Self Insured Workers Compensation Bill Review Services

The Vendor is required to provide for the city’s workers’ compensation bill review services. 
- The City intentionally unbundles its workers’ compensation cost control services.
- Currently employs approximately 2000 permanent employees, including sworn police officers and fire personnel.
- Contractor(s) selected for cost containment services will coordinate their activities with the City’s workers’ compensation third party claims administrator (TPA), Acclamation Insurance Management Services (AIMS).
- An overview of your companies’ experience in providing bill review services for Cities and other municipal clients;
- Minimum of 3 professional references;
- Bill review and cost savings PPO philosophy;
- Medical bill review software utilized and the software provider;
- Bill review work flow from receipt of bill through Explanation of Benefits and recommended payment;
- Experience and training of bill review staff;
- Average standard turnaround time for bills;
- Fee options and how fees are calculated;
- Average level of savings for bill review;
- In the absence of a fee schedule, how rate reductions are negotiated;
- Computer systems and the ability to interface with TPA and utilization review contractor computer systems. Also, the ability to generate reports documenting bill review activity, costs and savings for the City;
- PPO networks offered and the average below-fee schedule reductions;
- PPO fee options and how fees are calculated;
- Pharmacy PPO services and average savings;
- Any distinguishing or unique qualifications that your company possesses or any other information that documents your ability to provide quality bill review services.
- Explanation of Benefits for sample bills processed and submitted to the City per the scheduled activities calendar on page one.
- Services to Be Provided
•    Provide state of the art bill review service for the city;
•    Review all bills in a timely manner for compliance with applicable fee schedules and reduce accordingly, including those that fall outside of a fee schedule or PPO network;
•    Identify duplicate billings and how they are handled;
•    Deny charges for all items not required for injury described;
•    Identify all unauthorized charges to ensure billing does not exceed parameters of injured workers’ treatment plan;
•    Maintain contracts with effective organizations (including pharmacies), that include providers in the city area;
•    Provide reports on a monthly and annual basis outlining bill review activity, savings and costs. Provide ad hoc reports as requested;
•    Provide a computer system that interfaces with both the city’s workers’ compensation TPA and utilization review provider;
•    Handle all provider inquiries regarding bill reductions.
•    Assist in defense of liens at the workers’ Compensation Appeals Board.

- Contract Period/Term: 5 years