Third Party Administrative Services

Self-insured workers’ compensation program, plans to shift to a self-insured program for other lines of coverage as outlined below, and seeks to select a third-party claim service provider ("Contractor") to manage claims under those lines.
- CSP ("Contractor") Coverages Requiring Claim Handling Expertise - All States
1. Workers' Compensation, including Employers' Liability;
2. Auto Liability;
3. Auto Physical Damage;
4. General Liability, including Public Entity Liability and Professional Liability; and
5. Property Damage (First Party AL/GL).
- Claim Intake and Set Up Requirements
1. Online internet-based reporting available.
2. Acknowledgement of new claims back to County representative.
3. Ability to report via email.
4. Electronic acknowledgement of new claims back to reporting party and County representative.
5. Contractor may not accept new WC claim reports received directly from any claimant, attorney, or other party that is not a responsible management representative.
- Medical Management
1. Telephonic Case Management capabilities available.
2. Ability to administer and track the cost of claims under the County’s Initial Treatment Policy attached.
a. Claims will be charged as Medical Only Claims.
3. Field Case management and Rehabilitation Management capabilities available.
4. 24-7 Nurse Triage available.
5. Telemedicine/Telehealth available.
6. Review and re-pricing of all medical and bills required.
7. Preferred Provider Organization (PPO) networks and customization options available.
8. Quarterly reporting of expenses and savings on all aspects of medical management required.
9. All medical management expenses must be billed directly to the claim file.
10. Prescription Benefit Management Program available.
11. Utilization review, peer review, IME capabilities available.
12. Contractor must be willing to utilize County-preferred providers or unbundle Non-Bill Review ancillary medical management services.
- Claim Settlement and Reserve Authority
1. Reserve worksheet and full report required for the County, concurrence before any reserve increases for claims valued in excess of authority.
2. Supervisor approval and the County concurrence required on all newly established reserve and/or reserve increase above authority.
3. Pre-settlement discussion is required on all settlements. Both parties acknowledge that the County has ultimate authority.