Workers Compensation and Third-Party Administrator Services

The Vendor is required to provide third-party administrator (TPA) for claims administration of its active self-insured workers’ compensation claims administration for approximately seven (7) active workers’ compensation claims which occurred under authority previous self-insured program
- Claims management
•    To provide medical case management as needed on all valid workers’ compensation claims. Including, but not limited to all cases involving restricted or different duty releases, lost time greater than three (3) days, coordination of medical treatment, in-patient hospitalization, etc. For claimants covered under workers’ compensation plan. 
•    To provide up-to-date printed materials including compliance notices, panel of physicians, and other printed materials required under state workers’ compensation law. 
•    To review, approve, and pay medical providers’ invoices, statements, and bills in accordance with the appropriate fee schedules. 
•    To closely coordinate with authority staff, to ensure each employee has the medical assistance he or she needs for a speedy recovery. 
•    To provide management reports which should include, but not be limited to, the following information:
o    Breakdown by work location, position and by name which reflects to-date incurred expenses, reserves, and time loss. 
o    Breakdown by claimant of all claims received by work status, restricted or different duty release, lost days within waiting period and lost-time (exceeding waiting period). 
o    Ability to pull both above-mentioned reports in a year-to-date format. 
o    Breakdown by claimant of next physician’s appointment, physical therapy appointment or next medical treatment, also listing appointments missed.
•    For TPA services to provide notification and communication to the excess carrier when a legacy claim approach 50% of the self-insured retention amount of $300,000, or as otherwise stated.
•    Outcome of tasks
o    The tasks to be accomplished include the timely preparation and distribution of required printed materials; the coordination of medical case management services where needed on a case-by-case basis; and the provision of bill review re-pricing and check issuance services.
•    Processing of workers’ compensation disbursements and claims payments
o    Work with insurance company and broker to establish an effective process to manage payment of claims and timely disbursements on behalf of claimants. 
o    Authority reserves the right to approve said process before finalizing commitment with company
•    Takeover claims administration for approximately seven (7) self-insured workers’ compensation legacy claims. 
•    Coordinate timely and efficient transition of all existing claims data from the current TPA. 
•    Ensure claim conversions are accurate with respect to data integrity including, but not limited to, data mapping, historical financial transactions, payment history and classification.
•    Facilitate a seamless integration of the existing medical provider network program.