Third Party Administrators Services

The vendor required to provide third party administrators services to manage the reviewing of disability retirement applications, disability retirement periodic reviews, reinstatement reviews, and employment reviews.
- Services shall include the following:
•    Physicians licensed in the state of performing case file reviews for:
o    Application reviews
o    Periodic disability reviews
o    Reinstatement reviews
o    Employment reviews
o    Reapplication reviews
o    Appeal reviews
o    Issues raised in administrative disability hearings at the request of legal staff
o    Disability fraud investigations at the request of legal staff
•    Nurse case managers who
o    Review forms and medical records submitted by the applicant and determine if any additional information is needed
o    Review recommendations completed by the physicians
o    Manage the review to ensure they are timely processed and returned to authority
•    Nurse case managers who
o    Review forms, medical records, and employment information submitted by disability recipients for their periodic employment and medical review and determine if any additional information is needed or appears to be missing.
o    Review recommendations completed by the physicians
o    Manage the reviews to ensure they are timely processed and returned to authority
•    Vocational expert(s) for disability recipient employment reviews who shall have
o    A master’s degree or higher degree in counseling or rehabilitation, or
o    An american board of vocational experts’ certification, or
o    A certification as a
1.    Certified rehabilitation counselor, or
2.    Certified disability management specialist, or
3.    Associate disability case manager, or
4.    Licensed rehabilitation counselor, or
5.    Certified case manager
•    Collecting and electronically storing medical records and forms necessary for disability retirement reviews and periodic reviews from members, with scheduled follow-ups for missing information. 
•    There are occasions when vendors may need to also collect public records, such as workers’ compensation, court records, public licenses, tax records, etc.
•    Review of each claim for disability retirement by up to three (3) physicians licensed in the state in accordance with KRS 61.665, disallowing collaboration between reviewing physicians.
•    Review of each periodic review or reinstatement review claim by one (1) physician, licensed in the state.
•    Review of each employment review claim by one (1) physician licensed in the state or one (1) vocational expert.
•    Ability to accommodate the submission of appeals for disability denials, disability discontinuances or employment denials back to the same physician(s) who originally reviewed the claim.
•    Ability to accommodate additional physician reviews by the same reviewer(s) when additional information is requested from the member or when the member is asked to submit to an independent medical examination.
•    Ability to assign reapplications for disability retirement to up to three (3) physicians who did not originally review the claim, when possible.
•    Ability to provide physicians with transcription and review document from that physician’s previous review for subsequent reviews by the physician, such as for appeals, requests for additional information, and independent medical examinations.
•    Ability for authority to send a case back for review with no additional compensation when claims are not reviewed properly according to statutes, and regulations or when there is missing documentation or missing justification for the decision by a physician reviewer.
•    Accommodate the completion and submission of a document on which the reviewer will indicate their decision based on their review.
•    Physician determinations are to be submitted to authority in writing.
•    Application status must be accessible to authority during every step of the application process.
•    This may be accomplished by a report, an electronic interface or application or by direct contact with the vendor. 
•    Authority would like direct access to the vendor’s electronic interface or application used to track case status and store all records and forms collected.
•    Physician reviews need to adhere to the review timeline once all records and forms have been received and provided to the reviewing physicians:
o    Six (6) to eight (8) weeks for application and periodic reviews
o    Two (2) weeks for reviews designated as high priority (i.e., employment reviews, reinstatement reviews)
•    Provide independent medical, psychiatric and psychological examinations and functional capacity evaluation services when required.
•    Ability to assign priority based on review type and expedite claim reviews as requested by authority.
•    Manage disability retirement periodic reviews:
o    Contact members at their scheduled review time.
o    Collect medical records and forms from the member.
o    Send follow-up requests for missing information.
•    Manage disability retirement recipient employment reviews.
•    Maintain detailed security measures to ensure all protected health information (phi) and personally identifiable information (PII) of the members are received, handled, and delivered securely.
•    Maintain detailed, complete records for each claim processed from start to finish.
•    Ability for vendor physicians to be deposed or to testify in administrative hearings when requested by authority. 
•    If a member and their legal counsel requests the vendor physicians to testify or be deposed, it is the responsibility of the member and their legal counsel to provide payment at a rate negotiated between the vendor and the member and their legal counsel.

- Contract Period/Term: 2 years
- Questions/Inquires Deadline: December 10, 2025