S23DWC021 Utilization Review

The California Department of Industrial Relations (DIR) is soliciting proposals from qualified contractors to provide utilization review services for the Uninsured Employers Benefits Trust Fund (UEBTF) and the Subsequent Injuries Benefits Trust Fund (SIBTF) within the DIR, Division of Workers Compensation Board (DWC). The selected contractor will be responsible for reviewing Requests for Authorization (RFAs) submitted to the UEBTF by physicians to determine whether the requested treatment is medically necessary based on established medical treatment guidelines. The 36-month contract has a total budget of $576,000.00, and the contractor must maintain a 99% timeliness rate in the completion of utilization reviews. The contractor must have a web-based utilization review tracking system (URTS) to manage the receipt, completion, and status of RFAs, as well as the issuance of notices. Proposals exceeding the $576,000.00 budget may be deemed non-responsive, and any violations of utilization review laws that lead to untimely responses may trigger an audit and assessment of penalties.

The RFP does not specify any set-aside designations or restrictions on the types of organizations that can respond. The incumbent vendor or current contractor is not mentioned, and there is no information provided about any existing infrastructure or technology that requires integration. The total contract value of $576,000.00 is the only budget range indicated.