Riverside Transit Agency PlanetBids #S26089

Riverside Transit Agency Seeks Third Party Administration and Managed Care Services for Workers’ Compensation

Riverside Transit Agency (RTA) is seeking a qualified contractor to provide comprehensive third party administration (TPA) and managed care services for its self-insured workers’ compensation program. - Government Buyer: - Riverside Transit Agency (RTA), Riverside, California - Contact: Contracts Manager, Lon-Det Givens - Services Requested: - Third party administration of workers’ compensation claims, including: - Claims investigation, adjustment, processing, and resolution - Medical bill auditing for accuracy and compliance with California regulations - Utilization review of medical treatment requests (must comply with Labor Code 4610 and URAC standards) - Medical case management, including nurse case manager assignment and coordination - Medicare reporting services to ensure compliance with federal requirements (Section 111 reporting) - Medical Provider Network (MPN) management - Fraud prevention, cost containment, and secure electronic data management - Detailed monthly, quarterly, and annual reporting, including compliance with state and federal regulations - Assumption of all open claims at contract start and transfer of claims data upon contract termination - Additional hourly services for processing claims left open after contract expiration - Notable Requirements: - Contractor must be registered with the State of California and hold a valid Certificate to Administer from the Office of Self-Insurance Plans (OSIP) - Must be listed on California’s Roster of Third Party Administrators - Minimum five years of relevant experience required - Must provide secure online access to claims system and maintain a toll-free number for inquiries - No guaranteed minimum level of service; services are provided on an as-needed basis - No specific OEMs or product part numbers are involved, as this is a service-based contract - Contract Structure: - Firm-fixed price agreement - Three-year base term with two one-year option terms (up to five years total) - Services priced monthly, with additional hourly rates for certain tasks

Description

Riverside Transit Agency (RTA) is soliciting proposals from experienced and qualified contractors to provide third party administration for workers’ compensation claims and managed care services. The scope includes claims administration, medical bill auditing, utilization review, medical case management, and Medicare reporting services as detailed in Exhibit A, Scope of Work. Contractors must be registered with the State of California and hold a valid Certificate to Administer issued by the Office of Self-Insurance Plans (OSIP), and be listed on the state’s Roster of Third Party Administrators at proposal submission. The contract is anticipated to be firm-fixed price for a three-year base term with two one-year option terms.

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