DEPARTMENT: Finance
DEPARTMENT HEAD: Troy Elliott, CPA
COUNCIL DISTRICTS IMPACTED: City Wide
SUBJECT:
Engagement of Third-Party Administrator (TPA) for Workers' Compensation Program
SUMMARY:
This ordinance authorizes the City Manager or her designee to enter into a contract with AS&G Claims Administration, Inc. to provide third-party administration services for workers' compensation claims for the City of San Antonio. The term of this contract is three years, beginning January 1, 2017 and ending December 31, 2019, with an option to extend the contract for up to two one-year extensions, subject to and contingent upon funding by City Council. The estimated cost for the first year is $1,032,000.00. If all options are exercised, the estimated total cost of the contract is $5,586,000. This sum represents professional fees paid directly to the Third Party Administrator. The contract also provides for costs of services paid to subcontractors, such as bill audit review and investigation services, that are charged directly to the claim file and vary on a claim by claim basis.
BACKGROUND INFORMATION:
The City receives an average of 1,400 workers' compensation claims annually. The City retains the services of a Third-Party Administrator (TPA) to oversee and process these claims. The TPA is responsible for claims management, which involves the investigation, adjusting and payment of claims; medical cost containment, which involves bill review, utilization review and peer review of claims; pharmacy benefit management, which involves audit and payment of pharmacy bills in accordance with Texas Department of Insurance fee guidelines and negotiation of special pharmacy discounts; and Risk Management Information System (RIMS) Services, which provides a claims platform for the City's internal liability claims handling.
The Finance Department, Purchasing Division released a Request for Proposals (RFP) for Workers' Compensation Third-Party Administrator Services ...
Click here for full text