Third Party Insurance Administrator and Medical Bill Re-Pricing and Intake Services

Third Party Insurance Administrator and Medical Bill Re-Pricing and Intake Services provided shall include investigation, evaluation and administrative handling of all general,
employment related practices and automobile liability claims as well as all workers’ compensation claims.
- TPA is responsible for maintaining computerized claim data, setting appropriate loss reserves, monitoring all litigation and maintaining communication with the attorneys, obtaining necessary casespecific client authority, required reporting to excess insurance carriers, making claim settlement and expense payments, pursuing subrogation opportunities, attending regular Fund meetings, and complying with Fund claim handling and reporting requirements.
- Third-Party Claims Administrator, and:
• Provide a list of network physicians, health care facilities and rehabilitation sites that include County, as well as contiguous counties.
• Re-price all medical bills and if necessary, medical care (physical therapy, rehab nurse, etc.) related to worker’s compensation injuries.
• Required to be available to attend Insurance Fund Committee meetings, when requested. Currently the committee meets two times a month.
• Provide a list of health providers for independent medical examinations or provide a link to the health providers in your Network.
• Considering that County of Morris employees work in Morris County and principally live in the County, proposer must indicate the percentage of these network providers that have Offices in County.
• Provide a list of providers of specialty tests locations, e.g. Functional Capacity Examination.
• Provide case management services to the County Division of Risk Management on an as needed basis.
- Intake Services as follows:
• Provide case management services to the County Division of Risk Management on an as needed basis.
• Provide 24/7 access 800 number for employees to report all work-related injuries. There are approximately 400 reports of injuries per year, including “record only” reports.
• Conduct an initial interview with the employee or supervisor ascertaining all information regarding the injury.
• Refer employee to appropriate provider.
• Provide all reports to the Office of Risk Management the day of injury. If an injury occurs on a weekend, holiday, or night, reports must be received first thing the following business day.