Virginia Workers' Compensation Commission

The buyer seeks a contractor to provide administrative services for the Uninsured Employer's Fund. Services include claims administration, medical bill review, utilization review, and discounted prescription drugs. The contractor will investigate claims, process payments, assist with legal matters, and maintain claim records. The contract is for an initial 2-year period with five 1-year renewal options.

• 2/13/2025 - Proposal Due Date
• 7/1/2025 - Contract Start Date
• 6/30/2027 - Contract End Date

• Administer and investigate all claims on the Uninsured Employer's Fund
• Provide medical provider bill review based on CPT codes and diagnostic codes
• Conduct utilization review for inpatient hospital stays
• Provide discounted prescription drugs and medical supplies to claimants
• Establish and update workers' compensation reserves on claims
• Assist Special Counsel in preparing for hearings and appeals
• Process and pay indemnity and medical benefits on compensable claims
• Review and approve Special Counsel invoices for legal fees
• Maintain all original claim files on-site for access by claimants and counsel
• Prepare and update action plans for all claims every 60 days