Huntington Beach Planet bids #140635

Workers’ Compensation Claims Administration and Managed Care Services for City of Huntington Beach

The City of Huntington Beach is seeking experienced vendors to provide Third-Party Administrator (TPA) and Managed Care Program (MCP) services for its workers’ compensation claims administration. - Government Buyer: - City of Huntington Beach, Risk Management Department - Services Requested: - Third-Party Administrator (TPA) Services for comprehensive workers’ compensation claims administration - Administration of approximately 200 open indemnity claims, 425 future medical claims, and 46 medical-only claims - Includes employee interface, claim file management, compensability determinations, medical treatment monitoring, fraud investigation, subrogation, and compliance with Alternative Dispute Resolution (ADR) program - Managed Care Program (MCP) Services, divided into: - Bill Review: Medical bill compliance review, processing within five business days, application of PPO and Pharmacy Benefit Management discounts, expert witness services - Utilization Review: Medical necessity review by California-licensed Medical Director and reviewers, URAC certification required by July 1, 2026, integration with bill review - Pharmacy Benefit Management: Pharmacy network management, medication screening, prior authorization, out-of-network bill management, electronic billing, secure online PBM system access - Unique/Notable Requirements: - Vendors must have at least 10 years of experience serving California public agencies - Compliance with California workers’ compensation statutes and ADR program administration - Access to claims management software and comprehensive reporting - Insurance and indemnification requirements for selected vendors - City reserves the right to award TPA and MCP components separately or bundled - Proposals must remain valid for at least 180 days - URAC certification for Utilization Review required by contract start - No specific OEMs or product part numbers are mandated; this is a service-based solicitation - Place of Performance: - City of Huntington Beach, 2000 Main Street, Huntington Beach, CA 92648 - Contract Term: - Three years from commencement, with possible extensions and transition period prior to service implementation

Description

The City of Huntington Beach is seeking proposals for Third-Party Administrator (TPA) services and Managed Care Program (MCP) services related to workers' compensation claims administration. The MCP services include three components: Bill Review, Utilization Review, and Pharmacy Benefits Management. Consultants may submit proposals for any combination of TPA and MCP services. The City reserves the right to award the TPA services to one consultant and the MCP components to one or more consultants, either bundled or unbundled at its discretion. The proposal submission is electronic, with a due date of June 15, 2026.

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