Workman’s Compensation Claims Services

The Vendor is required to provide to administer workman’s compensation claims internally; requiring third party services to be acquired.
- Requirement:
1. Existing claims
•    The city will transfer all active claims to the new claims administrator. 
•    The claims administrator must be prepared to immediately take over the administration of approximately fifty claims that are all in different stages of the process. 
•    The active claimants must be able to continue treatment with their approved providers and services. 
•    Changes can be discussed if it won’t have a substantial impact on the claim.
2. Vendors and providers
•    The city is seeking a claims administrator that offers an extensive list of vendors and providers. 
•    The city must maintain the ability to identify which of the listed vendors and providers our claimants are sent to; refuse specific vendors and providers; and identify providers for network inclusion. 
•    The city reserves the right to direct care to providers and use vendors outside of the network as needed.
3. Medicare and Medicaid reporting
•    Claims administrator will be required to manage all steps of the Medicare and Medicaid reporting process.
•    Proposer shall assume responsibility for penalties attributable to reporting errors or failures within its control
4. Risk management information system (RMIS)
•    The RMIS must include claims tracking, financial tracking (payments and reserves), document storage, reporting (standard and ad-hoc), and role-based access. 
•    The city would prefer it also include dashboards with advanced visualization requirements, mobile apps, and automated loss analytics.
•    System capabilities that enhance program oversite, analytics, or user experience; however, such items must be clearly identified as optional in the budget section of the proposal.