CITY OF CHANDLER

NOTICE OF REQUEST FOR PROPOSAL HR5-953-4870

SOLICITATION TITLE: THIRD PARTY CLAIMS ADMINISTRATION –

WORKERS COMPENSATION

SOLICITATION NO.: HR5-953-4870

PROPOSAL DUE DATE: January 30, 2025

PROPOSAL DUE TIME: 4:00 pm local Arizona time

SUBMIT TO: Via email to:

Christian.Jonson@chandleraz.gov

Email and attachments may not exceed 50 MB

PRE-PROPOSAL CONFERENCE: January 14, 2025

10:00 am local Arizona time

CONFERENCE ATTENDANCE:

Webex (copy and paste):

https://chandleraz.webex.com/chandleraz/j.php?

MTID=m500a4aaae43934043a96b025bbbdda0e

Meeting number (access code): 26629401235

Meeting password: Mi453cC5YdY

CONTACT: Christian Jonson, CPPB

Procurement Officer

Phone: (480) 782-2405

Email: Christian.jonson@chandleraz.gov

ISSUE DATE: December 19, 2024

Proposals for the commodity or service specified will be received by the Purchasing Division, City of

Chandler, via email to Christian.Jonson@chandleraz.gov, until the time and date cited above. The City does not accept proposals submitted through the Arizona Procurement Portal. Proposals must be submitted via email to the Procurement Officer.

Proposals must be received in the email inbox of the responsible Procurement Officer on or prior to the exact time and date indicated above.

Instructions for preparing proposals are provided on the following pages.

RFP Summary: The City is requesting proposals from qualified offerors to provide the City with claims handling services pursuant to the attached agreement.

INFORMATION AND INSTRUCTIONS TO PROPOSERS

1. Vendor Registration. Proposers must register via the on-line vendor registration system to automatically receive notification of addenda to this solicitation or notice of other solicitation opportunities. Visit https://www.chandleraz.gov/business/vendor-services/purchasing, select Vendor Registration and Management.

2. Addendum. This RFP may only be modified by a written addendum. Proposers are responsible for obtaining all addenda. A Proposer must not rely on verbal responses to inquiries. A verbal reply to an inquiry does not constitute a modification of the solicitation.

3. Late Proposals. Late proposals will not be accepted. It is the sole responsibility of the

Proposer to ensure that its proposal is received at or prior to the exact date and time indicated on the Notice Page. The time stamp of the City’s email system will govern timeliness of submission.

4. Cost of Proposal Preparation. The City will not reimburse any Proposer the cost of responding to a solicitation.

5. Duty to Examine. It is the responsibility of each Proposer to examine the entire solicitation, seek clarification and make inquiries, and examine its proposal for accuracy before submitting it. Lack of care in preparing a proposal will not be grounds for modifying or withdrawing the proposal after the due date and time, nor will it give rise to any claim.

6. Inquiries. Any inquiry related to this solicitation, including any requests for or inquiries regarding standards referenced in the solicitation must be directed solely to the

Procurement Officer listed on the cover page of the solicitation. Proposers will not contact or direct inquiries concerning this solicitation to any other City employee unless the solicitation specifically identifies a person other than the Procurement Officer as a contact.

All inquiries, except those at the Pre-Proposal Conference, should be submitted in writing and refer to the appropriate solicitation number, page and paragraph. The City will consider the relevancy of all inquiries but is not required to respond in writing.

Any inquiry must be submitted as soon as possible and should be submitted at least ten days before the proposal due date and time for review and determination by City. Failure to do so may result in the inquiry not being addressed in a solicitation addendum.

7. Remote Attendance at Pre-Proposal Conference. The City may offer remote attendance at the Pre-Proposal Conference via a City-hosted dial-in meeting. If remote attendance is offered, meeting details will be provided on the Notice Page. Interested Offerors attending remotely may be required to register and provide, at a minimum, attendee name and company name.

Remote attendance is provided as a courtesy. Attendees are responsible for all aspects of their attendance. The City will not provide technical support for remote attendance.

https://www.chandleraz.gov/business/vendor-services/purchasing https://www.chandleraz.gov/business/vendor-services/purchasing

8. Exceptions to the Solicitation. Any exception to the solicitation must be submitted as soon as possible and should be submitted at least ten days before the proposal due date and time for review and determination by City. Failure to do so may result in the exception not being addressed in a solicitation addendum.

9. Proposal Amendment or Withdrawal. A proposal may be withdrawn at any time before the due date and time. A proposal may not be amended or withdrawn after the due date and time except as otherwise provided by applicable law.

10. Unit Price Prevails. In the case of discrepancy between the unit price or rate and the extension of that unit price or rate, the unit price or rate will govern.

11. Non-Collusion and Non-Discrimination. By signing and submitting the proposal, the

Proposer certifies that the Proposer did not engage in collusion or other anti-competitive practices in connection with the preparation or submission of its proposal; and the

Proposer does not discriminate against any employee or applicant for employment or person to whom it provides services because of race, color, religion, age, sex, national origin, or disability, and that it complies with all applicable Federal, state and local laws and executive orders regarding employment.

12. Waiver and Rejection Rights. The City reserves the right to waive any immaterial defect or informality; or reject any or all proposals, or portions thereof; or reissue the Request for

Proposal; and will be the sole judge of the merits of the proposals received.

13. Proposal Opening. Proposals will be opened as indicated on the Notice Page, unless amended in writing by the Procurement Officer issuing the solicitation. The name of each

Proposer will be public information following the proposal opening. No other information will be publicly disclosed at that time.

14. Public Record. All proposals submitted in response to this solicitation and all evaluation related records will become property of City and will become a matter of public record for review, subsequent to publication by the City of the proposed award in the agenda for the

City Council Meeting, or upon award by the appropriate approving authority or as otherwise required by law.

15. Confidential Information. A request for nondisclosure of data such as trade secrets or other proprietary information must be submitted with the proposal and must contain the basis for the request. Any information included in the request must be submitted as a separate file. Price is not confidential and will not be withheld. A blanket statement of confidentiality will not be considered. It is the Proposer’s responsibility to identify and segregate the information in the proposal provided to the City.

The City will review all requests for confidentiality and may approve or deny all or portions of the request. Information denied confidentiality will be released as public information. In the event of a public records request for information granted confidentiality, the City will endeavor provide 48-hours’ notice before releasing materials in order for the Proposer to apply for a court order blocking the release of the information.

16. Proposal Acceptance Period. All proposals will remain valid for 120 days after the day of the opening of proposals. The City may, at its sole discretion, release any proposal and return any security (as applicable) prior to that date. No Proposer may withdraw a proposal during this period without written permission from the City. Should any Proposer refuse to enter into an agreement, under the terms and conditions of the procurement, the

City may retain any security (as applicable) as liquidated damages.

17. Discussions with Proposers and Revisions to Proposals. Discussions and additional investigations may be conducted with responsible Proposers who submit proposals determined to be reasonably susceptible of being selected for award for the purpose of clarification to assure full understanding of, and responsiveness to, the solicitation requirements. Proposers will be accorded fair and equal treatment with respect to any opportunity for discussion and revision of proposals, and such revisions may be permitted after submissions and prior to award for the purpose of obtaining best and final proposals.

In conducting discussions, there will be no disclosure of any information derived from proposals submitted by competing Proposers. The purposes of such discussions will be to:

determine in greater detail such Proposer’s qualifications; explore with the Proposer the scope and nature of the project, the Proposer’s proposed method of performance, and the relative utility of alternate methods of approach; determine that the Proposer will make available the necessary personnel and facilities to perform within the required time;

agreeing upon compensation, which is fair and reasonable, taking into account the estimated value of the required services, and the scope, complexity and nature of such services.

18. Clarifications. City reserves the right to obtain Proposer clarifications where necessary to arrive at full and complete understanding of Proposer’s product, service, and solicitation response. Clarification means a communication with a Proposer for the purpose of eliminating ambiguities in the proposal and does not give Proposer an opportunity to revise or modify its proposal.

19. Agreement Negotiations. City reserves the right to conduct exclusive or concurrent negotiations with responsible Proposer(s) for the purpose of agreeing to the conditions, terms and price of the proposed agreement unless prohibited. Proposers will be accorded fair and equal treatment in conducting negotiations and there will be no disclosure of any information derived from proposals submitted by competing Proposers. Exclusive or concurrent negotiations will not constitute an agreement award nor will it confer any property rights to the successful Proposer. In the event the City deems that negotiations are not progressing, the City may formally terminate these negotiations and may enter into subsequent concurrent or exclusive negotiations with the next most qualified Proposer(s).

20. Payment. Proposers may agree to accept the City Procurement Card (Mastercard) for payment. Proposers should indicate on the Proposer Information and Offer Section of this

RFP, their willingness to accept City Procurement Card payments. The inability to accept payment by City Procurement Card will not disqualify a Proposer’s response.

Proposers may also agree to accept other traditional payment methods, including automated clearinghouse (ACH). Payment terms for traditional payment methods are Net

30 upon receipt of an accurate invoice. Proposers may propose additional discounts for early payment within their proposal.

21. Local Business Consideration. Where the Chandler Administrative Regulation MS-16

Local Business Consideration is applicable, any applicable Chandler Transaction Privilege

Tax will be deducted from the net cost for the purpose of evaluation.

22. Protests. A protest must be in writing and be filed with the Purchasing Division. Filed means delivery to the Procurement Officer or Procurement and Supply Senior Manager, whichever is applicable. A time and date of receipt will be documented in a verifiable manner for purposes of filing.

A protest must include:

a. The name, address, telephone number and email address of the protester;

b. The signature of the protester or its representative;

c. Identification of the solicitation or contract number;

d. A detailed statement of the legal and factual grounds of the protest including copies of relevant documents; and

e. The form of relief requested.

A protest based upon alleged improprieties in a solicitation that are apparent before the solicitation due date must be filed not less than five calendar days before the solicitation due date.

A protest of a proposed award requiring City Council approval must be filed within five calendar days of the first posting of the award recommendation on the Purchasing Division website or the City Clerk’s website, whichever occurs first. If the deadline for filing a protest occurs on a weekend or holiday, the protest must be filed the next business day.

A protest of an award not requiring City Council approval must be filed within ten days after the protester knows or should have known the basis of the protest.

23. Award. Unless otherwise provided in this solicitation, the City reserves the right to make multiple awards, award by item, group or as a total, as is deemed most advantageous to the City.

24. Execution of Agreement. Within ten days of notice that Proposer is the recommended awardee, Proposer will execute and return the Agreement to Purchasing.

25. Persons with Disabilities. Persons with a disability may request a reasonable accommodation, such as a sign language interpreter, by contacting the Procurement

Officer. Requests must be made as early as possible to allow time to arrange the accommodation.

PROPOSAL CONTENT

Proposers must submit one copy of the proposal via email to the responsible Procurement

Officer. The REQUEST FOR PROPOSAL TITLE, NUMBER AND OFFEROR NAME should be in the subject line of the email. Emails and attachments may not exceed 50 MB in size. Attachments should be in .pdf format and named with the RFP number and Offeror name. A single email is preferred, however multiple emails are permissible provided that all are received prior to the due date and time.

Proposals should include the following information in the order listed:

1. Completed Proposer Information and Offer Section. Complete and submit the Proposer

Information and Offer Section in the format provided in this solicitation. Failure to do so may result in the proposal being rejected as non-responsive. The Proposer Information and

Offer Section within the solicitation must include a signature by a person authorized to sign the proposal. The signature must signify the Proposer’s intent to be bound by its Proposal and the terms of the solicitation and that the information provided is true, accurate and complete.

2. Responses to Proposal Evaluation Criteria. Submit information requested in the

Evaluation Criteria Section provided in this solicitation. Forms, such as pricing forms, must be completed in the format provided in the solicitation. Failure to do so may result in the proposal being rejected as non-responsive.

3. Exceptions to Agreement. The City’s standard Agreement is included as a part of this solicitation. By submitting a proposal, the Proposer acknowledges having reviewed the

Agreement. Any exceptions to the Scope of Work or Specifications or to Agreement terms and conditions must be included with the proposal and be clearly identified. Exceptions not included in the proposal may not be introduced in the future. Any exceptions to the

Scope of Work, Specifications or the Agreement language will be considered and included in City’s evaluation of the proposal. A proposal that takes exception to a material requirement of any part of the Scope of Work, Specifications or Agreement language may be rejected as non-responsive.

4. Disclosure. If the Proposer has been debarred, suspended or otherwise lawfully precluded from participating in any public procurement activity, including being disapproved as a subcontractor with any Federal, state or local government, or if any such preclusion is currently pending, the Proposer must make disclosure. In the proposal, the

Proposer must include information including the name and address of the governmental entity, the effective date and duration of this suspension or debarment, and the relevant circumstances. The City reserves the right to reject a proposal received from a Proposer, including each of its principals, who is currently debarred, suspended or otherwise lawfully prohibited from any public procurement activity.

PROPOSER INFORMATION AND OFFER SECTION

Company Name

Business Type (Corporation, Partnership, etc.)

State of Incorporation (if applicable)

Federal Tax I.D. No.

Address

City, State, Zip

Authorized Signature

Name and Title

Contact Name

Title

Telephone

E-mail

Chandler Transaction Privilege Tax (TPT)

No. (if applicable) Date of issue:

Is proposed purchase subject to TPT? _______yes _______no

Will you accept a City Procurement Card

(MasterCard) for payment of invoices? _______yes _______no

If you accept a MasterCard for payment, do you charge a fee?

_______yes _______no If yes, what is the fee?______

Will you accept automated clearinghouse

(ACH) for payment of invoices? _______yes _______no

Prompt Payment Terms Offered _______% Net _________ days

Disclosure of Debarment or Suspension

_______yes _______no

(If yes, please attach description of the circumstances)

Exceptions Taken

_______yes _______no

(If yes, please attach a clearly identified section)

Date Addendum #1

Acknowledged/Received

Date Addendum #2

Acknowledged/Received

Date Addendum #3

Acknowledged/Received

SCOPE OF WORK

BACKGROUND

The City of Chandler was established in 1912, incorporated on February 17, 1920. The Charter, which currently governs the City of Chandler, was adopted on May 25, 1964. The city has a

Council-Manager form of government. Traditional public services include police and fire protection services, municipal court, water, sewer and wastewater services, streets, maintenance facility for City equipment and vehicles, recreation programs, swimming pools, and numerous public parks.

A. Payroll - The City has approximately 2394 employees on payroll, with approximately 610 employees in part-time or seasonal positions. A chart showing classifications for all employees is attached as Exhibit F. Total payroll (including all related expenses) in fiscal year 2023/2024 was approximately $134,110,485.19. The city provides coverage for its volunteers, and Council members under its Workers’ Compensation program.

B. Claims experience – Historically, the city averages 150 claims per year, 126 of which are medical only. The most recent six-year claims history is shown on Exhibit G.

C. City Involvement – The City actively participates in the administration of its Workers’

Compensation program. Injured workers are encouraged to return to work as soon as possible. Injured employees are referred to the City’s designated preferred occupational health facilities for initial treatment. The city has a structured, compulsory return to work program with more than 100 temporary modified duty assignments available.

D. The City’s Human Resources Division is responsible for management of the City’s Workers’

Compensation program, including contract administration of the 3rd Party Administrator contract. Human Resources coordinates all aspects of the program. This includes reporting of injuries; employee contact; providing lost time and salary information;

training; return to work program; service evaluations and maintenance of employee exposure; injury and illness Workers’ Compensation claims files. The Human Resources

Division utilizes Origami software applications and Business Objects applications of the current TPA to manage claim and loss data.

E. Definitions:

Medical only claim – a claim where only medical expenses are paid.

SCOPE OF SERVICES

The City of Chandler is seeking proposals from qualified organizations to provide 3rd Party

Workers’ Compensation claims services for the City’s Self-Insured Workers’ Compensation program authorized by the Industrial Commission of Arizona. All fees charged for services pertinent to the workload suggested by the proposal must be identified and listed within your submittal. The city will not pay any hidden costs or add on fees for services not described within a proposal. The successful Contractor shall assume the responsibility for all new Workers’

Compensation claims and all outstanding Workers’ Compensation claims, except for claims managed by State Compensation Fund, effective July 1, 2019. The city will maintain a self-insured retention.

CLAIMS HANDLING SERVICES

Contractor shall provide claims handling services. Contractor shall provide a 24-hour toll-free phone and fax number for use by City, claimants, medical provider, telemedicine, and shall accept delivery of Industrial Commission of Arizona (ICA) Form 101’s via internet email.

CONTRACTOR shall provide, at a minimum, the following 3rd Party Claims administration services:

1. CLAIMS HANDLING SERVICE AND MEDICAL CONTROL SERVICES:

1.1 Review and process all industrial injury or illness claims in accordance with the requirements of the Industrial Commission of Arizona, and related applicable statues, rules, and guidelines. Must comply with Section 111.

1.2 Follow-up on each claim shall be made every 2 weeks via email or other electronic means.

In addition, viewing of all attachments shall be made available electronically.

1.3 Determine compensation for injuries and illnesses in accordance with Arizona Workers’

Compensation laws and ICA rules, guidelines, and formulas.

1.4 Authorize independent medical examination, as necessary, to determine the nature and extent of temporary and/or permanent partial or total disability, if claimant is permanent and stationary, and/or if further treatment is needed.

1.5 Determine eligibility for and authorize payment of medical treatment in accordance with

Arizona Workers’ Compensation rules, make payments in a timely manner, and utilize available cost containment measures.

1.6 Administer permanent disability compensation and/or death benefits in accordance with

State of Arizona Workers’ Compensation laws, awards, or settlement agreements.

1.7 Maintain files and computerized records of all reported claims, cross-referenced by the name of the claimant, date of loss, claim number and current reserves, estimated recoveries and total incurred.

1.8 Retain files administered under this agreement until notified of disposition by City. All files shall be the property of City.

1.9 Have knowledge of Phoenix area medical providers of Workers’ Compensation treatment and their specialties and providers for diagnostic, pharmaceutical, and ancillary medical services.

1.10 Have knowledge of Phoenix area medical providers and their specialties for referral and/or independent medical examinations.

1.11 Notify City immediately when any claimant is represented by legal counsel, and work with any legal counsel retained by City to defend contested cases or other ICA-related matters, including making any information available and providing legal counsel with appropriate assistance.

1.12 Treat all files and claims information as strictly confidential, and not discuss the nature of any claim or the amount paid or reserved under it, with any person who is not a party to the contract, except when and to the extent City authorizes, or when ordered to do so by a court of competent jurisdiction.

1.13 Alert City to statute changes, court decisions and ICA procedures, which impact the

Workers’ Compensation program.

1.14 Monitor treatment programs every two weeks or sooner for injured or ill employees, including review of all medical reports.

1.15 Recommend and schedule independent medical examinations no later than 5 days after receiving the physician’s report that an IME is needed.

1.16 Maintain a close working relationship with treating physicians and City contact clinics.

1.17 Work with City to optimize return to work and light duty programs.

1.18 Monitor and adjust medical bills in compliance with Arizona Workers’ Compensation medical fee schedule, through use of bill review or PPO agreements, and/or usual, reasonable and customary fee schedules. Date of Services and Vendor’s name should be included in the bill processing and notations in order for the City to make sure the billing is correct and there are no double payments.

A penalty for double payment is subject to 33 % of the billing error.

1.19 Promptly notify and seek approval from City on questionable claims, which may benefit from claimant activity checks or investigation with approval from the City. Arrange for activity or investigational services and promptly report back findings, on questionable cases. as necessary and appropriate.

1.20 Recommend vocational assessment of injured employees, when necessary and appropriate, with approval of City.

1.21 Obtain prior claim and medical history, and when applicable submit the claim to the

Second Injury Fund at ICA for apportionment of compensation.

1.22 Subrogate against third parties when they are liable for any injuries to employees.

Contractor shall notify employee or the employee’s attorney, of the existence of a

Workers’ Compensation lien, and provide information to the responsible party, the City, or to the court of the lien amount. All lien or recovery checks shall be made payable to City and sent to City’s Human Resources Division. Any waiver or reduction of any lien or other settlement shall receive prior approval from City’s designated representative.

1.23 Provide 1099 forms for each respective medical provider as required by IRS.

1.24 Assist City with the determination of appropriate Workers’ Compensation rate settings, reserve limits, actuarial projects, and reporting to excess and/or reinsurance carriers as required.

1.25 Provide narrative written initial status, and settlement evaluation reports on all claims/cases with an indemnity reserve of $25,000 or greater.

1.26 The claims adjustor selected to handle claims for the City of Chandler shall carry a total case load of no more than 125 active claims at any one time, in order for there to be no compromise of care to City employees.

1.27 The claims adjustor will obtain all medical records (ex. MRI’s, CAT scan, physical therapy and medical notes) and any other pertinent information on each claim that has had a pre-existing issue on the same body part before accepting the claim.

1.28 This RFP only references the contract is for claims management only. If there are ancillary services available, the Offeror should provide a list and price for those services, but the City does not guarantee those services will be awarded as part of this contract. Background qualifications on the ancillary services must be provided.

1.29 The IME companies being used will be a decision between the City’s Human Resources

Division and the Third Party Claims Administrator.

2. REPORTING REQUIREMENTS: Contractor shall:

2.1 Make available electronically, check registers that can be sorted by check number, claim number, payee, payment type, and date of service.

2.2 Make available for review at facility by claimant bills, bill review documents and payment history.

2.3 Make available electronically reports that show paid medical, reserves for medical and indemnity claims, allocated expenses, and total incurred by claim. The report shall summarize information by department, division, and City as a whole. The loss runs at a minimum, shall contain claims data by year, with field of information detailing date of loss, claimant’s name, description of accident, medical paid, medical reserved, indemnity paid, indemnity reserved, expenses paid, expense reserves, and total incurred loss. Reports shall include status on all claims.

2.4 Provide City with copies of all Notice(s) of Claim Status issued to claimant at the time of issuance.

2.5 Provide quarterly written status reports and meet quarterly with City on all claims originated during the previous quarter as well as all open claims.

2.6 Share all relevant internal and external Workers’ Compensation audit reports with City generated during the term of the contract.

2.7 Provide any data and/or reports required by the ICA, such as the preparation and submission of annual Self-Insurers Statement.

2.8 Pull all subrogations and provide a quarterly report on recoveries.

2.9 Prepare loss run and other reports to supplement City’s excess Workers’ Compensation insurance application or renewal.

2.10 Claim administrator shall be required to meet with City to review outstanding claim status at least Four (4) times per contract year.

3. DELINEATION OF RESPONSIBILITIES:

3.1 Responsibilities of Contractor:

3.1.1 Contractor shall be responsible to undertake the services identified under Section 2 above and as delineated in Contractor’s response to the Questionnaire (Exhibit E) as negotiated and directed by City.

3.1.2 All invoices shall be submitted in duplicate and no more often than on a monthly basis. Mail all invoices to CITY OF CHANDLER; Human Resources, PO Box 4008 –

Mail Stop 703, Chandler, Arizona, 85244-4008.

3.2 Responsibilities of City:

3.2.1 City will make available to Contractor all documents, which will be useful in completing the project work. However, it shall remain Contractor’s responsibility to request and verify all data and information provided by City.

3.2.2 City will pay invoices submitted in conformance with the contract within thirty (30) calendar days after submittal, but no more than once per month.

PHARMACY

(City shall award all parts of contract to one vendor or award separate contracts for claims handling, pharmacy and bill review)

Contractor shall provide Pharmacy Services. Contractor shall provide a 24-hour toll-free phone and a fax number for use by the TPA, City, claimants, and medical providers.

1. Review and process all prescriptions on all industrial or illness claims and meet the requirements of the ICA on fee schedule. The prescription will be approved in 1-2 hours of the employee delivering the script to the pharmacy.

2. Each claimant will be delivered a card that will approve continuation as medications get refilled.

3. Medications will be approved by the TPA and a number will be made available to the pharmacies so there will be no delays in treatment.

4. The TPA will advise the Contractor when a claim is closed.

5. Treat all files and information as strictly confidential and not discuss the nature of any/all medication(s), or amount paid.

6. Retain file administered under this agreement until notified of disposition of the TPA/ or as the law dictates.

7. Alert the TPA or the City of Chandler’s Medical Leave Coordinator(s) of any discrepancies that might be noticed.

8. Have knowledge of Phoenix providers, diagnosis and medications that are applicable to the injury/illness.

9. Alert City of any State or CDC guideline changes that effect medication dispensing

10. Alert City and claimants in writing of any drug recalls that may have affected a claimant.

BILL REVIEW

(City shall award all parts of contract to one vendor or award separate contracts for claims handling, pharmacy and bill review)

Contractor shall provide Bill Review Services. Contractor shall provide a toll-free phone and a fax number for use by the TPA, City.

1. Determine eligibility for an authorize payment of medical bills within 1-3 days after receiving the official bill.

2. Review and process all bills on industrial or illness claims and meet the requirements of the ICA on fee schedule.

3. Have knowledge of the fee schedule and any changes made and to make the City aware of any changes.

4. Document each bill approved, each service provider, and the date of the service provided.

5. The contractor will send a monthly report to the Human Resources Division for all approved bill payments.

6. Retain files administered under this agreement until notified of disposition of the TPA/ or as law dictates.

7. Treat all files and information as strictly confidential and not discuss the nature of any/all bill (s), or amount paid.

8. Any questionable bills submitted shall be inspected and either the TPA or the Medical

Leave Coordinator(s) will approve or give the Contractor the approval.

EVALUATION CRITERIA

Evaluation Criteria: The evaluation criteria are listed below in their relative order of importance. The offer should contain responses to all of the specific information requested below. The Offeror’s submittal should be organized by section based on the listed criteria.

Qualifications and Experience 45 points max

1. Provide a brief history of the company including number of years in business, primary business focus and number of years providing the services described in the Scope of Work. Please explain experience with Arizona Workers’ Compensation Claims and public sector employers/clients.

2. Provide the qualifications of the company and its leadership relative to the services described in the Scope of Work. Provide resumes or statements of qualifications for company leadership.

3. Fully complete the attached Exhibit E: Questionnaire with as much detail as possible.

Method of Approach 30 points max

1. Provide a narrative that describes the approach to the Scope of Work. Include: Timeline, milestones, deliverables, and personnel responsible for milestones and deliverables, number of hours each team member will expend on the project.

2. Describe quality and procedures for compensation claims management as defined in the Scope of Work as it relates to Arizona Workers’ Compensation claim rules, guidelines and practices.

3. Please describe the proposed implementation and transition process should contractor be awarded contract.

Price Proposal 20 points max

Complete and submit Exhibit B, Price Proposal Page.

Performance Guarantees 5 points max

Complete the Performance Guarantee Chart

EXHIBIT B

PRICE PROPOSAL PAGE

Offerors shall complete and submit the Price Proposal in the format requested below.

Assume an average of 126 medical and 40 indemnity claims per year. See Exhibit G for claims history.

CLAIMS HANDLING

DESCRIPTION YEAR 1 YEAR 2 YEAR 3

Cost for handling claims:

A. Open at inception of contract and/or B. Reported during each contract year:

Medical only, per claim Indemnity, per claim Report only, per claim

C. Annual fee for claims that continue to be open or are reopened:

Medical only, per claim Indemnity only, per claim

Charge per claim if more than 126 medical and / or 40 indemnity claims reported in one-year period

If claim fees are not all inclusive, list other applicable fees:

Estimated total annual fees:

Preferred method of payment:

□ Monthly

□ Quarterly

□ Annually

PHARMACY

List standard fees a.

b.

c.

Fees for optional Services b.

c.

BILL REVIEW

List standard fees b.

c.

Fees for optional Services b.

c.

Exhibit B - End

PERFORMANCE GUARANTEES

Include performance guarantees you are willing to offer and the maximum you are willing to put at risk.

The City is interested in guarantees around implementation, customer service call wait times, response to the City of Chandler, timely and accurate claims handling.

PERFORMANCE GUARANTEES: IMPLEMENTATION

Category How Measured Financial

Penalty

PERFORMANCE GUARANTEES: POST-IMPLEMENTATION

Category How Measured Financial

Penalty

EXHIBIT E

QUESTIONNAIRE

Contractor’s Qualifications. Claims Management Services.

1. Using a five (5) year history, provide Contractor background, including ownership, number of employees, staff size and turnover rate.

2. Identify any other business services provided by Contractor other than 3rd Party Workers’

Compensation claims administration.

3. Provide resumes of those persons in charge of this account, including their experience and job history, and identify average active caseload for time loss/ medical only claim adjuster.

4. List location, including any toll-free phone and/or fax numbers, of Contractor offices where claims will be administered, and number of employees at each location involved in claims administration. Provide disaster recovery plan for claim history retention.

5. List three (3) current self-insured Workers’ Compensation clients for which Contractor provided third party administration services that are considered similar to the scope of work described herein for self-insured Workers’ Compensation, specifically for governmental entities, if possible. For each client listed, state the type of service provided, years of service for the client, and name, title, telephone number and email address of the person to contact as a reference, regarding Contractor’s performance.

6. List three (3) self-insured Workers’ Compensation client references, governmental entities, if possible, that no longer use Contractor’s services. For each client listed, state the type of service provided, years of service for the client, and name, title, telephone number and email address of the person to contact regarding Contractor’s performance.

7. Provide a copy of Contractor’s claims handling protocol and/or a copy of the claims procedure manual reflecting Contractor’s processes for claims handling.

8. Describe internal and external audit procedures and provide the most recent report.

9. Provide Contractor’s method of establishing and monitoring reserves, if not outlined in response to Question 7 above.

10. Detail how Contractor will control medical expenses, get employees back to work, use subrogation techniques, and claim closure procedures to City’s benefit, while maintaining quality of care.

11. Explain the extent to which Contractor, and/or legal assistance, is available for claims requiring employer representation at hearings and how litigation or subrogation claims are handled. City retains the right to select and/or approve of legal counsel and to control litigations and/or settlements.

12. List handling fee charges for subrogation against a third party or recovery from the second injury fund, or retention of any portion of the recovery from a third party or the second injury fund.

13. Explain Contractor’s policy and/or procedure on assignment to vocation rehabilitation.

14. Explain Contractor’s policy and/or procedure on assignment for sub rosa activity.

15. Explain Contractor’s policy and/or procedure on retaining outside case management assistance. City retains the right to select and/or approve case management services.

16. Describe security to ensure client data confidentiality and privacy.

17. Describe how City can assess Contractor’s on-line claim management and reporting system and any fee for this service.

18. Provide sample printouts showing what information and analysis is available through

Contractor’s system.

19. Provide a sample monthly or quarterly report and an annual report that allows City to complete its self-insured, reports, tax forms, that meet requirements of the ICA.

20. List any limitations on Contractor’s ability to provide City requested custom reports and provide City a listing of any fees associated with custom reporting.

Medical Cost Management/Bill Review

21. Describe the medical cost containment / management program, including any Preferred

Provider Organization (PPO) type networks.

22. Describe procedures and available cost containment options to ensure that all medical bills are reviewed and paid per schedule or best available pricing.

23. Indicate if these services are provided in-house or by third party Contractor(s).

24. Indicate any fees associated with any bill review or reduction services.

25. Describe the process to ensure that claims are not double paid.

26. Describe the procedure for handling provider challenges of re-pricing.

27. If there are fees for medical cost management / bill review, describe how the fees are applied to individual claim.

28. Currently, all bills are reviewed. If no savings, there is no charge. Provide the fee charged for bills reviewed with savings, charged to the individual claim.

Provide average time for payment of medical bills from date Contractor receives the bill with supporting documents to check being issued. The City pays a flat rate for the actual bill review service, and a percentage only for PPO/audit, which is a percentage of the amount of savings that vendor is able to get through PPO discounts and negotiation with the providers.

29. Most indemnity checks are to be sent to City, c/o Human Resources Division, payable to the claimant and City. Will this present any problems for Contractor? (Injured workers wages and benefits are kept whole by City for most employees).

Start-Up Activities

30. Provide a detailed action plan, with timelines, to implement the new claims handling and for transition of records and initiation of claims management for existing claims.

Legal Issues

31. Has Contractor ever been sued or had other legal action initiated by claimants or providers for cost management services or decisions? If yes, describe the nature of each suit, the outcome, and the settlement amount. A response is also required for each third-party

Contractor that Contractor contracts with for services.

32. Has Contractor ever been the subject of any complaint filed with the Industrial Commission of Arizona (ICA) or any other Workers’ Compensation board or regulatory agency in any state for Contractor’s cost management services or decisions? If yes, describe the nature of each complaint, location, and outcome. Provide same information for each third-party

Contractor.

Banking

33. Advise and explain the current system for check issuance, including who will have check signing authority for the City’s account, and whether these employees are bonded, security procedures to ensure the safeguard of funds, and process by which checks are requested, processed and mailed.

34. City uses a positive pay system to monitor all transactions daily. This requires Contractor’s system to nightly upload electronically to City’s bank, the checks that were issued that day.

Is Contractor’s system capable of electronic data transmission to City’s financial institution?

Are there any fees associated with this process?

35. Discuss Contractor’s process for handling stop pays, voided checks, and reimbursements.

36. Explain security procedures to ensure the safeguard of funds, and process by which checks are requested, processed, and mailed.

37. Who will have check signing authority for City’s account? Are these employees bonded?

Miscellaneous

38. City anticipates a long-term relationship with Contractor’s. However, in the event of a termination of the relationship, detail how records and electronic files would be provided to the new TPA and the timeline for transition.

39. Are ISO fees included in the claim handling fee? If no, explain the ISO fee.

40. The City would prefer to have one dedicated claims adjuster who will handle both indemnity and medical only claims. Please clearly identify that your company can perform this, or if this is not possible, please describe how communication and transition of claims will work with two adjusters.

EXHIBIT F

CITY OF CHANDLER POSITION – CLASSIFICATIONS

FY 24/25

TOTAL # OF EE

WORK CODE TOTAL WORK CODE DESCRIPTION

5506 59 STREETS

7403 6 AIRPORT

7520 110 WATER

7580 36 WASTEWATER

7710 243 FIREFIGHTERS

7720 385 POLICE OFFICERS

8380 15 MECHANICAL MAINTENANCE-VEHICLES

8810 74 ADMINISTRATIVE/CLERICAL

8820 46 LAW

9015 337 BUILDINGS,GROUNDS,WAREHOUSE/MAINT

9063 234 RECREATION CENTERS

9102 65 PARKS MAINTENANCE

9403 15 SANITATION

9410 69 BUILDING INSPECTORS

TOTAL: 2394

EXHIBIT G

WORKERS’ COMPENSATION CLAIM EXPERIENCE

City Clerk Document No.

City Council Meeting Date:

CITY OF CHANDLER SERVICES AGREEMENT

THIRD PARTY CLAIMS ADMINISTRATION – WORKERS COMPENSATION

CITY OF CHANDLER AGREEMENT NO. HR5-953-4870

THIS AGREEMENT (Agreement) is made and entered into by and between the City of Chandler, an

Arizona municipal corporation (City), and [INSERT NAME OF SERVICE PROVIDER], [INSERT

JURISDICTION AND BUSINESS ORGANIZATION] (Contractor), (City and Contractor may individually be referred to as Party and collectively referred to as Parties) and made

, 2025 (Effective Date).

RECITALS

A. City proposes to enter into a contract for services as more fully described in Exhibit A, which is attached to and made a part of this Agreement by this reference.

B. Contractor is ready, willing, and able to provide the services described in Exhibit A for the compensation and fees set forth and as described in Exhibit B, which is attached to and made a part of this Agreement by this reference.

C. City desires to contract with the Contractor to provide these services under the terms and conditions set forth in this Agreement.

AGREEMENT

NOW, THEREFORE, in consideration of the premises and the mutual promises contained in this

Agreement, City and Contractor agree as follows:

SECTION I: DEFINITIONS

For purposes of this Agreement, the following definitions apply:

Agreement means the legal agreement executed between the City and the Contractor

City means the City of Chandler, Arizona

Contractor means the individual, partnership, or corporation named in the Agreement

Days means calendar days

May, Should means something that is not mandatory but permissible

Shall, Will, Must means a mandatory requirement

SECTION II: CONTRACTOR’S SERVICES

Contractor must perform the services described in Exhibit A to the City’s satisfaction within the terms and conditions of this Agreement and within the care and skill that a person who provides similar services in Chandler, Arizona exercises under similar conditions. All work or services furnished by Contractor under this Agreement must be performed in a skilled and workmanlike manner. Unless authorized by the City in writing, all fixtures, furnishings, and equipment furnished by Contractor as part of the work or services under this Agreement must be new, or the latest model, and of the most suitable grade and quality for the intended purpose of the work or service.

SECTION III: PERIOD OF SERVICE

Contractor must perform the services described in Exhibit A for the term of this Agreement.

The term of the Agreement is 1 year (s), and begins on July 1, 2025 and ends on June 30, 2026 unless sooner terminated in accordance with the provisions of this Agreement. The City and the

Contractor may mutually agree to extend the Agreement for up to 4 additional terms of 1 year (s) each, or portions thereof. The City reserves the right, at its sole discretion, to extend the

Agreement for up to 60 days beyond the expiration of any extension term.

SECTION lV: PAYMENT OF COMPENSATION AND FEES

4.1 Unless amended in writing by the Parties, Contractor's compensation and fees as more fully described in Exhibit B for performance of the services approved and accepted by the City under this Agreement must not exceed [_________________]. Contractor must submit requests for payment for services approved and accepted during the previous billing period and must include, as applicable, detailed invoices and receipts, a narrative description of the tasks accomplished during the billing period, a list of any deliverables submitted, and any subcontractor’s or supplier’s actual requests for payment plus similar narrative and listing of their work. Payment for those services negotiated as a lump sum will be made in accordance with the percentage of the work completed during the preceding billing period. Services negotiated as a not-to-exceed fee will be paid in accordance with the work completed on the service during the preceding month. All requests for payment must be submitted to the City for review and approval. The City will make payment for approved and accepted services within 30 days of the City’s receipt of the request for payment.

4.2 Applicable Taxes. The Contractor will pay all applicable taxes. The City is subject to all applicable state and local transaction privilege taxes. To the extent any state and local transaction privilege taxes apply to sales made under the terms of this Agreement, it is the responsibility of the Contractor to collect and remit all applicable taxes to the proper taxing jurisdiction of authority.

4.3 Tax Indemnification. The Contractor and all subcontractors will pay all Federal, state, and local taxes applicable to its operation and any persons employed by the Contractor. The Contractor will and require all subcontractors to hold the City harmless from any responsibility for taxes, damages, and interest, if applicable, contributions required under Federal, state, and local laws and regulations and any other costs including transaction privilege taxes, unemployment compensation insurance, Social Security, and Worker’s Compensation.

4.4 All prices offered herein shall be firm against any increase for the initial term of the

Agreement. Prior to commencement of subsequent renewal terms, the City may approve a fully documented request for a price adjustment. The City shall determine whether any requested price increases for extension terms is acceptable to the City. If the City approves the price increase, the price shall remain firm for the renewal term for which it was requested. If a price increase is agreed upon by the Parties a written Agreement Amendment shall be approved and executed by the Parties.

SECTION V: GENERAL CONDITIONS

5.1 Records/Audit. Records of the Contractor's direct personnel payroll, reimbursable expenses pertaining to this Agreement and records of accounts between the City and Contractor must be kept on the basis of generally accepted accounting principles and must be made available to the

City and its auditors for up to three years following the City’s final acceptance of the services under this Agreement. The City, its authorized representative, or any federal agency, reserves the right to audit Contractor's records to verify the accuracy and appropriateness of all cost and pricing data, including data used to negotiate this Agreement and any amendments. The City reserves the right to decrease the total amount of Agreement price or payments made under this

Agreement or request reimbursement from the Contractor following final contract payment on this Agreement if, upon audit of the Contractor's records, the audit discloses the Contractor has provided false, misleading, or inaccurate cost and pricing data. The Contractor will include a similar provision in all of its contracts with subcontractors providing services under the Agreement

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