The General Services Department is seeking a qualified Third-Party Administrator (TPA) “Contractor” to handle all State of New Mexico Worker’s Compensation claims made by covered State employees. The Contractor must have an effective claims management system that is easy to access with enough information that is readily available when RMD asks for information. The TPA and its claims management system must be capable of interfacing with RMD’s existing ClaimsVISION software for a two-way data exchange. The Contractor shall provide expertise in New Mexico Worker’s Compensation laws in the State of New Mexico to include claim handling, intake, set up, initial and ongoing contact with the claimant, claim investigation and documentation, medical management, claim authority levels, legal management, quality control, data system and reporting. The Contractor shall adhere to the staff and caseload requirements which states that all Indemnity adjusters handling the State of New Mexico cases will maintain an open inventory at of 135 or below; Medical Only adjusters’ caseload at best practices industry standard. The Contractor must have special investigations capabilities and must be willing to unbundle Special Investigations Unit ancillary services and are responsible for all Medicare reporting services requirements regarding State of New Mexico claims. The Contractor is responsible for examining each new claim when reported, and regularly thereafter, for subrogation potential. The Contractor must have the ability to offer daily, weekly, and monthly Automated Clearing House escrow analysis and provide data reporting to the Procuring Agency on a regular basis. The Contractor is responsible for following reserving practices for all claims. The Contractor is subject to audits and claim reviews up to four times per year by a third-party auditor. The initial contract term will be any combination but not to exceed four years total. We anticipate the resulting contract will be effective 07/01/2024.
