Third Party Administrator Services

The Vendor is required to provide third party administrator services for include:
• Management of the county’s self-insured workers compensation program to include claim qualification determination, processing all required payments for all workers’ compensation claims, and reporting as required by the state workers’ compensation commission and CMS filing for workers’ compensation.
• Day-to-day claims management of all open claims cooperatively with department of finance, risk management division staff, attorneys and actuaries as needed.
• Submission of monthly management and financial reports and participation in related presentations.
• Recommendation in the selection of a revised panel(s) of physicians, specialists and mental health providers in the geographic area.
- Requirements
• Consultation for periodic revision of the panel(s) of physicians, specialists, and mental health providers in the geographic area within which county is located in surrounding areas, in addition to providing recommendations that will meet both the county’s needs and provides employees with viable options.
• Consistently reinforce that county employees need to utilize the county’s panel(s) of physicians, specialists, and mental health providers, and shall promptly provide same to claimants.
• County, create a comprehensive claim handling document that aligns with industry best practice.
• Provide adjusters, handling claims, with a minimum of at least three years’ experience in adjusting state worker’s compensation (WC) claims.
• Pending claim volume should be reasonable to allow for thorough claims investigations, regular communication with the insured and timely returning of phone calls.
• The adjuster should maintain a pending of no more than 125 claims.
• Assemble any statistical WC claims data required by the state department of insurance in a timely manner
• Convert and facilitate the transition of any outstanding workers’ compensation files from current TPA, including conversion of all existing data files and scanned documents to the successful offeror’s claim management system.
• Also included in this transition will be historical claims data, to ensure that a complete claims history is available and accurate.
• Staff need to be trained in utilizing the on-line claim system in order to access all claim information, all reports from detailed claim files, financial and online claim reporting along with any other training necessary to utilize the successful offeror’s resources and work with county staff as needed to assist in data conversion.
• Receive claims on a 24/7 basis via fax transmission, emails or other electronic means.
• 24/7 on-line access to an on-line claims system that provides real-time information on both open and closed claims, including adjuster’s notes and the option for county personnel to easily communicate with the adjuster on any given claim.
• Claims account executive, designated as a contact person, for the county to contact in the event of service issues or other concerns.