Third Party Workers Compensation Claims Administration and Insurance Consulting Services

The Vendor is required to provide for third party workers' compensation claims administration and workers' compensation medical cost containment services.
- Claim showing flat rate pricing on a per claim basis for life of contract handling, indemnity, and medical only.  
- All work-related accident/injury claims are either coded Medical Only or Indemnity.
- Claim fees must be reconciled to actual at 18 and 24 months from the inception date of the contract, with the 24-month reconciliation being final.
- TPA shall clearly identify the services that are included in the basic fee structure, as well as all services that are provided in addition to or outside of the standard fee
- Allocated versus unallocated expenses need to be itemized. 
- State clearly the definition for Indemnity and Medical only claims
- The option must be presented to retain the on-site staff.  
- TPA will agree to handle any indemnity claim in which all indemnity has been paid at a medical only rate.
- Administration / Services
•    TDI DWC benefit review conference
•    TDI DWC contested case hearings
•    TDI DWC electronic reporting
•    Litigation management
•    Subrogation 
•    TDI DWC forms
•    Austin representation
•    Check writing, printing, and stuffing
•    Banking fees
•    Ach/bank clearing house 
•    Field investigation
•    Photocopying
•    Transcriptions
•    Phone charges
•    Preparation of 1099’s
•    Closed file storage
•    Electronic data
•    Electronic data maintenance
•    Use of computer system
•    Use of computer system by consultant
- Medical Cost Containment
•    There are approximately 685 medical bills per month.
•    Medical Bill Audit
o    Per Line
o    Per Bill
o    Other Options
•    Hospital Bill Audit
•    Preauthorization
•    PPO Fee Schedule
•    Peer Review Services
•    Independent Medical Exam Services
•    Savings Reports
•    TDI DWC Reporting
•    Assistance with Medical Dispute Resolution.

- Contract Period/Term: 1 year
- Questions/Inquires Deadline: October 28, 2025