The Fund seeks a partnership through innovative services, solutions and technology that addresses the County’s self-insured liability, workers’ compensation and automobile claim management issues and needs. The Fund desires a collaborative effort yielding custom designed programs, constantly finding ways to strengthen and improve relationships among claim management, provider network, the County and the employee. Communication among all parties is critical and shall be maintained when providing timely and comprehensive claims handling.
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. The TPA is responsible for maintaining computerized claim data, setting appropriate loss reserves, monitoring all litigation and maintaining communication with the attorneys, obtaining necessary case- specific 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. The TPA shall be responsible for the above while performing the following minimum duties as well as those prescribed by applicable law, subject to the review and approval of the Fund.
The bidder must establish a secure electronic data interface (EDI), between the TPA and bill-repricing agency for the purpose of transmitting all claim processing in HIPAA compliant 837 formats. The frequency of the feed between the contractor and the TPA shall be no less than one time per week; daily is the preferred method. In addition, they must provide on-line access to all claim information and to Network Providers. Web based sites must be secure and use the HTTPS protocol. The site must be compatible with all browsers.
