This section defines the minimum scope, deliverables, and performance expectations. Proposers should structure responses to show how their solution will meet or exceed NHCC’s needs across administration, claims handling, reserving, investigations, litigation support, reporting, and continuous improvement to achieve NHCC’s program goals and applicable regulations. 1. Programs Covered The TPA shall manage NHCC’s full spectrum of claims risk management, including: a. General Liability – administration of all premises, property damage, and non-clinical injury claims. b. Professional Liability – oversight of clinical, medical malpractice, and civil rights litigation, including ensuring timely excess carrier notification and coordination of litigation management. c. Automobile Liability – handling of all vehicle-related claims involving NHCC-owned or operated vehicles. d. Workers’ Compensation – administration of employee injury claims, including medical management, benefit coordination, and return-to-work programs. e. Claims data is included in Appendices A, B & C 2. Program Administration and Governance Describe how the TPA will oversee and manage all aspects of NHCC’s liability programs, ensuring compliance, accountability, and cost control: a. Staffing and account management structure b. Policy and procedure development and review c. Regulatory and legal monitoring d. Analytics, reporting, and trend analysis e. Regular governance and strategy meetings f. Recordkeeping, file retention, and data transfer g. Client education, training, and risk management support 3. Claims Administration Explain how claims will be handled from intake through closure, consistent with best practices and service-level standards: a. Centralized intake, file opening, and adjuster assignment b. Early assessment and liability determination (i.e., within 30 days) c. Communication standards and response timeframes d. Reserve management and periodic review e. Investigation and documentation protocols f. Settlement, negotiation, and legal coordination g. File closure, quality review, and audit support 4. Litigation Management Provide insight regarding how the TPA will oversee and manage litigation management to ensure legal and claims cost effectiveness: a. Maintain close coordination with NHCC’s Legal Department and outside defense counsel. b. Provide case information, assist with discovery, and conduct additional investigations as needed throughout litigation. c. Recommend vetted network of reputable external law firms and specialty service providers with expertise relevant to NHCC’s liability programs, ensuring optimal defense counsel selection based on track record, geographic presence, and cost efficiency. d. Assist with ensuring recommended firms adhere to NHCC’s quality, cost, and timeliness standards. e. Facilitate regular litigation strategy meetings involving NHCC’s Legal Department and outside counsel to review case progress, discuss risk mitigation, and align on resolution approaches. 5. Reporting and Data Management Describe the TPA’s capabilities for providing timely, accurate, and transparent data access, reports, and analytics: a. Monthly claim status and financial reports b. Quarterly and annual trend and performance reports c. Ad-hoc and special analytical reports upon request d. Secure, real-time system access for NHCC staff e. Data migration and export in industry-standard formats f. System integration with NHCC’s internal platforms (risk, ERP, finance) g. Compliance and reporting to excess insurers and reinsurers
