Third Party Claims Management Services

The Vendor is required to provide a third-party administrator with on-staff attorney(s) to assist in the proactive and aggressive management of its self-insured (as of July 1, 2025) and state-funded claims.
- The third-party administrator shall provide all claims management services including:
• Complete file retention on every claim.
• Provide assistance, when necessary, in determining validity and compensability of claims.
• Filing of claims and associated documents with the bureau of workers’ compensation.
• Monitor all claims for cost-effective handling.
• Coordinate all independent medical examinations, referral to case management, rehabilitation and/or work-hardening programs.
• Provide legal representation at all administrative hearings with a follow-up report to agency within ten (10) days of the hearing; the hearing report shall outline events of the hearing and include recommendations for future handling.
• Provide agency with online access (view only) to workers’ compensation data maintained by the third-party administrator.
• Monitor action by bureau of workers’ compensation, claimant and his/her representative and, with the approval of agency, initiate corrective action.
• Provide actuarial services for self-insured program:
1. Determine reserve amount for all new claims;
2. Maintenance of check stock;
3. Calculation of temporary total disability compensation;
4. Review all bills submitted for payment to ensure rates are usual, customary and reasonable;
5. Issue checks and/or ach payments for medical and compensation payments (a check register must be received and approved by agency before checks are finalized and mailed); and
6. Provide assistance in completion of s1-40, icd-9, yearly renewal application, and all other required self-insured paperwork.
• Audit all commission assessments/charges, invoicing and refunds; if necessary, file protest with the bureau of workers’ compensation to correct any errors.
• Provide quarterly reports listing the following for each claim:  claimant name, injury date, claim number, type of injury, a running total of all medical and compensation costs incurred, reserve established, current and historical claims data by year.
• Meet at least semi-annually with agency with analyses, claims comparisons to previous years, and recommendations.
• Keep agency updated on current trends, procedural and/or form changes, and changes in the law which affect the administration of workers’ compensation claims.
• Meet the evolving workers’ compensation needs of the agency.
• Bill agency monthly for services rendered.
- Contract Period/Term: 3 years
- Pre-Proposal Conference (Non Mandatory) Date: April 3, 2025
- Questions/Inquires Deadline: April 4, 2025