:

(1) Vendor needs to provide workers compensation and third-party liability claims administrative services, that embodies our philosophy of meeting the reasonable, necessary, and related medical needs of our injured workers for expedient and healthy return to work,
- The City seeks a partnership through innovative services, solutions and technology that addresses workers’ compensation claim management issues and needs,
- The City desires a collaborative effort yielding creative, custom-designed programs, constantly finding ways to strengthen and improve the relationship among claim management, provider network, management and the injured worker,
- Adequate staffing to provide a high level of service and client satisfaction as described in this solicitation,
- Administration of all new and old claims for the life of the contract plus an additional 90 days,
- Conversion of all old claims data into their claim management system in manner that makes the data accessible to the City and for other reporting purposes,
- First notice of injury reporting services,
- All bill review services,
- All indexing,
- All telephonic case management services,
- Access to internet-based information system,
- Access to prescription benefit management services,
- All provider network access,
- Third party liability claims include but may not be limited to: general liability, automobile liability, automobile physical damage and other city property damage claims including subrogation, errors and omissions, including police and fire professional claims.
- Proposer will review bills, invoices, and other claims for payment submitted by health care providers to identify proper authorization, over utilization, underutilization and billing errors and will adjudicate/pay those bills and mail (postmark) payments within 20 days,
- Required Services: administrative services, claims services, telephonic case management services, first notice of injury services, loss statistic services, network access, medical bill review and audit services, field case management services, pharmaceutical benefit management services
- Claims Services:
- Provide toll-free customer service lines for employees from the hours of 8:00 am to 5:00 pm EST,
- The city may select specific vendors and pricing schedules for the following services: legal services, field case management, translation services, transportation services, surveillance and investigation services, Medicare set-aside services and court reporting services,
- Review all medical bills and bills for other services for which a claim is being made for reasonableness and conformity to rules, regulations, and legally imposed medical and surgical fee schedules,
- Where appropriate or desirable, attend hearings, depositions, mediations, and other proceedings. The adjuster handling the claim file will provide an updated written file report within 48 hours after the hearing, deposition, mediation or other proceeding,
- Telephonic case management services:
- Medical care coordination, including evaluation of appropriate referrals for specialty care, physical therapy and diagnostics,
- Provide review of requests for durable medical equipment, treatments and other procedures.
(2) A non-mandatory pre-proposal conference will be held on October 29, 2019
(3) All the questions must be submitted no later than November 5, 2019.

[C] Eligibility:

- Onshore (USA Only);

[D] Work Performance:

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

Expiry Date : Monday, 2 December, 2019

Pre-proposal Conference Date : Tuesday, 29 October, 2019

Question Answer Deadline : Tuesday, 5 November, 2019

Category : Medical Billing and Coding

Country : USA

State : Florida

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