RFP for Third Party Claims Administration & Cost Containment Services

The City of Merced is seeking qualified third‑party administrators to provide a bundled “TPA + Managed‑Care” program that includes bill review, case management, development and maintenance of medical provider and PPO networks, utilization review, and comprehensive reporting/technology solutions. The contract will replace the current handler (TriStar) and requires dedicated staffing (program manager and claims adjuster), strict compliance with the City’s claim‑handling guidelines and LAWCX standards, and proof of extensive insurance coverage. • Scope of work covers full workers‑comp claims lifecycle – bill review, case management, network creation, utilization review, and transition services. • Must provide dedicated program manager and dedicated adjuster, plus technology portals, dashboards, and Medicare reporting tools. • Requires detailed fee schedule (administrative, managed‑care, UR, etc.), robust insurance policies (GL, Auto, E&O, etc.) with A‑M Best rating ≥ A:VII, and adherence to extensive procedural timelines.