Audit_Results.png

This is an audit results image related to San Mateo County's Workers' Compensation Third Party Administration and Managed Care Cost Containment Services RFP. The image displays audit findings and performance metrics relevant to the County's self-insured workers' compensation program, which covers approximately 694 total open claims comprised of 643 indemnity, 36 medical, and 15 first aid/info only claims, with 249 open for Safety employees. The County seeks qualified Third-Party Administrators to manage claims for all new and existing claims supporting approximately 7,250 employees across 29 departments. The County requests that the selected TPA maintain a staffing structure including 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, with flexibility for the chosen TPA to propose alternative staffing arrangements. The County reserves the option to adjust staffing needs after the first 6 months and annually thereafter.

The audit results depicted in the image provide performance baseline data and compliance metrics for evaluating potential TPA proposals. The County's workers' compensation program 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. Additional third-party vendors contracted through the current TPA provide Bill Review, Utilization Review, and Nurse Case Management services, indicating the scope of integrated services expected from the selected TPA.