Workers' Compensation Third Party Administration

The County of Tuolumne, hereinafter referred to as “County”, is soliciting proposals from qualified third-party administrators, hereinafter referred to as “TPA”, for claims administration of the County’s Workers’ Compensation Program. The County is seeking a strong, long-term partnership with a TPA to manage its Self-Insured Workers’ Compensation claims. It is the intent of the County to contract with a qualified firm to provide claims administration and medical cost containment services for the period beginning July 1, 2024, through June 30, 2026 with an option for two (2) two (2) year extensions. T he County is seeking proposals for bundled and unbundled services, whichever is determined to be in the best interest of the County. The County requires a TPA partner who demonstrates an innovative and effective claims management process that is streamlined, user-friendly, and that allows for exceptional customer service to the County and its staff served through the Workers’ Compensation program. Customer service includes the provision of consistently correct claims management and appropriate internal oversight for checks and balances, consistent direct dissemination of communication via reporting, updated technological capabilities, timely dissemination of information to the County’s Human Resources-Risk Management office (HR-RM) and employees served through the Workers’ Compensation program. Competitive rates and fees and the ability and willingness to comply with PRISM’s Claims Administration Standards are also desired. The proposing TPA’s staff should have proper licensing to perform claims administration services. The proposing TPA should demonstrate a strong regional presence in the County’s surrounding areas and maintain the staff necessary to perform the claims administration services requested now, and into the future. This Request for Proposal (RFP) contains specifications covering the administration of the County ’s Workers’ Compensation program. This RFP and all subsequent modifications thereto are hereby designated as the sole reference and authority for the preparation of proposals. The release of this RFP supersedes all other documents related to the work to be done. The contents of this RFP and subsequent modifications thereto take precedence over any and all information related to the administration of the program obtained from any source, either by written or verbal communications This RFP shall not be construed: to create an obligation on the part of the County to enter into a contract with any firm, or to serve as the basis of a claim for reimbursement for expenditures related to the development of a proposal. Also enclosed is a draft of the scope of services required of the selected TPA and includes a pricing request. The selected TPA will enter into mutually agreed upon, binding, client specific service procedures. These procedures are anticipated to be detailed in all areas of specific claims handling requirements, including experience levels for technical claims staff, caseload levels, authority levels, reporting requirements, and claims file documentation format, supervisor and manager file review requirements (e.g. how often, how the review will be conducted, form of documentation, etc.). Additionally, the TPA must follow all standards outlined within both the County’s Performance Standards and PRISM’s Addendum A Claims Administration Standards. Respondents must respond within the prescribed timeline and must indicate willingness to agree to a performance guarantee subject to mutual agreement between the TPA and the County.