Workers' Compensation Services

The Vendor is required to provide workers’ compensation claims and cost containment services for all claims activities on or after July 1, 2027, for all claims incurred July 1, 1986 and later.
- Requirement:
• Oversee and manage employees and subcontractors to provide claims administration services (with specific delegated authorities to be negotiated), program administrative support, short term disability (STD) and long term disability (ltd) disability coordinator, paralegal, medical preferred provider network, document imaging, medical bill adjudication including reductions to the prevailing community rate as authorized by the act for medical services rendered prior to January 1, 2018 and reductions to the fee schedules adopted by the commission for medical services rendered on or after January 1, 2018, provider bill review, utilization review, discount prescription drug, supplies and apparatus program, surveillance, field investigation, two dedicated loss control and safety staff to provide consulting and training services, payroll classification audit, field medical and vocational placement, telephonic nurse consulting, on-line claim reporting intake program proprietary to the FROI (first report of injury) app which includes named and anonymous user functionality and security (including tailored fields such as program, healthcare, RTW (return to work), and disability reporting on an ongoing basis after claims intake; ability for agencies to send notes and attachments directly into the claims system), secure portal for client agency use in uploading documents to the claim service provider, online portal for client agency reporting of lost time, and claims system client claim data reporting program.
• Also oversee and manage claims services on an as needed basis for claims prior to this date period for a small quantity of claims
• An example of this would be the quarterly payments on a claim with a 10% fee added of the payments made in that quarter.
• This will include cloud storage
• Services include surveillance, payroll classification audit, field investigation, IME, FCE, and other special claims or loss control services (i.e. - industrial hygienist services), not identified above may be priced on a per service/per hour/per item basis.
• It is expected that the claims service provider will provide medical bill adjudication within the claims system platform or collaborate with the medical bill adjudication subcontractor to provide updated billing viewing capability in the claims system real-time.
• Security access to view all claims activities including medical bill processing.
• Initial marketing, promotion and statewide seminars shall be included in the contractor’s responsibilities under this agreement.
- Claims and loss control management:
• Oversee and manage a full-time dedicated staff to provide workers’ compensation claims case management in accordance with the workers’ compensation act and accepted industry standards.
• Providing two full time dedicated loss control professionals to analyze the claims, evaluate risks, develop inspection programs, provide consultative services and develop and conduct training programs in coordination with risk management staff.
• Claims management system for workers’ compensation that includes the ability to track and report on all claims activities by all human resources, payroll, and loss control agency customers.
• The claims management system shall support a robust imaging platform for all claim related documents and a primarily paperless workflow among internal and external customers in a secure fashion.
• Aggressively work to identify and convert wherever possible paper processes to an electronic workflow.
• Extend to software that supports electronic signatures and other electronic efficiencies.
• Responsible for assuring that all cases are properly investigated and managed by a supervisory staff.