REPORT TO COUNCIL
SUBJECT
Title
Award of a Three-year Contract for Workers' Compensation Claims Administration Services (F15-57)
Report
REPORT IN BRIEF
Approval is requested to award a three-year contract, not to exceed $924,316, to Acclamation Insurance Management Services, Inc. (AIMS) to provide workers' compensation claims administration services and to authorize the City Manager to renew the contract for additional one-year periods. Depending on the level of service and pricing, the total duration of this type of service contract is typically five years.
ENVIRONMENTAL REVIEW
N/A
BACKGROUND AND DISCUSSION
The City utilizes a state-licensed third party administrator (TPA) to manage workers' compensation claims of injured workers through a contract managed by the Department of Human Resources. Workers' compensation administration services consist of four components:
* Claims Administration - The largest component of the services provided, this includes the contracted cost for day-to-day handling of workers' compensation claims, and making disability payments and payments to doctors.
* Utilization Review - This is the assessment of the medical necessity of any medical treatment requested on the workers' compensation claim.
* Nurse Case Management - Services provided by nurses both telephonically and in the field to coordinate care for the injured worker. The Nurse Case Manager communicates with both workers and medical providers.
* Bill Review - Review of medical bills to confirm that doctors are charging only for authorized services and to verify that they are coded properly. Where necessary, coding is changed to reduce the bill to the State fee schedule amount.
The City has contracted with the current vendor, York Risk Services, since 2004 as the result of two separate Request for Proposals (RFP) processes. The current three-year contract with York, in the amount of $757,238 was awarded in June, 2011 (RTC No. 11-143). One addi...
Click here for full text