WORKERS’ COMPENSATION THIRD PARTY ADMINISTRATION AND MANAGED CARE COST CONTAINMENT SERVICES RFP

RFP Description

Location: California. The County of San Mateo (the “County”) covers most of the San Francisco Peninsula. The region covers 744 mi2 and is home to nearly 800,000 residents and 20 incorporated cities. The County provides for the health and welfare of all people within its borders and serves as the local government for the unincorporated areas. Innovation thrives here in industries including bioscience, computer software, green technology, hospitality, financial management, healthcare, education and transportation. The County prides itself on how that prosperity fosters its commitment to protecting and enhancing the health, safety, welfare and natural resources of the community. The County is seeking proposals from qualified Third-Party Administrators (TPA) to provide Workers’ Compensation Claims Management and Managed-Care Cost Containment Services for its self-insured Workers' Compensation Program. Services will be for all new and existing claims. There are approximately 694 total open claims comprised of 643 indemnity, 36 medical and 15 first aid/info only, with 249 open for Safety employees. The County’s services and operations are supported by approximately 7,250 employees in 29 departments. We request that our future Third Party Administrator’s staffing structure includes 2 fully dedicated Claims Supervisors, 4 fully dedicated Senior Claims Examiners, 1 fully dedicated Future Medical Claims Examiner, and 2 fully dedicated Assistant Claims Examiners, however the chosen TPA will have some flexibility to propose staffing. The County reserves the option to adjust staffing needs after the first 6 months, and then on an annual basis going forward. The County uses Origami Risk Management Information System, which is managed by a third-party vendor, and claims information is imported and exported through the current TPA’s workers’ compensation information system. The County also uses third-party vendors contracted through the current TPA for Bill Review, Utilization Review, Nurse Case Management and Investigation. The County reserves the right to approve all third-party vendors contracted through the chosen TPA.