Medical Case Management

The State of Minnesota, Department of Labor and Industry, is seeking a qualified vendor to provide medical case management services. The selected vendor will be responsible for providing medical case management and utilization review and payment of uninsured employer and bankrupt self-insured employer claims in accordance with Minnesota Statutes §176 and Minn. Rules Chapter 5221. The scope of work includes ensuring the availability of proper linkages and communication between the proposed services and other services provided to the claimant, reviewing medical reports, advising the SCF's claims staff, reviewing medical bills, and issuing payments to providers. The vendor will also be required to provide reports and data to the state, including an Explanation of Benefits (EOB) form. Some of the key responsibilities of the vendor include: • Ensuring the medical ability to minimize costs while providing timely access to quality health care services for claimants with work-related injuries • Providing timely and accurate processing and continuous review of medical care received by injured claimants to ensure reasonableness and medical necessity • Ensuring that any type of functional abilities prescribed for injured claimants are consistent with the type of injury, the diagnosis, and the treatment plan • Reviewing all medical decisions to ensure that they are appropriate and consistent with the treatment plan • Ensuring that medical providers are reimbursed according to the fee schedule established by administrative rules and within mandated timeframes The contract term is anticipated to be from July 1, 2026, to June 30, 2028, with the option to extend up to an additional 3 years in increments determined by the State.