TPA will administer workers' compensation claims of insolvent SIEs and SIAs, including, but not limited to claim management and administration; case management; bill review; excess insurance recovery; subrogation; payment; and settlement in consultation with Division staff and in accordance with applicable Nevada laws. TPA will assume the complete handling of all open and reopened claims as well as new claims, accepted by the Division and assigned to the contracted TPA, of insolvent SIEs or SIAs, whether currently insolvent or determined in the future to be insolvent, from the effective date of this contract. Division approval is required before a new or reopened claim may be paid by either Fund. TPA will ensure that requests for all outside case management services utilized, including, but not limited to, nurse case management and special investigation services, must be discussed with and approved by the Division in advance. TPA will ensure that prior to reopening any previously closed claims, the adjuster must provide and discuss the rationale with Division staff. Within thirty (30) calendar days of the award of the contract, with input and agreement of the Division, the TPA shall develop a Claims Handling Protocol document delineating handling of claims in the following areas: processing claims; issuing timely claim determinations; managing medical treatment; providing litigation support; establishing and maintaining reserves; maintaining accurate and timely payment of bills to ensure no duplicate payments; and providing timely payment of any and all workers’ compensation benefits. The document should also include TPA staff contact information, expectations and process descriptions. TPA will ensure a list of treating providers is filed with the DIR in accordance with NRS 616C.087 and any subsequent legislative changes. TPA shall produce an electronic copy of a claim file at the request of the Division. TPA will comply with all State and federal laws and adhere to all State and federal reporting requirements.
