Third Party Administration for Workers Compensation

{
  "id": 33892,
  "_slug": "tucson-az",
  "title": "Third Party Administration for Workers Compensation",
  "status": "closed",
  "summary": "<p>The City of Tucson is seeking bundled and/or unbundled proposals from specialist firms for third party administration (TPA) services for workers&rsquo; compensation claims, per specifications called for herein. The City is requesting that the Contractor provides a definition of an indemnity adjuster and medical only adjuster.</p><p>The City is looking for a best value solution with a multi-year TPA contract and is requesting bundled and/or unbundled responses from TPA&rsquo;s. The City may at a later date chose to perform any of these services in house. The city has a preference for a fully bundled solution but reserves the right in subsequent years to evaluate the value and performance of these ancillary services:</p><ul><li>Comprehensive Bill Review and Audit</li><li>Utilization Review</li><li>Pharmacy Benefit Management</li><li>PPO and Other Network Services</li><li>MSA Preparation</li><li>CMS Lien Investigation</li><li>Telephonic Case Management</li><li>Field Case Management</li><li>Other</li></ul><p>The TPA shall be expected to provide data to demonstrate successful outcomes and added value of these ancillary services in six (6) month intervals. It is the expectation of the client that the TPA make recommendations and manage the use of the vendors necessary to provide these services. Finally we ask that you list the vendors that will be providing the above to include what services they provide and the length of your relationship with said vendor. If TPA will be providing any of the above services in house, please provide a list of these services.</p><p>The City is a full service, qualified self-insurer authorized by the Industrial Commission of Arizona. The City employs approximately 4750 employees and has filed an average of 453 claims per year for the last five years. The claims history for recent years is as follows:</p><p>Year&nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; Total Claim&nbsp; &nbsp; Indemnity&nbsp; &nbsp; Medical Only</p><p>2021/2022&nbsp; &nbsp; &nbsp; &nbsp;351&nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp;136&nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; 215</p><p>2020/2021&nbsp; &nbsp; &nbsp; &nbsp;426&nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp;166&nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; 260</p><p>2019/2020&nbsp; &nbsp; &nbsp; &nbsp;478&nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp;191&nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; 287</p><p>2018/2019&nbsp; &nbsp; &nbsp; &nbsp;483&nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp;170&nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; 313</p><p>2017/2018&nbsp; &nbsp; &nbsp; &nbsp;530&nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp;171&nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; 359</p><p>The Contractor must be experienced in administering claims in accordance with Arizona Workers Compensation law and will provide services for all workers compensation claims for the City including new claims and run-off or &ldquo;tail&rdquo; claims. Offerors must carefully examine the Scope of Work to determine the risks to be covered. The City will assume that each Offeror has made such investigations and is fully informed of the extent and character of any and all requirements included in the Scope of Work.</p><p>The contractor will be licensed to conduct business in the State of Arizona. The Contractor agrees that all services performed pursuant to the Contract will be rendered through an Arizona-based office. The employees assigned to work under the Contract will have the appropriate adjuster&rsquo;s license, experience and training applicable to the types of claims they are handling, i.e. Senior Adjusters must have the experience to properly handle indemnity claims in accordance with Arizona Workers Compensation law. The Contractor will assign dedicated adjusters to the City with no more than 100 indemnity claims per indemnity adjuster and no more than 200 medical only and/or low activity claims to medical only adjusters. Assigned adjusters must be permanent employees of the contractor (non-permanent employees are not permitted assignments under this contract). The City retains the right at any time during the Contract to prohibit any of the Contractor&rsquo;s staff from performing services on behalf of the City. The City may request a specific staff member employed by the Contractor to perform one or more particular assignments.</p><p>Failure to maintain and adequately staff an Arizona-based office, perform all claims services timely and competently in compliance with Arizona workers compensation law, and to protect the City&rsquo;s interests at all times against actions resulting in a conclusion of bad faith by the City, will be a material breach of the Contract and will be grounds for termination of the contract. The City reserves the right to unbundle specific elements of service associated with the City&rsquo;s workers compensation claims. These can include, but are not limited to medical case management, bill review cost containment, utilization review, and pharmacy benefit management.</p><p><strong>Offeror should submit a response in both PDF and WORD unprotected.&nbsp;&nbsp;</strong></p>",
  "isPaused": false,
  "template": {
    "title": "Request for Proposal"
  },
  "addendums": [],
  "copyCount": 0,
  "isPrivate": false,
  "comingSoon": null,
  "created_at": "2022-12-27T20:19:23.000Z",
  "department": {
    "id": 506,
    "name": "Human Resources"
  },
  "government": {
    "code": "tucson-az",
    "organization": {
      "city": "Tucson",
      "logo": "https://assets.procurement.opengov.com/logo-uploads/7dbfd78d-0fa5-4c02-a28f-bdfb438234fd_Tucson_Logo_6-17-22.png",
      "name": "City of Tucson",
      "phone": null,
      "state": "AZ",
      "website": "https://www.tucsonprocurement.com/",
      "zipCode": "85701",
      "address1": "255 W Alameda St",
      "address2": null,
      "phoneExt": null,
      "timezone": "America/Phoenix",
      "countryCode": "US",
      "phoneCountry": "1"
    }
  },
  "financialId": "230084",
  "closeOutReason": null,
  "closedSubstatus": "awarded",
  "proposalDeadline": "2023-05-25T21:00:00.000Z",
  "releaseProjectDate": "2023-04-20T07:00:00.000Z"
}