Workers’ Compensation Third Party Administration Services

expired opportunity(Expired)
From: Fairfield(City)

Basic Details

started - 30 Jan, 2024 (2 months ago)

Start Date

30 Jan, 2024 (2 months ago)
due - 27 Feb, 2024 (1 month ago)

Due Date

27 Feb, 2024 (1 month ago)
Bid Notification


Bid Notification


City of Fairfield

Customer / Agency

City of Fairfield
unlockUnlock the best of InstantMarkets.

Please Sign In to see more out of InstantMarkets such as history, intelligent business alerts and many more.

Don't have an account yet? Create a free account now.

The City of Fairfield invites proposals for Third Party Administration (TPA) of Workers’ Compensation Benefits. The City is looking for a TPA partnership that will deliver objective and measurable results that will reduce the cost and duration of workers’ compensation, provide claim processing in a timely and professional manner, proactively assist in returning injured employees back to work, focus on quality of care, and maintain strong communications with the injured worker and the City. . The RFP Process Timeline is as Follows: January 30, 2024 RFP Released February 13, 2024 Last day to submit any questions related to the RFP no later than 5:00 p.m. PST February 15, 2024 City will post responses to previously submitted questions. February 27, 2024 Proposal submissions due in our office no later than 4:00 p.m. PST Below dates are tentative March 8, 2024 Selection of TPA Finalists March 18, 2024 In-Person panel interview with TPA Finalists March 20, 2024 Notification of intent to
award sent to selected TPA May 7, 2024 City Council approves contract July 1, 2024 Service Agreement Begins For detailed information please read the Full RFP Document. Responses to Questions Received By February 13, 2024 Responses to questions are provided in bold font below and or can be downloaded here. General Questions Who is the incumbent/current vendor? Innovative Claim Solutions Claims Data Please provide additional details on Workers' Compensation loss claims data is provided in MS Excel format for the periods 01/01/2018 through 01/01/2024. This loss data is available to download here and provides the following information: Types: Indemnity, Medical Only, Incident-Report Only, other Dates: Loss Date, Report Date, Close Date, Coverage Year / Calendar Year Claim Status: Open, Closed, Re-Opened Litigation: Yes or No data Employee: Job Description / Class Code / Department / Class Code / Other Claim Type: Lost Time, Medical-Only, Incident/Report Only, or other Expenses to include: [1] Reserves, [2] Paid, [3] Total Incurred for the following columns: (a) Indemnity, (b) Medical, (c) Legal, (d) Other and (e) Total Incurred What are the total number of open WC indemnity claims valued as of 02/01/2024: 143 What are the number of open WC indemnity claims w/ occurrence dates prior to 07/01/2018: 41 What are the total number of open 4850 claims effective 01/01/2024: 108 What are the number of open-litigated indemnity claims as of 01/01/2024: 67 Does the City utilize an MPN? No Workers' Compensation Program Managed Care and Subrogation Nurse Case Management How frequently was NCM utilized [annually] during the past five years? 16 Aggregated annualized data for 01/01/2020 through 01/01/2024. number of telephonic assignments: 0 number of in-person assignments: 14 gross annual expense for telephonic: 0 gross annual expense for in-person: $84,153.72 Does the City utilize the incumbent's Pharmacy Benefit Management (“PBM”) services or a separate vendor? Separate Vendor PBM statistics Specifically, aggregated annualized data for 01/01/2020 through 01/01/2024. number of prescriptions filled: 304 gross annual expense: $12,642 gross savings: $6,490/year net savings: $6,160/year Does the City utilize the incumbent's medical bill review or a different vendor? Diamond Bill Review ICS Review If yes, provide detailed annualized medical bill review statistics Specifically, aggregated annual data for 01/01/2020 through 01/01/2024: number of invoices/number of lines: 7752 invoices, 14,163 lines gross annual expense: $90,993 gross savings: $7,981,750 net savings: $7,522,472 percentage of saving: 72% Does the City utilize 24/7 Nurse Triage? No; current incumbent does not provide. Detailed utilization review statistics, such as net-gross savings report and utilization review volume for the past five years: Refer to the following document here. aggregated annual data for 01/01/2020 through 01/01/2024: number of assignments: 208 gross annual expense: $16,608.38 gross savings: $331,437 net savings: $265,003.05 percentage of saving: 80% Annualized Medicare, Medicaid and SCHIP Extension Act of 2007 (“MMSEA”) reporting volume for the past 5-years. Aggregated annual data for 01/01/2019 through 01/01/2024: All claims are reported to Medicare on a quarterly basis. Incumbent TPA is then informed who is a Medicare beneficiary, and those claims are tracked separately. The report provided here is the initial submission list. number of assignments: 79 reported gross annual expense: $0 Does the incumbent TPA pursue subrogation for the City? Yes What is the fee structure and is it Gross or Net of recovery? $0 What has been the annual recoveries 01/01/2020 through 01/01/2024? $12,136.27 What is the percentage of savings charged by the incumbent TPA for Subrogation? $0 Is there a maximum or capped dollar amount regarding subrogation fees? No charge Is the City open to an unbundled program approach and accepting responses for cost containment services (bill review, UR etc..) only or will one contract be awarded? The City is not accepting responses only for cost containment services; only one contract will be awarded. How many medical bills were processed in 2021, 2022 and 2023? 2021: 1338 (fiscal year 20/21) 2022: 1480 (fiscal year 21/22) 2023: 1588 (fiscal year 22/23) Guaranteed cost bill review program Does the City want pricing for a flat annual fee? Or can this be priced as a fee per service? City is open to proposals that provide flat annual fee and/or per service fees. If an interested party is unable to provide a guaranteed cost bill review program, can we still bid on the TPA administration services? No; the City requires a bill review process. Any TPA who elects to provide medical bill review services internally shall provide a guaranteed cost bill review program. The TPA must identify any costs associated with the medical bill review services separately from its administrative fees. Any TPA who proposes using a vendor to provide medical bill review services shall identify the vendor and its fee schedule. The City retains its right to select, approve, or reject the proposed Bill Review vendor. What is the City’s current staffing model? City staff includes 1 Human Resources Manager and 3 Human Resources Technicians, allocated to the Workers’ Compensation program at roughly 30% of their time. Incumbent TPA provides 1 full-time Claims Examiner to the City, and other support staff as required. Can the City please provide the annual self-insured report? See here for FY 22/23. What is the current annual administration fee? $164,808 Does the City prefer designated or dedication staffing from the TPA? In other words, can the team work on other account(s) or does everyone need to be fully dedicated to the City of Fairfield? The objective of this RFP is the establishment of a dedicated claims unit to service and manage the City’s account exclusively. The respondent shall establish a dedicated claims office, or a segregated unit whose sole responsibility is the handling of the City’s workers’ compensation claims. Please provide a staffing plan as requested in this document. The TPA shall designate a full-time Claims Supervisor to be assigned to this account that will act as the primary contact for the City and will be selected with the concurrence of the City. Free viewers are required for some of the attached documents. They can be downloaded by clicking on the icons below. Acrobat Reader Windows Media Player Word Viewer Excel Viewer PowerPoint Viewer

1000 Webster Street,Fairfield, CA 94533Location

Address: 1000 Webster Street,Fairfield, CA 94533

Country : United StatesState : California

You may also like

Third Party CDL Skills Testing Services

Due: 30 Nov, 2024 (in 7 months)Agency: Transportation

Third Party Administration of Regional Jail Health Care Services

Due: 26 Apr, 2024 (in 12 days)Agency: Richmond County

Workers' Compensation Premium Audit Services

Due: 02 Jul, 2026 (in about 2 years)Agency: General Services Department

Please Sign In to see more like these.

Don't have an account yet? Create a free account now.