South Dakota State TPA Workers' Compensation

1.1.1 Background: The State of South Dakota, Bureau of Human Resources and Administration (“State”) is seeking a licensed and qualified business partner to provide Third Party Claims Administration for the State’s Workers’ Compensation Program. The selected vendor will be required to provide Medical Case Management, Medical Bill Review, and Medicare, Medicaid, and SCHIP Extension Act of 2007 (MMSEA) reporting 1.1.2 Goals and Objectives: • Ensure timely, accurate, and consistent administration of workers’ compensation claims in accordance with applicable laws, regulations and State policies. • Implement cost-containment strategies that reduce claim duration and overall program costs while ensuring injured employees receive appropriate medical care and benefits. • Provide guidance and recommendations to assist the State in mitigating risk and improving workplace safety. • Delivering meaningful reporting, analytics, and benchmarking that enables the State to monitor program performance in real time, identify trends, and make informed decisions. • Serve as a strategic partner with the State to identify opportunities to improve claim outcomes, employee experience, return-to-work efforts, and overall program effectiveness. • Provide specialized expertise and proactive management of complex workers’ compensation claims. All written questions should be sent to: SD RFP Project Peggy.Canter@state.sd.us, only emailed questions will be accepted. Each offeror may submit questions via email concerning this RFP to obtain clarification of requirements. No questions will be accepted after the date and time indicated in the above schedule of activities. Email questions to the email address listed above with the subject line “RFP#26RFP19880”. The questions and their answers will be sent to all offerors that submitted Letters of Intent, submitted questions, or requested the questions and answers via email before the proposal submittal date and will be sent by the date and time indicated in the above calendar of events. Offeror may not rely on any other statements, either of a written or oral nature, that alter any specification or other term or condition of this RFP that have not originated from the SD RFP Project Contact. Offerors will be notified in the same manner as indicated above regarding any modifications to this RFP. Offerors and their agents may not contact any state employee other than the Primary Contact regarding any of these matters during the solicitation and evaluation process. Inappropriate contacts are grounds for suspension and exclusion from specific procurements.