MB-10555 - USA (South Dakota) - Workers Compensation Third Party Claims Administration Services - Deadline November 26,2026

(1) Vendor needs to provide workers compensation third party claims administration services.1. Third party claims administration:– The TPA is responsible for the intake and management of every state employee injury and illness or disease claim submitted by an employee or the employer on behalf of the employee. To include, but not limited to: electronic payments, monthly payment report (report 107), reporting form 101, initial claimant letters, requesting medical information to determine compensability and necessary medical records for ongoing management of the workers’ compensation claim and 1099 reporting.– The TPA or their bill review company may be required to develop and maintain a comprehensive preferred provider organization network that will provide the state with the greatest possible opportunity for discounts as provided by state statutes for workers’ compensation injuries.2. Medical case management:– Case management contractors must include in proposal sample progress and case management report.3. Bill review:– The TPA or their bill review company will review duplicate bills, bills for excessive treatment, and bills for treatment unrelated to the compensable injuries and coordinate the process and communication for refunds or subrogation accordingly.– Bills are re–priced in accordance with the state mandated workers’ compensation medical fee schedule and usual and customary charges.(2) All question must be submitted no later than October 30, 2026.(3) A contract period will be for three years.