City of Salinas utilizes CorVel as WC TPA and is generally pleased. Though, I think Mark's tips are helpful.

Mark, would you be willing to share your RFP format?  

Our contract is expired and I'll be working on an RFP in the very near future. 

SB uses AdminSure as its WC TPA. The City plans to renew the contract in the next few months. The TPA contract includes both Bill Review and UR/Case Management services as a separate annual flat fee (not billed to the claim file).  The annual flat fee for these services creates significant savings for the city. The savings are seen in two areas - fees and case reserves.

Fees - the costs are limited and known. No surprises or windfall expenses when an large bill arrives (surgery or hospital stay). The annual fee paid is far less than the typical amount required to be placed in a claim reserve using the DIR formula. 

Case Reserves - Using an annual flat fee for administrative costs places claim reserves in a different light. Now the reserves simply reflect the costs for indemnity, medical treatment, and when needed legal fees. This change does require some training for the TPA staff on establishing case reserves that do NOT include these administrative expense items.  

Good morning!  It was nice to meet all of you last week.  

We have been using Pegasus Risk Mgmt. for many years as our TPA for WC claims and I'm wondering if any of you have used them.  If so, were you happy with their services? 

I know someone mentioned Sedgwick and it seemed you weren't happy with them.  Can you share any insight into why?  Thanks. 

Thanks, Oles. We did an RFP recently and Intercare is one of the finalists. We are thinking of a pilot projects as well. I may call you to pick your brain. 

Thanks, Jena. AIMS didn't respond to the RFP. Someone told me they recently had a reduction in staff, is that true?

Hi Betsy - in 2017, we started a pilot under which the administration of WC claims moved to a TPA. Intercare was selected through the RFP process. Earlier this year, we made a move to have a TPA permanently handle claims for Dept of Transportation, formerly know as BBB and extended Intercare's contract for three years. UR and BIll Review is bundled with their claims administration service. After the contract's expiration, I'm considering unbundling these services, as it might result in cost savings. Thanks!

We utilize AIMS, and I issue a separate RFP for UR/Nurse Case Management, and Bill Review.  It just so happens we are contracted with Allied Managed Care for both UR/Nurse Case Management and Bill Review.  The City of Bakersfield moved to Allied Managed Care for bill review in just the last couple of years.  Allied Managed Care is a sister company to AIMS.