Workers Compensation Third Party Administrator Services

The Vendor is required to provide workers’ compensation third party administrator services.
- Provider for medical bill review, preferred provider networks, and utilization review.
- The entity that would be performing bill review services (outside vendor or own TPA staff), as needed and required for a particular claim.
- Managed Care services may include, but are not limited to the following:
•    Medical Care Management by healthcare professionals
•    Medical Director/Physician Advisor consultation
•    Provider Network Development and Management
•    Nurse Case Managers
•    Field Nurse Case Management
•    Pharmacy Benefit Management
•    Transportation
- Must notify all employees and claimants with open files of changes in administration, transfer of computer data from the prior administrator, and movement and storage of all files.
- Assign claims professionals with a minimum of 2 years’ adjusting experience (with an assigned caseload) to handle medical-only claims.
- Assign at least one full-time claims assistant to provide administrative and technical support to the dedicated claims team.
- Workers’ compensation technical skills, all assigned staff must possess effective analytical verbal and written communication skills.
- Investigate each reported claim to determine validity and compensability.
- Authorize medical evaluations, obtain relevant medical records and forward to evaluating physician to determine the nature and extent of disability in a timely manner.
- Properly and adequately document and monitor defense of all claims requiring referral to outside counsel, through all stages of litigation.
- Develop a meaningful examiner action plan to resolve each outstanding issue with associated timeframes, at each diary review.
- Provide timely notice where permanent disability is found and issue timely notice of offer of regular, modified or alternate work or supplemental job displacement benefit.
- Maintain contact with treating physicians to ensure employees receive proper medical treatment and are returned to full or modified employment at the earliest possible date.
- Arrange for all managed health care services as needed, including but not limited to: physician services; pharmaceutical services; health care facility services; durable medical equipment; home health care services; and nurse case management.
- Provide all treating physicians with documentation of injured employees’ essential job duties with emphasis on early return to work.
- Each claim file must contain the examiner’s plan of action for the future handling of that claim and must be identified in the claims management information system.

- Contract Period/Term: 5 years
- Pre-Proposal Meeting Date: August 20, 2025
- Questions/Inquires Deadline: August 21, 2025