Workers’ Compensation Third Party Administration and Managed Care Cost Containment Services

The Vendor is required to provide workers’ compensation third party administration and managed care cost containment services will be for all new and existing claims.
- Administrator shall provide the following services:
• Develop procedures, forms, instructions, schedules and other materials related to claim management within 30 days of the effective date of the signed contract and update such materials as needed.
• Procedure manual shall include the county’s current client handling instructions (chi) provided by the county.
• Provide group education for county staff regarding claim management as requested.
• Assist the county in the development of directives, notices, and other program communication to employees as requested or needed based on administrator’s expertise and suggestion.
• All forms and supplies necessary for the efficient operation of the workers' compensation insurance program, including customized benefit checks bearing the county's name and logo, and prepare all legally required forms and documents including but not limited to, 1099 reports to the I.R.S., osha required reports, and any and all other documents and reports now or in the future required by the state or federal government or any other agency associated with the county's workers' compensation program.
• Administrator will report any osha-reportable injuries to the county’s safety manager, risk manager and OSHA.
• Work with county controller's office and bank to establish controls.
• Coordinate and attend regularly scheduled meetings and conduct periodic in-person file reviews of claims as may be requested by the county.
- Claims administration
• Administrator shall assume all claims administration services including transfer, conversion, installation and adjustment of all open claims records as of July 1, 2027.
• This will include maintenance of all closed claim records.
• Establish and maintain a claim file, with a diary date not to exceed 30 days, on each active claim where indemnity benefits are being paid; a diary system not to exceed 60 days on all other open, active indemnity claims; and a supervisory review diary not to exceed 120 days, or more often when needed.
• Manage timely receipt of all pertinent claim information from county providers and other sources.
• Attend workers’ compensation hearings and mediations as requested by the county.
• Contact and document bi-weekly calls to injured workers while they are receiving lost time benefits and notify risk management when the injured worker’s work status has changed from “no work” to “light duty”.
• Administrator will support the county’s light duty, early return to work programs in conjunction with personnel from risk management
• Determine, on behalf of employer for each reported employee injury or illness, those benefits, if any that should be paid or rendered under the state workers' compensation laws.
• Such determination shall include an estimate of future claim payment.
• Document in each indemnity claim file good faith efforts to contact all injured workers by telephone within 1 business day of receipt of claim, and in no event later than 2 business days of receipt of claim.
• Establish phone contact with appropriate employer department for initial discussion of claims, as needed, within 3 business days of receipt of claim.
- Record keeping and reporting requirements
• Provide special specific focus loss run reports within 24 hours and larger or major analysis reports within 7 business days.
• The county require that administrator prepare special reports which require additional programming costs, it is understood that there may be an additional charge for said reports.
• Conduct injury trend analysis, loss control reviews, and develop reports to identify areas for improvement, working with the employer regarding specific report data to be provided.
- Computerized claims management system
• Provide the county access to administrator's computerized claims management system.
• This system will provide the county with all financial and statistical data relating to the county’s workers' compensation claims, narrative "notepad" reports, and records on each individual claim.
• The system will also include OSHA log generation; and complete report generation capabilities.
• All claim-related documents from any source will be put into the administrator’s computer system.
• Maintain an effective claim electronic data security system including adequate access and integrity controls, and continuity program for uninterrupted systems operations.