Posted Date : March 31,2020
Product (RFP/RFQ/RFI/Solicitation/Tender/Bid Etc.) ID : MB-4037
USA (Connecticut) – Worker Compensation Program Services
[A] Budget: Looking for proposal
[B] Scope of Service:
(1) Vendor needs to provide third party administrator (TPA) services to help manage the city’s workers’ compensation program and heart and hypertension program claim and the proposer will manage all claims - both existing and future claims as well as future re-opened claims.
1. Claims Management Describe: - Your recommended injury reporting procedures - Your initial claimant contact process between your staff and the injured worker - Your on-going contact with:
o the claimant;
o the claimant’s department; and,
o Human Resources. - How you review or score a claim for possible fraud investigation - Your process for setting claim reserves - Any process you may have for major claim communications such as significant reserve increases or changes in work status - Your internal staff responsibilities and supervision protocols.
2. Medical Management Describe: Please provide proposer’s managed care/medical cost-containment program including, but not limited to your medical provider network, case management services, utilization review, bill review, etc. • Please indicate which services are performed by your firm, and which services are contracted out. • If services are contracted out, does the firm receive commissions and/or any other type of compensation from the companies used? • Discuss the recommended panel of medical experts, including specialists who may be utilized to review and/or provide treatment. • Do you have in-house medical staff that will interface with medical providers? If so, please describe your in-house medical staff responsibilities. • Describe procedures for auditing of prescriptions and medical costs. • Does your firm contract with medical facilities for discounted fees for services such as MRIs, CT scans, etc.? If so, please describe. • Describe the types of cases that would benefit from medical case management. What type of activities should the City expect from a nurse case manager? When should medical case management services begin and end? • Please describe your firm’s philosophy regarding utilization review plans, including development and use of prior authorization processes.
3. Litigation Management: - The City’s Corporation Counsel will assign legal counsel upon request.
- For more information describe in documents.
[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.
Budget :
Deadline to Submit Proposals: April 08,2020
Cost to Download This RFP/RFQ/RFI/Solicitation/Tender/Bid Document : 5 US$
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Product (RFP/RFQ/RFI/Solicitation/Tender/Bid Etc.) ID : MB-4037
USA (Connecticut) – Worker Compensation Program Services
[A] Budget: Looking for proposal
[B] Scope of Service:
(1) Vendor needs to provide third party administrator (TPA) services to help manage the city’s workers’ compensation program and heart and hypertension program claim and the proposer will manage all claims - both existing and future claims as well as future re-opened claims.
1. Claims Management Describe: - Your recommended injury reporting procedures - Your initial claimant contact process between your staff and the injured worker - Your on-going contact with:
o the claimant;
o the claimant’s department; and,
o Human Resources. - How you review or score a claim for possible fraud investigation - Your process for setting claim reserves - Any process you may have for major claim communications such as significant reserve increases or changes in work status - Your internal staff responsibilities and supervision protocols.
2. Medical Management Describe: Please provide proposer’s managed care/medical cost-containment program including, but not limited to your medical provider network, case management services, utilization review, bill review, etc. • Please indicate which services are performed by your firm, and which services are contracted out. • If services are contracted out, does the firm receive commissions and/or any other type of compensation from the companies used? • Discuss the recommended panel of medical experts, including specialists who may be utilized to review and/or provide treatment. • Do you have in-house medical staff that will interface with medical providers? If so, please describe your in-house medical staff responsibilities. • Describe procedures for auditing of prescriptions and medical costs. • Does your firm contract with medical facilities for discounted fees for services such as MRIs, CT scans, etc.? If so, please describe. • Describe the types of cases that would benefit from medical case management. What type of activities should the City expect from a nurse case manager? When should medical case management services begin and end? • Please describe your firm’s philosophy regarding utilization review plans, including development and use of prior authorization processes.
3. Litigation Management: - The City’s Corporation Counsel will assign legal counsel upon request.
- For more information describe in documents.
[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.
Budget :
Deadline to Submit Proposals: April 08,2020
Cost to Download This RFP/RFQ/RFI/Solicitation/Tender/Bid Document : 5 US$