Workers' Compensation Third-Party Administration Services

The vendor is required to provide workers' compensation third-party administration services for include:
- Administrative and managerial
• Workers compensation (WC) claims data in the format requested by the county's actuary by October 15 of each year and provide any supplemental data as requested by the actuary.
• Coordinate and respond on the county's behalf to the state or federal government, including occupational safety health administration (osha) and the center for Medicare services (CMS) and any other audits or requests that may be required of or by the county, including investigating and responding to state's notification of late payments, related fines, and inquiries on special disability trust fund and permanent total disability cases.
• Responsive and professional account management, administrative services, information technology services, 1099 filing, subrogation and recovery services, special investigative unit (SIU) services to investigate fraud, and any other professional services per industry standards and claims handling best practices.
• Provide prescription, bill review, and payment services in a manner that allows the county to realize optimum savings.
• Pay benefits on time per state requirements and file all information required by the division of workers compensation (DWC) per state EDI guidelines for all WC claims benefits and WC claim related expenses and is solely responsible for any fines or fees including but not limited to attorney's fees imposed against the county or employee as a result of any failure to pay timely.
• Maintain a documented and successful quality assurance program to ensure proper protocols are established and maintained for all claims processed.
• Information management system for the county (risk management information system or RMIS) with the following capabilities: i. Manage and store, in native format, all WC claims data, documents, and forms, including but not limited to medical records, payout sheets, referrals, reports, duty status including restrictions, and any other forms related to WC.
- Claims management, adjusting, investigation, and reporting
• Investigate WC claims for compensability, validity and liability for subrogation purposes and provide field adjusters/investigations when necessary.