SCOPE OF SERVICES The MPRB is using the RFP as an open-ended process to allow each respondent to specifically address how they envision administering the MPRB’s self-insured workers’ compensation program and working 16 collaboratively in delivering TPA services. Vendors should be based in the United States with all tasks performed in the United States. The MPRB requires that a TPA agrees to furnish services including, but not limited to, the following: 1. Claim administration a. Claim investigation b. Communication with claimant, medical provider and MPRB c. Medical/Disability Management Services d. File documentation protocols e. Development and implementation of claim action plans f. Denial of liability or payment of claims g. Settlement negotiation with proper authority granted h. Medical cost containment measures i. Indemnity cost containment measures j. Litigation cost containment measures k. Procedures for determining appropriate use and selection of outside service vendors l. Subrogation and recovery protocols m. Internal quality control protocols n. Integration or customization of client service directives within service procedures o. Medical billing review services p. Quarterly claim reviews 2. Regulatory Reporting Services a. Minnesota Department of Commerce reports b. Minnesota Department of Labor and Industry reports c. Workers Compensation Reinsurance Association (WCRA) d. Minnesota Workers Compensation Reinsurance Association (MWCIA) e. Centers for Medicaid and Medicare Services (CMS) f. Any other regulatory reporting as required 3. Financial Accounting for Claim Funds a. Types of claim account required b. Funding requirements and notifications based on thresholds c. Reconciliation repo
