Workers Compensation Certified Network and Cost Containment Services
Location:
Texas, United States
Posted on:
Deadline:
Summary:
Seeking a provider for certified network and cost containment services for a self-insured workers’ compensation program, involving medical bill audit, provider network management, and electronic claims processing.
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The selected vendor will provide certified network and cost containment services for a self-insured workers’ compensation program in Texas. Responsibilities include offering medical cost containment through a certified provider network, engaging in the auditing of medical bills and reports across hospital, physician, pharmacy, and ancillary service providers, and ensuring that all charges comply with established reimbursement schedules. Vendors are expected to supply comprehensive provider lists, including detailed contact and tax information, and to update provider directories on a quarterly basis.
Additional requirements include professional bill auditing, providing access plans for healthcare, and implementing automated review and adjustment of medical bills as they are processed. Vendors must be equipped to electronically receive and process claims data daily and manage all associated hospital, pharmacy, medical supplier, and other medical bills. This contract is set for a period of three years.
Best-fit vendors:
• Experience managing workers’ compensation certified networks in Texas
• Expertise in medical cost containment and professional bill auditing
• Ability to electronically process and review medical claims daily
• Established relationships with healthcare providers and efficient provider directory management
• Proven track record serving self-insured or public sector clients
