3-2023 SI-40.pdf

This is a Scope of Work document for the City of Cincinnati, Ohio, detailing third-party administration services for the city's self-insured workers' compensation program and nurse case management for its Return to Work Program. The city seeks a qualified administrator to manage claims processing, medical bill review, return-to-work coordination, and case management services. Key responsibilities include handling workers' compensation claims from receipt through closure, performing utilization review and medical management, coordinating with healthcare providers, managing the nurse case management program for injured employees, and providing regular reporting and data analytics. The contract term is for an initial period with renewal options available at the city's discretion. The scope requires the administrator to maintain compliance with Ohio workers' compensation regulations and provide 24/7 claims intake and customer service capabilities.

The pricing structure requires vendors to submit detailed fee schedules including per-claim administration fees, medical bill review fees, utilization review costs, and nurse case management rates. The city anticipates a moderate claims volume based on its employee population and expects the selected vendor to demonstrate experience managing self-insured programs for public sector employers. Vendors must provide evidence of financial stability, appropriate licensing and certifications, and references from comparable municipal clients. The incumbent vendor information and specific contract value are not detailed in this scope document. The selected vendor will be responsible for all administrative costs associated with service delivery and must maintain professional liability and errors and omissions insurance.