Workers Compensation Claims Administration Services

The vendor is required to provide for a licensed and qualified third-party administrator (TPA) to partner with district to cost effectively manage its workers’ compensation program.
- Provide professional services and dedicated personnel necessary to perform the following:
• Establish and maintain complete claims files for each claim.
• If the proposing company does not engage in ‘full scanning’, please explain what documents are not scanned or preserved in non-editable format.
• Comply with all applicable laws and regulations regarding workers' compensation benefits.
• Continuously advise the district with regard to actions, procedures, etc. which will result in control of claims
• Comply with the state board adopted electronic reporting standard including any changes to, additions to, deletions from the standard, regardless of whether the change is technology (e.g. enhanced security protocols) or technical (e.g. changes to the data fields required).
• District considers any such changes to be a business cost of the TPA and accordingly the district will not pay any special programming charges for such changes.
• Maintain claims per examiner ratios at a level that is acceptable to the director of risk management but in no event shall the number of assigned active files (claims involving litigation, active medical management or complex issues) exceed 75 per examiner.
• Continuously monitor vendor performance to assure high-quality standards for each vendor type.
• Where appropriate, monitor vendors to best-in-class standards set by a trade group or association. report such monitoring to the director of risk management.
• Prepare and submit, in a timely manner, all claim related filings with the workers' compensation board in the board’s required format, including any future changes of filing or data interchange format.
• Coordinate claims payment including fund replenishment procedures and limitation on payments.
• The district is open to means of payment other than printed check methods for paying claimants, including but not limited to direct deposit and refillable debit cards.
• Any alternative means of payment will be selected on a claim-by-claim basis and must have a demonstrable benefit to the district, the injured workers or both.
• Prepare files for and coordinate representation with the districts outside counsel (selected by the TPA with the approval of the office of human capital).
• The TPA is responsible for coordinating e-case access for any attorney or law firm representing the district.
• If evidence is taken by telephonic or electronic means, assure that the witness has reliable access to the designated mode of communication so that the witness may hear and be heard by all hearing participants including the judge and attorneys.
• Coordinate appropriate medical management of files with appropriate telephonic or field case management.
• Provide examples of reports that are available for the district’s safety and workers’ compensation usage
• Provide plan stewardship information to the district and any other designated parties on a regular basis but no less than semi-annually.
• Continuously monitor the office of foreign asset control (OFAC) list and take any appropriate investigate actions for possible matches
• Provide proof adequate data integrity standards, including system redundancy and catastrophic protections
• Make available, at least semi-annually appropriate personnel to conduct training for district staff on both claims system operations and workers’ compensation requirements.
• Provide a quality assurance and testing methodology and approach for ongoing support and maintenance of the interface as vendor releases upgrades and patches to its core software application.
• Provide a scheduled and automated channel of data transfer between the two it systems for integration.
- Contract Period/Term: 1 year
- Pre-Proposal Conference Meeting and Call Date: April 24, 2025
- Questions/Inquires Deadline: April 21, 2025