Worker’s Compensation Third Party Administration Service

The Vendor is required to provide workers’ compensation (WC) third party administrator (TPA) firms with public sector experience.
- Claims are currently securely stored in an Athens password-protected cloud. Claim files have been imaged since 2005, and all documents are scanned and viewed electronically. All pre-authorizations and bills, attachments, and explanation of benefits (EOB’s) are interfaced with the electronic claims file.
- The City encourages employees to return to work as soon as possible and strives to have limited duty positions available whenever possible.
- Agree to provide electronic read only claim file access capability to all 3rd parties the City requests.
- Pay third party vendors within 60 days of invoice receipt and be responsible for payment if invoices are not paid timely.
- Fill key and dedicated vacant positions with a temporary employee within 30 calendar days and a permanent employee within 90 calendar days if there is a vacancy and take immediate measures to avoid delays in services as outlined in the contract.
- Shall establish:
• An operational claims database with all claims information imaged and online.
• A web-based claims reporting system with access capabilities by all departments.
• New claim processing shall be effective as of 12:01 a.m.
• Benefit payment issuance capabilities utilizing the established financial account.
- Shall timely void indemnity checks and/or issue stop payments on checks to avoid overpayments to employees. Contractor shall bear the cost of any stop payment charges.
- Claim payments to providers and employees shall be paid by either check or ACH, beginning day one of the program implementation.
- Refunds and credits received by the contractor should be applied against the claim payments, and details of the credits shall be included in the financial reports provided to the City.
- Shall bear any costs associated with the establishment, maintenance, and transaction activity fees on the bank account, at no additional cost to the City. This shall also include check stock. Approximately 25,000 drafts are issued per year.