SLED Opportunity · CALIFORNIA · PASADENA
AI Summary
The City of Pasadena seeks a Third-Party Administrator to manage its Workers' Compensation claims administration, including new and existing claims across all departments. The contract includes system access provisions and expansion of Alternative Dispute Resolution programs.
The City is seeking the services of a Third-Party Administrative firm to manage and provide claims administration services to further the City’s Workers’ Compensation program. Services will include new and existing claims. The City of Pasadena’s claims are currently self-insured and administered by a Third-Party Administrator. Non Safety claims with dates of injury 7/1/2012 and continuing are handled by an outside Third-Party Administrator. Police and Fire Department claim are also handled by an outside Third-Party Administrator (TPA). The in-house Workers’ Compensation Section operates under, and reports to, the City Manager's Office. This section is currently responsible for administration of approximately 13 open claims. The TPA is currently administering approximately 601 open claims across all City of Pasadena departments. The TPA reports directly to the Workers’ Compensation Supervisor. The City also has a full Carve-Out program for the Police Department and Fire Department. The City is moving toward a carve out program for all City employees.
The City of Pasadena’s organizational structure for the Workers’ Compensation Section includes a Claims Supervisor, two Claims Examiners and one Senior Office Assistant. The Senior Office Assistant provides clerical support for the City’s claims department. The files are assigned based upon an alphabetical split, with one examiner assigned to last names beginning A-K, and the other assigned to L-Z. The Examiner’s caseloads include maintenance claims.
The City is requesting that the responders include in their proposal, system access for the City staff for the claims administered by the City of Pasadena. The City of Pasadena will be looking at the possibility of contracting for their own claims management system during this contract. Proposals should include pricing variability should the City procure a claims management system during this contract for both the City and the Third-Party Administered claims.
The City currently operates an approved Alternative Dispute Resolution (ADR) program for a portion of its California Workers’ Compensation claims. As part of its ongoing risk‑management strategy to reduce litigation exposure, streamline claim resolution, and improve outcomes for injured employees, the City intends to expand ADR coverage to all Workers’ Compensation claims. To support this initiative, the City is seeking a vendor with demonstrated expertise in California Workers’ Compensation ADR programs and a proven track record of collaborative, compliant, and solution‑oriented partnership.
The City uses Ventiv which is managed through the current TPA’s workers’ compensation system. The City also uses a third party for bill review, Utilization Review and Nurse Case Management.
The City requests that proposals provide Workers’ Compensation administration for all City departments with all dates of injury (approximately 601 claims).
Points will be assigned based on Ease of Use; Mobile Capability/Support; Data Queries and Reporting; Support and Maintenance; Integration with existing systems; Training and Documentation; Software and Workflow Requirements.
Points will be assigned based on how effectively and efficiently the product can fulfill the requirements in the SCOPE OF WORK. The demonstration will be scored based on it's ability to successfully demo a Script of agreed upon items including but not limited to: System overview; Menus; Features; System navigation; Customization capabilities; Reports; Security features; and Support.
Points will be assigned for “Functional and Technical Merit” based on the capability of the proposer to satisfy the City requirements identified in the SCOPE OF WORK and as delineated. Points will be assigned for “Completeness of Proposed Solution” based on the vendor submitting a proposal that follows the guidelines specified in the SCOPE OF WORK.
Points will be assigned for “Experience with Projects of this Size and Scope in an Agency of Similar Size” based on a vendor’s previous experience with municipal agencies, as delineated in the SCOPE OF WORK, and CLIENT REFERENCES. Relevant experience, and technical expertise of the Consultant and sub-Consultants (if allowed) to perform the work. Points will be assigned based on references that named professionals are responsive to requests for analyses and information, have met or exceeded all performance expectations, and would be contracted with again. Nature and quality of completed work for other governmental agencies.
Points will be assigned based on an implementation timeline and milestone plan in the form of a Gantt chart that includes but is not limited to dates for installation, training, project rollout, and payment milestones.
Points will be assigned for the proposed schedule to complete the project. .
Proposals will be scored on the following:
Points will be awarded based on the following factors:
1. The Proposer has clearly identified a reasonable financing structure for the overall Project Site that allows the City to ground lease the City Property to the Proposer.
2. The reasonableness of the proposed Project Budget and assumptions of construction costs.
Points will be awarded based on the following:
Points will be awarded for projects that maximize the site potential and capitalize on the site constraints. This includes neighborhood continuity:
Points will be awarded if the project’s timeline is reasonable and project can move from predevelopment to construction quickly. Points will be awarded as follows for schedules deemed reasonable:
Points will be assigned based on a “Ratio Method.” The proposer’s cost must include the delivery of the proposed solutions, as well as any recurring costs (if any) as delineated in the Scope of Work and the PRICE PROPOSAL.
With this method, the proposal with the lowest cost receives the maximum points allowed. All other proposals receive a percentage of the points available based on their cost relationship to the lowest price. This is determined by applying the following formula:
Lowest Price / Evaluated Price X maximum points available = Awarded Points
Example: The cost for the lowest proposal is $100,000. The next lowest proposal has a cost of $125,000. The total points available for cost = 30 points.
( $100,000 / $125,000 ) X 30 = 24 points
To be awarded a 5 point preference for this category, the proposer must have an official business address within the City of Pasadena at the time that this RFP is posted on the City’s Website.
To be awarded a 5 point preference for this category, the proposer must be certified by the State of California as a small or micro-business. Refer to the State of California Department of General Services Division for further information. https://caleprocure.ca.gov/pages/sbdvbe-index.aspx
By submitting this bid the proposer hereby certifies under penalty of perjury of the laws of the State of California that all representations made in the documents that comprise the proposal for Third-Party Administrator for Workers' Compensation Program due on Wednesday, April 15, 2026 are true and correct to the best of my knowledge at the time of the proposal’s submission.
By confirming, the vendor is acknowledges the following:
The entire proposal must be formatted on standard-size 8½”x11” pages; 12 point font only. The "Technical Proposal," "Additional Data," and "Statement of Qualifications" can be no more than 50 grand total pages.
Subsequent to the closing of this solicitation, the selected vendor will be required to provide the following documents within 10 calendar days of being notified, otherwise the submitted proposal may be deemed non-responsive.
All Insurance Required by this Solicitation (If Required) #Insurance Requirements
Proposers must provide a response for all requirements detailed in the Scope of Work and in the General Development Requirements.
Upload your Cover Letter and Table of Contents :
“Cover Letter” shall be a maximum one-page letter including the name and address of the organization submitting the proposal; whether the proposing firm is an individual, partnership, corporation or joint venture; and the name, mailing/e-mail addresses, and telephone/fax numbers the contact person who will be authorized to make representations for the organization.
“TECHNICAL PROPOSAL” should demonstrate the PROPOSER’S full understanding of the SCOPE OF WORK and the effort needed to complete the Project on time and within the budget through the submittal of a proposed work plan including project deliverables (identify specifically and thoroughly for each portion of and phase). No pricing shall be included in this section.
The TECHNICAL PROPOSAL shall include a proposed work schedule to indicate duration and completion dates, including the dates of Deliverables/Milestones and estimates of the amount of time to be spent with City Staff during each phase of the project.
The entire proposal must be formatted on standard-size 8½”x11” pages; 12 point font only. The "Technical Proposal," "Additional Data," and "Statement of Qualifications" can be no more than a grand total of 50 combined.
PRICE PROPOSAL shall be submitted in this upload apart from the proposal.
Reference PRICE PROPOSAL.
Each Proposer must submit a PRICE Proposal containing all costs associated with the technical proposal. Using the attached Price Proposal in this RFP, provide Proposer’s lump-sum price for performing all services and work called for in the SCOPE OF WORK. The Proposer’s lump-sum price shall include, without limitation:
“Additional Data” shall include any other data the PROPOSER deems essential to the evaluation of the proposal, i.e., letter of reference, other related projects, etc., or other required documents.
The entire proposal must be formatted on standard-size 8½”x11” pages; 12 point font only. The "Technical Proposal," "Additional Data," and "Statement of Qualifications" can be no more than a grand total of 50 combined.
If this preference is applied to the solicitation, and your company is seeking this preference, you must provide a copy of the certification from DGS.
Please upload a copy of your: TBD
Solely for the purpose of verification. Please enter your Public Works Contractor Registration Number. This will be verified against the state database for the Department of Industrial Relations Registration.
The Statement of Qualifications should highlight your company’s most applicable products, services, and experience.
Please download, complete and submit any required forms below.
If your proposal does not include all of the below items, it may be deemed non-responsive.
Evidence of certification by State of California as a small or micro-business, if claiming such preference – https://caleprocure.ca.gov/pages/PublicSearch/supplier-search.aspx
Please download the below documents, complete, and upload.
ADDITIONAL REQUIREMENT
For RFP/RFQ where the selected vendor/contract will require City Council approval (check with City project manager for clarification), the following requirement applies:
Please download the below documents, complete, and upload.
Complete and submit the attached Relevant Experience Form with your bid to demonstrate experience with projects of similar scope and size to that which is to be performed.
Please download the below documents, complete, and upload.
Please download the below documents, complete, and upload.
This form is only required for the purchases of technology. If selected, proposers will be required to complete the Pasadena Department of Information Technology Technical Questionnaire. The questionnaire is included in the #Attachments. When completing the questionnaire, please note:
In order to comply with the section named “Data Security for Printers/Copiers/Scanners,” My company will:
Please download the below documents, complete, and upload.
Please download the below documents, complete, and upload.
Please download the below documents, complete, and upload.
Please download the below documents, complete, and upload.
Please download the below documents, complete, and upload.
Please download the below documents, complete, and upload.
Please download the below documents, complete, and upload.
Please download the below documents, complete, and upload.
In addition to the items listed above, the following list is provided for the convenience of both you and the City and to help eliminate errors and omissions which may render your bid unacceptable. The following forms are required to be submitted with your bid: https://www.cityofpasadena.net/finance/wp-content/uploads/sites/27/HUD-Federal-Forms-under-200k.pdf?v=1674593673378
HUD Federal Forms (under $200k)
In addition to the items listed above, the following list is provided for the convenience of both you and the City and to help eliminate errors and omissions which may render your bid unacceptable. The following forms are required to be submitted with your bid: https://www.cityofpasadena.net/finance/wp-content/uploads/sites/27/HUD-Federal-Forms-over-200k.pdf?v=1674593673378
HUD Federal Forms (Over $200k)
All vendors responding to this solicitation must provide a copy of their Active SAM Registration with their proposal.
Select a general funding source
For Example: "Homeland Security"
This amount is the dollar value of the award from HUD. Contact Housing if you have questions.
Do not erase the text below. Enter the number after the text that reads "FEDERAL-AID PROJECT NUMBER:"
Below is a list of potential attachments that may or may not apply to your procurement. Please review the attachments in the section named "Attachments" to ensure they are relevant and appropriate.
Goods/Equipment, Services, SAAS, Printers, Copiers/Scanners)
If any of the following items apply, please contact HR (Jaime Arellano, jarellano@cityofpasadena.net; (626) 744-7301) for approval before you proceed. DO NOT SUBMIT BEYOND THIS POINT UNTIL YOU HAVE OBTAINED APPROVAL FROM HUMAN RESOURCES.
This particular question is to be answered for the company (or their subcontractors) not their employees.
Please enter the specific License or Certification required to be eligible to compete on this solicitation. For example, "CPA - Certified Public Accountant."
State of California Definition: Construction, alteration, demolition, installation, or repair work done under contract and paid in whole or in part out of public funds. It can include preconstruction and post-construction activities related to a public works project.
Choose your evaluation factors. Below are example factors you can consider for your Evaluation Criteria. It is important that your actual evaluation of proposals is consistent with the factors and criteria you include in the RFP document. You will be able to add or edit any custom criteria along with the point values (using a 100-point-scale) while you are editing the Evaluation Section of this project.
General definitions and parameters of each approach.
Used for development projects typically by Housing or Economic Development.
Q (No subject): Is there a requirement for a bilingual examiner?
A: There is no requirement for any of the examiners to be bilingual. We do have a very diverse employee population that would appreciate examiners that were bilingual.
Q (No subject): Are their closed files in storage that the TPA would need to assume? If so, how many boxes?
A: All open files are digital. There are approximately 200 boxes of closed files with the current TPA.
Q (No subject): In the overview, the City noted that they are going to move all employees into an ADR program. Would this be a 7/1 transition?
A: No, there are currently 4 Bargaining Units representing 364 employees of the City’s 2,147 current employees that are in the ADR program. We are hoping to have the whole City workforce in the ADR program in the next 4 years.
Q (Teaming and Prime/Subcontractor Structure): Can the City confirm if it is acceptable for a technology and program management firm to act as the Prime Contractor, provided that all mandatory California self-insured certified claims adjudication services are fulfilled through a dedicated, legally binding teaming agreement with a licensed California Subcontractor?
A: The City will entertain all California-certified presentations that offer quality claims administration.
Q (Teaming and Prime/Subcontractor Structure): Regarding the 10 preference points for Local Pasadena and California Small/Micro Businesses: If the Prime Contractor is an out-of-state entity, but partners with a Subcontractor who meets the Local and/or CA Small Business criteria and performs a commercially useful function (e.g., providing the certified claims examiners), will the City award a prorated or full portion of those preference points to the proposing team?
A: No, there are no prorated points. The preferences points apply for the prime.
Q (Technology, Data Migration, and SaaS): For the transition of the approximately 10,350 existing claims, could the City clarify the current data format and the incumbent system being used?
A: Claim data is currently in Ventiv Claims Premier system.
Q (Technology, Data Migration, and SaaS): The RFP mentions 'AI usage disclosure.' Can the City clarify if the use of secure, internally governed AI (e.g., for automated data mapping during the transition phase, or for advanced reporting analytics) is viewed favorably, provided it strictly adheres to the AES 128-bit encryption, data sovereignty (US-only), and IT security requirements? Additionally, will the City provide an acceptable use policy?
A: Vendor solutions, whether or not they incorporate AI capabilities, shall fully comply with the data protection and security requirements as detailed in section 6 of the RFP. Additionally, any AI functionality included in a proposed solution must be clearly disclosed in accordance with section 6. Please refer to the requirements and evaluation criteria as written in the RFP. Solutions that meet the requirements and score high in the evaluation criteria will be viewed favorably.
Q (Pricing and Cost Structure): Given the hybrid nature of providing both SaaS technology and human TPA services, does the City prefer the Price Proposal to separate the SaaS implementation/licensing costs from the per-claim/lump-sum human administrative fees, or should all technology costs be baked into the claims handling rates?
A: The City defers to the proposers on how best to present their pricing.
Q (Managed care and bill review?): Is the City considering proposals that also include managed care services? Or are you only seeking a response for the claims administration services?
A: This RFP is limited to claims administration services.
Q (No subject): Are there any required data feeds that need to be established either with the City or an outside agency? If so, how many?
A: The Data Feeds that exist currently: 1) Between TPA & Bill Review vendor; 2) Between TPA and City (check register); 3) Between TPA and Pharmacy Benefit Manager (PBM); 4) TPA and EDI - State of California. 5) TPA and Center for Medicare Services (CMS).
Q (Reported Claims): Can the city provide the number of reported claims for the past 3 years, broken down by claim type (first aid/report only, medical only, indemnity, ADR)?
A: a. 2023: i. Indemnity – 171 ii. Medical Only - 63 iii. First Aid/Report Only – 5 iv. ADR – 53 (Inclusive in the Indemnity, MO & First Aid numbers above) b. 2024: i. Indemnity – 150 ii. Medical Only – 82 iii. First Aid/Report Only – 1 iv. ADR – 58 (Inclusive in the Indemnity, MO & First Aid numbers above) c. 2025: i. Indemnity – 183 ii. Medical Only – 134 iii. First Aid/Report Only – 11 iv. ADR – 72 (Inclusive in the Indemnity, MO & First Aid numbers above)
Q (Claims Data): 1. To provide accurate and competitive pricing, we ask for six years of detailed Workers’ Compensation claims data . This MS Excel loss data should include, but not be limited to: a. Dates: Loss Date, Report Date, Close Date, Coverage Year / Calendar Year b. Claim Status: Open, Closed, Re-Opened c. Litigation: Yes or No data d. Employee: Job Description / Class Code / Department e. Claim Type: Lost Time, Medical-Only, Incident/Report Only f. Expenses: i. [1] Reserves, [2] Paid, [3] Total Incurred for the following columns: o (a) Indemnity, (b) Medical, (c) Legal, (d) Other and (e) Total Incurred
A: No, this is confidential information.
Q (Staffing): 2. Does the City require a fully Dedicated claims staff ?
A: Yes, we request at minimum: 1 dedicated examiner for Police; 1 dedicated examiner for Fire; 1 dedicated examiner for Citywide claims (non-safety); 1 dedicated future medical examiner. It would be preferable to have an additional examiner that could work both Police & Fire claims to ensure caseloads remain manageable.
Q (Claims): 3. Of the open Indemnity claims, how many are classified as Future Medical?
A: 232
Q (Bill Review): 1. Does the City utilize the incumbent's Medical Bill review or a different vendor? a. Can you provide detailed medical bill review statistics? i. Specifically, aggregated annual data for 01/01/2023 through 12/31/2025. 1. number of invoices/number of lines, 2. gross annual expense, 3. gross savings, 4. net savings, 5. all related bill review, administrator, and vendor expenses
A: Medical bill review is managed under a separate contract. The RFP for Medical Bill Review is currently open. The requested medical bill review statistics are not applicable to this RFP.
Q (Utilization Review): 2. Does the City utilize the incumbent's Utilization Review or a different vendor? b. Can you provide detailed utilization review statistics? i. Specifically, aggregated annual data for 01/01/2023 through 12/31/2025. 1. number of invoices/number of lines, 2. gross annual expense, 3. gross savings, 4. net savings, 5. all related
A: The contract for Utilization Review is currently with Rehab West Inc. The requested utilization review statistics are not applicable to this RFP.
Q (PBM): 3. Does the City utilize the incumbent's PBM services or a separate vendor? a. Can you provide detailed PBM statistics? i. Specifically, aggregated annual data for 01/01/2023 through 12/31/2025. 1. number of prescriptions filled, 2. gross annual expense, 3. gross savings, 4. net savings, Any other related PBM expenses?
A: Yes, we are currently utilizing the incumbent’s PBM – Healthesystems Inc. 1. Number of prescriptions filled: a. 2023 – 1830 b. 2024 – 1945 c. 2025 - 1879 2. Gross annual expense: a. 2023 - $627,034.09 b. 2024 - $799,900.57 c. 2025 - $907,955.45 3. Gross savings: a. 2023 - $71,685.83 b. 2024 - $109,530.57 c. 2025 - $153,541.99 4. Net savings: Same as #3 5. Any other related PBM expenses? None
Q (Triage): 4. Does the City utilize the incumbent's 24-7 Nurse Triage or a separate vendor? ii. If yes to nurse triage, please share annual data for 01/01/2023 through 12/31/2025.
A: We currently do not use this type of service.
Q (MMSEA): 5. Can the City provide detailed MMSEA reporting volume for the past 5 years?
A: This is unavailable.
Q (NCM): 6. Does the City utilize the incumbent's Nurse Case Managers or a separate vendor? a. If yes, how frequently was NCM utilized annually for the past 5 years?
A: Nurse Case Management is managed under a separate contract. The contract with Nurse Case Management is with Rehab West Inc.
Q (Incumbent): 1. May we have a copy of the incumbent TPA’s service agreement that is current through calendar year 2026?
A: No.
Q (No subject): Who is the City's excess carrier?
A: Safety National
Q (No subject): Does the City settle cases via Compromise & Release, if reasonable?
A: Yes.
Q (No subject): What is the frequency and type of ADR statistical reporting requirements to provide to the City, in addition to the annual state reporting?
A: Annual ADR Report due 4/1, includes claims data (provided by TPA) and ADR data (provided by ADR ombudsperson) and contact information (provided by the City).
Q (No subject): Does the 180-caseload requirement consist of a blended caseload of Indemnity, Future Medical, and Medical-Only claims?
A: Yes. The 180 claim caseload reflects a blended mix of Indemnity, Future Medical, and Medical Only claims. The City is open to alternative staffing configurations, including the use of dedicated Future Medical and/or Medical Only examiners, along with correspondingly reduced Indemnity caseloads. A combined caseload would not exceed 180 claims.
Q (Section 7 RIMS): The RFP states that "The "Technical Proposal," "Additional Data," and "Statement of Qualifications" can be no more than 50 grand total pages". 7.5 Requires to submit samples of computer runs and reports, and an index of all available computer reports (Page 23). Do these samples count towards the 50 page limit or are these to be counted separately?
A: Yes, these samples count towards the 50 page limit.
Q (Section 8 Technical Information): The RFP states that "The "Technical Proposal," "Additional Data," and "Statement of Qualifications" can be no more than 50 grand total pages". 8.16 Requires to supply a sample of computerized Detail Loss Run, Management summaries, and Escrow Account reconciliation and other detailed reports that will illustrate the RMIS capabilities (Page 25). Do these samples count towards the 50 page limit or are these to be counted separately?
A: Yes, these samples count towards the 50 page limit.
Q (Section 8 Technical Information): The RFP states that "The "Technical Proposal," "Additional Data," and "Statement of Qualifications" can be no more than 50 grand total pages". 8.7 Requires to provide a list of 5 of our largest public agency clients and their contact information as a separate page (Page 24). Does this list count towards the 50 page limit or is this to be counted separately?
A: Yes, this list counts towards the 50 page limit.
Q (Claim Volumes): The RFP references an estimated inventory of approximately 601 open workers’ compensation claims; however, the pricing sheet appears to reflect a total of 540 claims across indemnity, future medical, and medical‑only categories. Can the City confirm the current total open claim volume and provide a five‑year workers’ compensation loss run that includes a breakdown of indemnity versus medical‑only claims, litigated versus non‑litigated claims, and Police and Fire claims versus non‑safety and other City departments?
A: As of 3/31/2026 Total Open Claims is 606; 331 Indemnity, 31 Medical Only, 244 Future Medical.
Q (Claim type clarification): The pricing sheet describes indemnity and medical‑only claims as “Open to Closure.” Can the City confirm whether this designation indicates that the program is intended to be structured as a life‑of‑claim administration contract for these claim types?
A: The program calls for pricing for life of contract.
Q (Pricing clarification): Page 3 of the RFP indicates that proposals should include pricing variability if the City elects to procure its own claims management system during the contract term. Please confirm whether the City is requesting two pricing scenarios: one assuming the TPA administers claims within a City‑selected claims management system, and a second assuming both TPA‑administered and City‑administered claims are handled within the TPA’s claims management system.
A: If there are variances in the proposed pricing due to use of TPA vs City claims management systems, vendors may submit separate pricing proposals reflecting the use of the TPA’s claims management system, as well as a hybrid model in which both the TPA’s system and the City’s claims management system are utilized. Vendors may also choose to incorporate pricing variations for these scenarios directly within the body of their proposal.
Q (Caseloads): The RFP states an average caseload of 180 claim files per examiner. Is this intended to represent a maximum caseload threshold, does it include future medical‑only claims, and does the City differentiate caseload expectations for litigated versus non‑litigated claims?
A: The 180 claim caseload reflects a blended mix of Indemnity, Future Medical, and Medical Only claims. The City is open to alternative staffing configurations, including the use of dedicated Future Medical and/or Medical Only examiners, along with correspondingly reduced Indemnity caseloads. A combined caseload would not exceed 180 claims.
Q (Medical Bill Review Vendor): Which vendor does the City currently utilize for medical bill review?
A: The current Bill Review vendor is Lien On Me.
Q (Nurse Triage Services): Would the City be interested in utilizing the TPA’s nurse triage services during the claims reporting process?
A: The City is open to exploring all TPA services that reduce costs and facilitate benefit delivery to our employees.
Q (Data feeds): If the City elects to utilize the selected TPA’s claims management system, will data feed integrations with managed care vendors be required, which vendors would require integration, and should the associated integration costs be assumed to be the financial responsibility of the TPA? If the City elects to utilize the TPA’s claims management system, which City or third‑party systems must be integrated at contract commencement, such as payroll, HRIS, finance, or excess insurance carriers reporting systems?
A: The Data Feeds that exist currently: 1) Between TPA & Bill Review vendor; 2) Between TPA and City (check register); 3) Between TPA and Pharmacy Benefit Manager (PBM); 4) TPA and EDI - State of California. 5) TPA and Center for Medicare Services (CMS). The City would like to extend the integration to include Utilization Review. The cost proposals should accurately reflect all costs to the City.
Q (ADR): The RFP indicates that the City currently utilizes an Alternative Dispute Resolution (ADR) program and intends to expand its use. Can the City clarify how ADR is currently utilized within the workers’ compensation program, such as for dispute resolution, medical treatment issues, claim resolution, or litigation avoidance, and specify the operational role the TPA is expected to perform in support of ADR?
A: The City’s ADR programs use mediation and arbitration to resolve disputes that cannot be settled informally. Utilization Review continues to operate within the ADR framework; however, any disputes regarding UR determinations that cannot be resolved informally are elevated to Independent Medical Review. All resolutions reached through the ADR process are reviewed and approved by the ADR Director. The ADR program places a strong emphasis on communication. This is supported through the involvement of the ombudsperson and consistently includes collaboration and input from the TPA claims team. The City, the TPA claims team, and the ombudsperson meet virtually each month to ensure that all claims are moving forward efficiently toward recovery, return to work, and timely resolution.
Q (No subject): The RFP requires to list California clients who purchased services - calendar years 2005-2010 and California clients who discontinued services - calendar years 2005-2010. Are these dates accurate or, would the City like to see more updated information?
A: The correct calendar years should be 2021 – 2025 for both parts of this question.
SLED stands for State, Local, and Education. These are solicitations issued by state governments, counties, cities, school districts, utilities, and higher education institutions — as opposed to federal agencies.
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