20220614_a_Agreement_with_Athens_Administrators_reso_078936_Contract_ID_00600-23-R078936.pdf

This document is a resolution (No. 078936) executed on June 14, 2022, by the County of San Mateo, California, related to an agreement with Athens Administrators for workers' compensation third-party administration and managed care cost containment services. The County, which covers 744 square miles on the San Francisco Peninsula with approximately 800,000 residents and operates with 7,250 employees across 29 departments, sought qualified third-party administrators to manage its self-insured workers' compensation program for all new and existing claims. At the time of the RFP, the County maintained approximately 694 total open claims comprised of 643 indemnity claims, 36 medical claims, and 15 first aid/info-only claims, with 249 claims involving Safety employees. The County specified that the selected TPA's staffing structure should include 2 fully dedicated claims supervisors, 4 fully dedicated senior claims examiners, 1 fully dedicated future medical claims examiner, and 2 fully dedicated assistant claims examiners, though the chosen vendor was permitted flexibility in proposing alternative staffing arrangements, with provisions for staffing adjustments after the initial 6-month period and annually thereafter.

The County utilizes the Origami Risk Management Information System, managed by a third-party vendor, with claims data imported and exported through the TPA's workers' compensation information system. The County also engages third-party vendors contracted through the TPA for bill review, utilization review, and nurse case management services. This resolution formalized the agreement with Athens Administrators as the selected vendor to fulfill these comprehensive workers' compensation administration and cost containment requirements for the County's self-insured program.