HomeMy WebLinkAboutC2025-109 - 6/24/2025 - Approved PROFESSIONAL SERVICES AGREEMENT NO. 6360
Workers' Compensation Third-Party Administrator Services
xses�
THIS Workers' Compensation Third-Party Administrator Services Agreement
("Agreement") is entered into by and between the City of Corpus Christi, a Texas home-
rule municipal corporation ("City") and CAS-Claims Administrative Services, Inc., dba
Claims Administrative Services, Inc. ("Contractor"), effective upon execution by the
City Manager or the City Manager's designee ("City Manager").
WHEREAS, Contractor has bid to provide Workers' Compensation Third-Party
Administrator Services in response to Request for Bid/Proposal No. 6360 ("RFB/RFP"),
which RFB/RFP includes the required scope of work and all specifications and which
RFB/RFP and the Contractor's bid or proposal response, as applicable, are
incorporated by reference in this Agreement as Exhibits 1 and 2,respectively,as if each
were fully set out here in its entirety.
NOW, THEREFORE, City and Contractor agree as follows:
1. Scope. Contractor shall provide Workers' Compensation Third-Party Administrator
Services ("Services") in accordance with the attached Scope of Work, as shown
in Attachment A, the content of which is incorporated by reference into this
Agreement as if fully set out here in its entirety, and in accordance with Exhibit 2.
2. Term.
(A) The term of this Agreement is three years beginning on the date provided
in the Notice to Proceed from the Contract Administrator or the City's
Procurement Division. The parties may mutually renew the term of this Agreement
for up to two additional one-year periods ("Option Period(s)"), provided, the
parties do so in writing prior to the expiration of the original term or the then-current
Option Period.
(B) At the end of the Term of this Agreement or the final Option Period, the
Agreement may, at the request of the City prior to expiration of the Term or final
Option Period, continue on a month-to-month basis for up to six months with
compensation set based on the amount listed in Attachment B for the Term or the
final Option Period. The Contractor may opt out of this continuing term by
providing notice to the City at least 30 days prior to the expiration of the Term or
final Option Period. During the month-to-month term, either Party may terminate
the Agreement upon 30 days' written notice to the other Party.
3. Compensation and Payment. This Agreement is for an amount not to exceed
$675,000.00, subject to approved extensions and changes. Payment will be made
for Services performed and accepted by the City within 30 days of acceptance,
Professional Services Agreement- Workers' Comp TPA Page 1 of 7
subject to receipt of an acceptable invoice. All pricing must be in accordance
with the attached Bid/Pricing Schedule, as shown in Attachment B, the content
of which is incorporated by reference into this Agreement as if fully set out here in
its entirety. Invoices must be mailed to the following address with a copy provided
to the Contract Administrator:
City of Corpus Christi
Attn: Accounts Payable
P.O. Box 9277
Corpus Christi,Texas 78469-9277
4. Contract Administrator. The Contract Administrator designated by the City is
responsible for approval of all phases of performance and operations under this
Agreement, including deductions for non-performance and authorizations for
payment. The City's Contract Administrator for this Agreement is as follows:
Gilbert Sanchez
Risk Management Div. - Legal Dept.
Phone: (361) 826-3739
Email: GilbertS2@cctexas.com
5. Insurance; Bonds; License.
(A) Before performance can begin under this Agreement, the Contractor must
deliver a certificate of insurance ("COI"), as proof of the required insurance
coverages, to the City's Risk Manager and the Contract Administrator.
Additionally, the COI must state that the City will be given at least 30 days'
advance written notice of cancellation, material change in coverage, or intent
not to renew any of the policies. The City must be named as an additional insured.
The City Attorney must be given copies of all insurance policies within 10 days of
the City Manager's written request. Insurance requirements are as stated in
Attachment C, the content of which is incorporated by reference into this
Agreement as if fully set out here in its entirety.
(B) In the event that a payment bond, a performance bond, or both, are
required of the Contractor to be provided to the City under this Agreement before
performance can commence, the terms, conditions, and amounts required in the
bonds and appropriate surety information are as included in the RFB/RFP or as
may be added to Attachment C, and such content is incorporated here in this
Agreement by reference as if each bond's terms, conditions, and amounts were
fully set out here in its entirety.
(C) Prior to beginning Services and work, Contractor must provide evidence of
any valid professional license necessary for the performance of the Services
under this Agreement.
Professional Services Agreement-Workers' Comp TPA Page 2 of 7
b. Standard of Care. Contractor warrants that all Services will be performed in
accordance with the standard of care used by similarly situated professionals
performing the same or similar Services under an identical kind of professional
license, if a license is required.
7. Quality/Quantity Adjustments. Any Service quantities indicated on the Bid/Pricing
Schedule are estimates only and do not obligate the City to order or accept more
than the City's actual requirements nor do the estimates restrict the City from
ordering less than its actual needs during the term of the Agreement and including
any Option Period. Substitutions and deviations from the City's product
requirements or specifications are prohibited without the prior written approval of
the Contract Administrator.
8. Non-Appropriation. The continuation of this Agreement after the close of any
fiscal year of the City, which fiscal year ends on September 30th annually, is subject
to appropriations and budget approval specifically covering this Agreement as
an expenditure in said budget, and it is within the sole discretion of the City's City
Council to determine whether or not to fund this Agreement. The City does not
represent that this budget item will be adopted, as said determination is within the
City Council's sole discretion when adopting each budget.
9. Independent Contractor. Contractor will perform the Services and work
required by this Agreement as an independent contractor and will furnish such
professional Services in its own manner and method, and under no circumstances
or conditions will any agent, servant, or employee of the Contractor be
considered an employee of the City.
10. Subcontractors. In performing the Services, the Contractor may use
subcontractors in connection with the work performed under this Agreement.
When using subcontractors, however, the Contractor must obtain prior written
approval from the Contract Administrator unless the subcontractors were named
in the bid or proposal or in an attachment to this Agreement, as applicable. In
using subcontractors, the Contractor is responsible for all their acts and omissions
to the some extent as if the subcontractor and its employees were employees of
the Contractor. All requirements set forth as part of this Agreement, including the
necessity of providing a COI in advance to the City, are applicable to all
subcontractors and their employees to the same extent as if the Contractor and
its employees had performed the work. The City may, at the City's sole discretion,
choose not to accept Services performed by a subcontractor that was not
approved in accordance with this paragraph.
11. Amendments. This Agreement may be amended or modified only in writing
executed by authorized representatives of both parties.
Professional Services Agreement- Workers' Comp TPA Page 3 of 7
I
I
12. Waiver. No waiver by either party of any breach of any term or condition of this
Agreement waives any subsequent breach of the same.
13. Taxes. The Contractor covenants to pay payroll taxes, Medicare taxes, FICA
taxes, unemployment taxes and all other applicable taxes. Upon request, the City
Manager shall be provided proof of payment of these taxes within 15 days of such
request.
14. Notice. Any notice required under this Agreement must be given by fax, hand
delivery, or certified mail, postage prepaid, and is deemed received on the day
faxed or hand-delivered or on the third day after postmark if sent by certified mail.
Notice must be sent as follows:
IF TO CITY:
City of Corpus Christi
Attn: Gilbert Sanchez, Risk Manager
Legal Dept. - Risk Management Div.
1201 Leopard St., Corpus Christi, TX 78401
Phone: (361) 826-3739
Fax: (361) 826-3697
IF TO CONTRACTOR:
CAS-Claims Administrative Services, Inc.
Attn: Dan Campbell, Executive Vice President
501 Shelley Dr., Tyler, TX 75701
Phone: (903) 509-8485 ext. 5745
Fax: (903) 509-1888
IS. CONTRACTOR SHALL FULLY INDEMNIFY, HOLD HARMLESS, AND DEFEND
THE CITY OF CORPUS CHRISTI AND ITS OFFICERS, EMPLOYEES AND
AGENTS ("INDEMNITEES') FROM AND AGAINST ANY AND ALL LIABILITY,
LOSS, CLAIMS, DEMANDS, SUITS, AND CAUSES OF ACTION OF
WHATEVER NATURE, CHARACTER, OR DESCRIPTION ON ACCOUNT OF
PERSONAL INJURIES, PROPERTY LOSS, OR DAMAGE, OR ANY OTHER KIND
OF INJURY, LOSS, OR DAMAGE, INCLUDING ALL EXPENSES OF
LITIGATION, COURT COSTS, ATTORNEYS' FEES AND EXPERT WITNESS FEES,
WHICH ARISE OR ARE CLAIMED TO ARISE OUT OF OR IN CONNECTION
WITH A BREACH OF THIS AGREEMENT OR THE PERFORMANCE OF THIS
AGREEMENT BY THE CONTRACTOR OR RESULTS FROM THE NEGLIGENT
ACT, OMISSION, MISCONDUCT, OR FAULT OF THE CONTRACTOR OR ITS
EMPLOYEES OR AGENTS. CONTRACTOR MUST, AT ITS OWN EXPENSE,
INVESTIGATE ALL CLAIMS AND DEMANDS, ATTEND TO THEIR SETTLEMENT
OR OTHER DISPOSITION, DEFEND ALL ACTIONS BASED THEREON WITH
Professional Services Agreement-Workers' Comp TPA Page 4 of 7
i
i
COUNSEL SATISFACTORY TO THE CITY ATTORNEY, AND PAY ALL
CHARGES OF ATTORNEYS AND ALL OTHER COSTS AND EXPENSES OF
ANY KIND ARISING OR RESULTING FROM ANY SAID LIABILITY, DAMAGE,
LOSS, CLAIMS, DEMANDS, SUITS, OR ACTIONS. THE INDEMNIFICATION
OBLIGATIONS OF CONTRACTOR UNDER THIS SECTION SHALL SURVIVE
THE EXPIRATION OR EARLIER TERMINATION OF THIS AGREEMENT.
16. Termination.
(A) The City may terminate this Agreement for Contractor's failure to comply with
any of the terms of this Agreement. The City must give the Contractor written
notice of the breach and set out a reasonable opportunity to cure. If the
Contractor has not cured within the cure period, the City may terminate this
Agreement immediately thereafter.
(B) Alternatively, the City may terminate this Agreement for convenience upon
30 days advance written notice to the Contractor. The City may also terminate
this Agreement upon 24 hours written notice to the Contractor for failure to pay or
provide proof of payment of taxes as set out in this Agreement.
17. Limitation of Liability. The Contractor's maximum liability under this Agreement is
limited to the total amount of errors and omissions coverage stated in Attachment
C to this Agreement. In no event shall the Contractor be liable for incidental,
consequential, or special damages.
18. Assignment. No assignment of this Agreement by the Contractor, or of any right
or interest contained herein, is effective unless the City Manager first gives written
consent to such assignment. The performance of this Agreement by the
Contractor is of the essence of this Agreement, and the City Manager's right to
withhold consent to such assignment is within the sole discretion of the City
Manager on any ground whatsoever.
19. Severability. Each provision of this Agreement is considered to be severable and,
if, for any reason, any provision or part of this Agreement is determined to be
invalid and contrary to applicable law, such invalidity shall not impair the
operation of nor affect those portions of this Agreement that are valid, but this
Agreement shall be construed and enforced in all respects as if the invalid or
unenforceable provision or part had been omitted.
20. Order of Precedence. In the event of any conflicts or inconsistencies between this
Agreement, its attachments, and exhibits, such conflicts and inconsistencies will
be resolved by reference to the documents in the following order of priority:
A. this Agreement (excluding attachments and exhibits);
B. its attachments;
Professional Services Agreement- Workers' Comp TPA Page 5 of 7
i
i
's
t
i
C. the bid solicitation document including any addenda (Exhibit 1); then,
D. the Contractor's bid response (Exhibit 2).
21. Certificate of Interested Parties. Contractor agrees to comply with Texas
Government Code Section 2252.908, as it may be amended, and to complete
Form 1295 "Certificate of Interested Parties" as part of this Agreement if required
by said statute.
22. Governing Law. Contractor agrees to comply with all federal,Texas, and City laws
in the performance of this Agreement. The applicable law for any legal disputes
arising out of this Agreement is the law of the State of Texas, and such forum for
such disputes is the appropriate district or county court in Nueces County, Texas.
In accordance with Chapter 2271, Texas Government Code, Contractor verifies
that Contractor does not boycott Israel and will not boycott Israel during the term
of this agreement. In accordance with Chapter 2274, Texas Government Code,
Contractor verifies that Contractor does not have a practice, policy, guidance,
or directive that discriminates against a firearm entity or firearm trade association
and will not discriminate during the term of the contract against a firearm entity
or fire trade association. In accordance with Chapter 2276, Texas Government
Code, Contractor verifies that Contractor does not boycott energy companies
and will not boycott energy companies during the term of this agreement.
23. Public Information Act Requirements. This paragraph applies only to agreements
that have a stated expenditure of at least $1,000,000 or that result in the
expenditure of at least $1,000,000 by the City. The requirements of Subchapter J,
Chapter 552, Government Code, may apply to this contract and the Contractor
agrees that the contract can be terminated if the Contractor knowingly or
intentionally fails to comply with a requirement of that subchapter.
24. Entire Agreement. This Agreement constitutes the entire agreement between the
parties concerning the subject matter of this Agreement and supersedes all prior
negotiations, arrangements, agreements and understandings, either oral or
written, between the parties.
Professional Services Agreement-Workers' Comp TPA Page 6 of 7
CONTRACTOR
Signature: DanielCni ,bet 111 7U,-r32513:41CDT)
Printed Name:
Title: Executive Vice President
Date:
CITY OF CORPUS CHRISTI M2025-079 �.u_ iiorizer.i sAw
s��'4
Sergln Vil sana(Ju11,202519:47 CDT) 6/24/2025
Sergio Villasana C:+��ii7iil
Director of Finance & Procurement
R SB
Date:
07/01/2025 RHSB
Attached and Incorporated by Reference:
Attachment A: Scope of Work
Attachment B: Fee/Bid/Pricing Schedule ATTEST:
Attachment C: Insurance and Bond Requirements
Attachment D: Warranty Requirements Rebecca 1fwf-ta
Rebecca H uerta(Jul 2,2025 09:07 CDT)
Rebecca Huerta
Incorporated by Reference Only: city secretary
Exhibit 1 : RFB/RFP No. 6360
Exhibit 2: Contractor's Bid/Proposal Response
Professional Services Agreement-Workers' Comp TPA Page 7 of 7
i
Attachment A - Scope of Work
1.1. General Requirements
A. The City of Corpus Christi is seeking qualified Contractor/Third-Party
Administrator (TPA) to provide professional claim services to the Risk
Management Division for its self-funded workers' compensation program. The
City has administered its self-funded program for over 20 years and is currently
contracted with Tristar for TPA services in full compliance with the State's
Governmental Accounting Standards (GASB 10) requirements.
The City's Managed Care Provider workers' compensation injuries is Injury
Management Organization (IMO) contracted by TRISTAR under its 504
network.
B. The City of Corpus is a home-rule city which operates under the Council
Manager form of government. The City provides a full range of municipal
service as prescribed by statute or charter. These services include police, fire
and emergency medical services, parks and recreational facilities, library
services, street maintenance and construction, public improvements, water
and wastewater utilities, solid waste and landfill, marina, airport operations
and gas utilities services and systems. The City of Corpus Christi employs 3,433
full-time employees, 30 part-time, and 145 City temporary/seasonal. This
number reflects 479 firefighters and 488 police officers.
C. The City of Corpus Christi's self-retention for workers' compensation is
$1,000,000. The City's excess carrier provides the excess workers'
compensation policy up to statutory limits.
D. The Contractor must provide a broad representation of medical providers in
its proposed workers' compensation health care network, to include vetted
treating physicians, clinics, specialists, physical therapists, rehabilitation
services, and pharmacies.
E. The City of Corpus Christi maintains the right to bundle or unbundle services
proposed in the RFP.
F. The Contractor shall indemnify, defend, and hold harmless the City of Corpus
Christi from all fines and penalties levied against the City, TPA, or TPA
subcontractors for TPA's failure to comply with federal and state
RFP Template 02/03/2025
Page 1 of 13
requirements. In no way will selected TPA pass cost on to the City or cause
the City to be responsible for fines or fees levied against the TPA or any
subcontractor.
G. The TPA will indemnify the City of Corpus Christi for all overpayments and
duplicate payments. Any overpayments and duplicate payments must
immediately be reimbursed to the City.
H. The TPA shall prepare and file with appropriate state agencies the forms
required for the City to maintain its qualifications as a self-insured political
subdivision, as authorized under the State Labor Code, Chapter 504, unless
otherwise advised by the Safety and Risk Manager.
I. The TPA will assume the role and responsibilities of the City's Reporting and
Recovery Agent pursuant to the Medicare, Medicaid, SCHIP Extension Act
(MMSEA) 2007 42 USCA Section 1395, amended. The TPA will prepare and
submit all queries and quarterly reports to the Center for Medicare and
Medicaid Services (CMS) in accordance with the (MMSEA) act at no
additional cost to the City including, but not limited to:
1 . Timely responding to each Conditional Payment Notice (CPN) and
each Conditional Payment Letter (CPQ and Conditional Payment
Response (CPR) received from the Conditional Repayment Center
(CRC) and take all necessary actions accordingly.
2. Timely investigate and respond to each recovery demand letter
issued by the CRC and take all necessary action thereto.
3. Investigate all notices and demands received from the CRC to
determine whether the claims listing of all line items and services paid
are related to the City employee workers' compensation claim.
4. Timely dispute any line item and services that are not related to City
of Corpus Christi employees.
5. Handle negotiations with either the Benefits Coordination Recovery
Center or the CRC as appropriate.
6. Submit payment when appropriate and take all necessary actions
thereto.
7. Keep City apprised of all CPNs, CPLs, and appeals with action taken.
RFP Template 02/03/2025
Page 2 of 13
J. The Loss information is in Exhibit A, through fiscal year 2024.
K. Notwithstanding the existence of mutual options, the contractor has indicated it will
honor pricing for these services totaling $225,000 ($210,000-CAS/$15,000-IMO)
annually for up to a total of five years effective October 1, 2025.
1.2 Scope of Work
A. Workers' Compensation TPA Program Requirements/Responsibilities
1 . The Contractor shall assign an account team to be available 90 days
prior to the start of the contract to ensure a smooth transition with the
current Contractor. The team is expected to be responsive daily to the
City's administrative needs and data reporting needs.
2. The Contractor's account team must include:
a. One senior account executive with at least 5 years' public entity
experience.
b. One dedicated senior workers'compensation adjuster to handle
indemnity claims with at least five years of experience in workers'
compensation, with experience in insurance matters for
municipalities handling no more than 150 open indemnity claims.
c. One qualified, dedicated medical only claims adjuster handling
maximum of 300 medical only claims.
d. One claims supervisor with at least 10 years supervisory public
entity experience.
e. All dedicated adjusters to the City of Corpus Christi account shall
maintain proper adjuster licensing requirements as required by
the Texas Department of Insurance.
Also, it is equally important to provide a list of back-up personnel
detailing, title, position, license and other designations should this
be required. Contractor will replace any member of the account
team who has departed for any reason with a permanent
replacement named no later than 30 days after separation with
equal or greater experience.
RFP Template 02/03/2025
Page 3 of 13
3. The Contractor shall provide a list of all servicing personnel on this
account with a current resume of the designated adjusters) and
backup adjuster who will handle City claims. Any additional personnel
to be involved in City claims handling at a later date should have a
resume submitted for prior consultation with the City.
4. In the event an assigned adjuster be unable to perform the assigned
duties satisfactorily as determined by the City, immediate
replacement of such adjuster is required. The City's Risk Manager will
be consulted in decisions regarding adjusters who will be handling City
claims.
5. The Contractor's hours of operation will be Monday through Friday 8:00
a.m. to 5:00 p.m.
6. The Contractor will collect and report data as required by federal,
State and local authorities, for the purpose of income filings for those
claim payments made by the Contractor and in accordance to best
claims adjusting practice.
7. The Contractor shall provide a full range of workers' compensation
claims administration services in accordance with all requirements of
the Texas Labor Code, Texas Insurance Code, Texas Department of
Insurance Administrative Rules, and the Texas Workers' Compensation
Act.
8. All administrative fines, fees and legal expenses levied by the Texas
Department of Insurance, or any other regulatory body for any
matters under the Contractor's control for failure to comply with the
Texas Workers' Compensation Act and related rules shall be handled
and paid by the Contractor.
9. The Contractor shall follow all rules applicable to HIPPA and any other
similar law.
10. The Contractor shall act as the City's designated Reporting Agency
for Section 111: Mandatory Reporting for Medicare and Medicaid
Extension Act of 2007.
B. Medical Cost Containment must include the following services within their 504
Network and shall treat employees in accordance with the Official Disability
Guideline:
RFP Template 02/03/2025
Page 4 of 13
1. Medical Case Management
2. Utilization review (prospective, concurrent, retrospective and pre-
procedure)
3. Pre-authorization services
4. Medical bill audits
5. Rehabilitation services and work hardening services
6. Vocational case management services
7. Telephonic case management
8. On-line computer services
9. Impairment ratings/review
10. Run-off (per-claim basis)
11. Run-in (per-claim basis)
12. Re-opened prior (per-claim basis)
13. Peer review
14. Attendance at mediation hearings
15. Surveillance
C. Pharmacy Benefit Management (PBM) must include the following services
1 . Audit and pay pharmacy bills in accordance to TDI-DWC fee
guidelines or special discounts negotiated with the providers.
2. Provide bill review, utilization review (prospective, concurrent,
retrospective, pre-procedure) peer review, pre-authorization, and
other workers' compensation PBM services as requested and
approved by the City for non-network claims.
RFP Template 02/03/2025
Page 5 of 13
3. Implement early medication intervention protocols where medication
peer panel reviews are done.
4. Monitor appropriateness of prescriptions) necessity, and continuation
prescription use in relation to the compensable injury.
5. Review pharmacy bills for irregularities, overlapping dates of service,
unrelated fees, and upcoding.
6. Comply with all rules and regulations promulgated by the
Commissioner of Workers' Compensation and all requirements
pursuant to the Texas Workers' Compensation statute.
7. Provide monthly reporting, analysis, trends and improvement
opportunities.
D. Risk Management Information System Requirements (RMIS)
1 . The Contractor will provide an on-line, web/cloud based computer
claims services and tracking system to the City that includes, but is not
limited to, diary narrative, supervisor and adjuster notes, and
electronic access to claims files. The claims system must have a
standard statistical reporting package.
2. The Contractor must identify and proceed to correct any problems of
inoperative software immediately upon notification by the City.
3. The claims system must be capable of generating IRS Form 1099 to
vendors and service providers as required by the Internal Revenue
Code. The Contractor will forward the Forms 1099 as required by
applicable law to the IRS electronically or magnetically based on IRS
guidelines.
4. The claims system must be able to provide special/customized reports,
and the City must be provided access to all claims data with the
capability to generate its own reports when needed. The claim
breakdown is to include, but not be limited to department; accident
type; worker's compensation class code, claimant age, gender and
occupation; claim severity;line of coverage;claimant experience level;
time of day, week and year of accident; and type of equipment
involved.
RFP Template 02/03/2025
Page 6 of 13
5. Should a claims data conversion be required, Contractor shall
accurately convert all claims data and electronic imaging from the
system of the current vendor into useable claims files and provide the
City access to all data no longer than one month from the beginning
of the contract period.
6. The claims system must allow the City to enter the first report of injury
electronically. The City will designate its authorized personnel by
department and Contractor shall be updated monthly.
7. All claims are to be electronic/paperless.
8. The Contractor shall scan and attach all claim documents to the
electronic claim. Physical storage for historical workers' compensation
claim files must be provided.
9. The Contractor must have a comprehensive business
continuity/disaster plan for data recovery in order to continue daily
operations.
10. The Contractor will utilize the same injury codes, classification codes
and departmental codes as the City's current system and
recommended by the City's payroll consultant.
E. Banking/Fund Requirements
1 . The City will make funds available that the Contractor may draw from
for indemnity and medical claims and/or loss or expense payments.
The City will hold all funds for outstanding claims and reserves. A loss
fund will be maintained in an amount agreeable to the Contractor
and to the City.
2. All payments made shall be made by issuance of checks from the
designated City-administered checking account established at the
City's depository bank.The Contractor shall electronically transmit a
check register to the City's Financial Services Department on a
monthly basis. Such check register shall be transmitted by the
Contractor no later than the second business day of the month
following the month to which the check register refers. Weekly check
runs, flash reports and new claims report shall be made in timely
fashion and submitted to the budget analyst and Risk Manager every
Monday morning prior to 12:00 p.m.
3. The Contractor shall transmit, via email, the check number, check
amount and date of the check to the City's depository before a
RFP Template 02/03/2025
Page 7 of 13
check is mailed. In lieu of issuing stop payment requests, the
Contractor shall void the check with the City's depository so that the
request to deny payment remains in effect indefinitely. For each
voided check the Contractor shall transmit to the City's depository via
electronic file transfer the check number, check amount and the date
of the check.
4. The City shall be responsible for balancing and reconciling this
account monthly, including processing of all unclaimed checks.
5. The Contractor will advise the City at least quarterly on the status of
outstanding checks so that the Contractor may determine whether
payment(s) to any payee should be voided and reissued or be
processed as unclaimed property.
6. Duplicate payments of any type which are unrecovered by the
Contractor shall be reimbursed to the City by the Contractor.
7. The Contractor will furnish the City with monthly summaries of the bank
account and expenditures, including a list of all checks, vouchers and
voidedchecks, in numerical sequence. The summaries must include
the following:
a) Claimant Name and Claim Number
b) Date of Issue
c) Amount
d) Payee
e) Type of Benefit Paid
f) Benefit Period
8. The Contractorwill review open reserves with the City's Risk Manager
monthly.
9. The Contractor will be subject to the approval of the excess workers'
compensation insurance company, if requested by the excess insurer,
as maybe applicable.
F. Claims Administration
RFP Template 02/03/2025
Page 8 of 13
1 . The Contractor will provide claims reporting services on a 24-hour basis.
2. Contractor shall contact the claimant and create a file within one
working day from receipt of the initial report.
3. The Contractor agrees to use investigative forms provided by the City,
or otherwise may furnish the forms to the City as may be necessary.
4. The Contractor will investigate, reserve, adjust, settle or decline all
reported claims in accordance with state workers' compensation
statutes and best claims adjusting practices.
5. All claims reported under the contract, including records only,
medical only, indemnity claims, and subrogation will be administered
until fully settled, regardless of the period of time involved or required,
in accordance with the fee structures indicated in the contract for
services. Approval of the City's Risk Manager is required before
discounting any subrogation lien.
6. Contesting the decision of any hearing officer requires the approval
of the City's Risk Manager.
7. The Contractor shall assign a reported claim to an adjuster within 24
hours ofthe Contractor's receipt of notice of injury.
8. The assigned adjuster will contact, or attempt to contact, all claimants
within 24 hours of receiving notice of claim assignment.
9. The Contractor will contact the injured employee's department and
medical provider within two business days of notification of an injury.
10. The Contractor will obtain recorded statements from claimants within
two (2) business days of notification of injury. In addition, the
Contractor will obtain recorded statements from any witness when
there is any lost time involved inthe claim.
11. The Contractor will advise the City prior to denying any claimor prior to
final disposition of any claim settlement that is outside the settlement
authority granted to the Contractor by the City. Any request for
settlement authority or declinations will be submitted in writing to the
City with the following information:
a) A description of the facts and nature of the incident
RFP Template 02/03/2025
Page 9 of 13
b) A description of the damages and/or injuries
c) An evaluation of the incident
d) The claimant's demand
e) The amount for which authority is requested
12. The City will reserve the right to direct the handling of any claim or to
take over the handling of any claim at any time during the life of the
service agreement and/or the life of the claim only when necessary.
13. The Contractor will monitor medical treatment of injured employees
and obtain appropriate medical reports.
14. On all claims reserved in excess of $50,000, periodic written reports, at
least bi-monthly, will be provided by the Contractor/TPA to City
accompanied by any pertinent file materials. As an alternative,
Contractor/TPA shall have the ability to submit reports electronically
through the Information System (IS).
15. The Contractor will keep all open claims on a current diary system,which
provides for periodic review by the assigned adjuster. Each file shall be
reviewed and updates as necessary, but not less than once every 30
days.
16. The Contractor will audit medical, hospital and miscellaneous invoices
prior to approving for payment.
17. The City will retain the right to select its own medical service providers,
as well asothers utilized for special claims handling procedures, inclusive
of internal medical resources; i.e., nurse practitioners.
18. The Contractor will authorize medical treatment and indemnity
benefits considered related, customary and necessary, issue checks
or authorize payments for treatment and benefits. The payment of
indemnity and medical benefits must be in accordance with the
express authorization issued by the Cityto the Contractor.
19. The Contractor will conduct an on-site investigation of any claim at the
request of the City within 24 hours of receiving the first notice of loss. At
the discretion of the City, claims with severe loss potential will be
investigated on the same day the claim is reported.
RFP Template 02/03/2025
Page 10 of 13
20. The Confracforwill prepare and provide the City with narrative reports
for seriousor contested injuries,when appropriate and as requested by
the City.
21. The Contractor will be alert and aggressively pursue subrogation, excess
insurance reimbursement and third-party liens and make every effortfo
secure and pursue the City's rights of recovery.
22. The Contractor shall prepare and maintain files necessary for legal
defense of claims or litigation.
23. The Contractor shall report all indemnity claims to the Index Bureau
upon file creation at no charge to the City with a copy to the file
24. The Contractor will negotiate settlement with injured employees, their
attorney or representatives within the discretionary settlement
authority.
25. The Contractor will consult with the City and defense attorneys in the
settlementof litigated claims, and provide and monitor files for the
defense and outcome ofthese litigated claims.
26. The Contractor may assist in the recommendation and selection of
defense attorney(s); however, the City will retain the right to select the
attorney(s) if chooses.
27. The Contractor will be available to assist in the development and/or
implementation of written procedures and instructions to assure
quality and ongoing operation of the City's claims management
program.
28. Medical Claims shall be reviewed by the handling claims adjuster and
supervisor every 30 days for possible closure.
29. Reserves will be reviewed by Claims Supervisor every 90 days and
adjusted according to claim development.
30. Reserves for death benefit claims shall be approved by the Safety and
Risk Manager.
31. Approval from the Safety and Risk Manager will be required for
surveillance, life expectancy plans and vocational rehabilitation.
RFP Template 02/03/2025
Page 11 of 13
32. Contractor shall adhere by the Salary Continuation policies of the City
for Police and Fire uniformed personnel.
33. Contractor shall notify and provide the injured employee with an
explanation of Temporary Benefits (TIBS), Impairment Income Benefits
(IIBS), Supplemental Income Benefits, Lifetime Income Benefits (LIBS)
and Death Income Benefits (DIBS) as applicable.
34. Contractor shall request review of all impairment ratings over 10% and
notify the City of all impairment ratings above 15%.
35. Contractor shall allow the City the opportunity to participate in regular
training sessions or seminars held for its servicing personnel.
36. Upon expiration or termination of the contract resulting from this RFP,
within 30 days of the City's request, at no additional cost to the City,
the current Contractor shall provide the new Contractor with all data
requested by the City.
37. Contractor will meet with the City's Safety and Risk Manager at a
location of the City's choosing at least quarterly to review the status
and/or handling of all open claims and any other matters at the
discretion of the City. An annual stewardship meeting will also be
conducted.
38. Contractor shall cooperate and comply with the City, the City's
Insurance Broker of Record, City Liability claims adjusters/attorneys,
the excess insurance carrier and Actuarial Consultant. Contractor
shall respond to inquiries within one business day.
39. The Contractor will notify the City's Risk Manager via email within 48
hours that a Benefit Review Conference or Contested Case Hearing
has beEnscheduled.
1.3 Quality Control
A. Contractor must have policies and procedures in place to ensure and
measure internal quality control. The policies and procedures should address
all aspects ofthe claims handling process, including, but not limited to:
1 . Claims adjuster/supervisor caseloads for employers' liability and
workers'compensation
2. Claims file documentation requirements
RFP Template 02/03/2025
Page 12 of 13
3. Web-based training program upon request
4. Investigation and communication
5. Initial contact with injured employee
6. Recorded statements
7. Reserving guidelines
8. Frequency of reviews of open claim reserves
9. Diary system maintained for all claim activities
10. Frequency of supervisor's review of each adjuster's claim files
11. Frequency of follow-up contacts with workers'
compensation lost-timeclaimants
12. Subrogation procedures
13. Litigation/attorney management
14. Expense controls of other vendors
15. Special investigation or surveillance procedures
16. Compliance with excess insurance reporting requirements
17. General client servicing requirements and guidelines
18. Index bureau query and reporting guidelines
B. Contractor will furnish administration with best practice operation manuals,
including instructions and forms within 30 days following the effective date
of the awarded contract.
1.4 Quality Assurance
The Contractorwill be subject to periodic claims audits by an independent firm at
the discretion of the City. The purpose of such an audit is to measure compliance
with the agreed-upon claims administration servicing standards desired by the
City.
RFP Template 02/03/2025
Page 13 of 13
�a .'.: Attachment B - Bid/Pricing Schedule
CITY OF CORPUS CHRISTI
Pricing Form
I - CONTRACTS AND PROCUREMENT
RFP No. 6360
xa�a Workers' Compensation Third-Potty Administrator
Services
PAGE 1 OF 2
' DATE: 4/16/202,5
j
CAS-Claims Administrative Services
PROPOSER U.THOR D SIGNATURE
1:. Refer to "Instructions to,Proposers" and Contract Terms and Conditions:before completing
proposal.
2. Provide your best price for eachi item.
3. In submitting this proposal, Proposer certifies that:
a. The prices in this proposal have been arrived at independently, without consultation,
communication, or agreement with any other Proposer or competitor, for the purpose
of restricting competition with regard to prices.
b. Proposer is an Equal Opportunity Employer; and the Disclosure of Interest information
on file with City's Contracts and Procurement office, pursuant to the Code of
Ordinances, is current and true.
c. Proposer has incorporated any changes issue through Addenda to the RFP in this
1
pricing. 1
I. : 3
"504.Network Pricin Option '
�_ .. Irtdemnit....... P.er claim flat fee .
.... .
$Q .uotin g..
2 ;Medical -Only Per claim $Quoting flat fee
3.., (.Report ..Only - _ _.... . Per claim_._.'.$:Quoting"fiat fee.
4 Indemnity ,Per claim $ .Quoting flat fee
5
i Medical-Only Per claim $ Quoting fla ee _
6 Other _ Per claim :$ Quotin flat fee
_ , g _
7 Indemnity _ Per claim $ Quoting flat fee. 1
8 Medicai -Only Per claim $ Quoting flat fee
9 Other Per claim $.Quoting flat fee
Y
10 Medical Case Management Per claim $95.00/100+ Mileage
11 Utilization Review Services Per claim $170
12 Medical Bill Audits Per. claim $1-.5- 9.00 1
i 13 Use of 504 Physician Panel Network Per claim $M * includes 3 hours
of TCM 150*
14 Rehabilitation Services _ Per claim [$95
93
{
f
f
Page 1 of 3
i
I
Page 2 of 2 i
I
i
15 Vocatiorial Case Management-Services Per claim $95 0
16 Return to Work/Medical Provider Programs Per claim $Included in Access
Fee
17 Online Computer-Services Per claim Included
18 Attending DWC Hearings(BRC and CCH) Per claim $See Note
19 Attending Mediation Hearings Per claim $At Cost
20 Impairment Rating Review Per claim $350
21 Pursuing Subrogation Per claim $See.Note
22 Re-op:en prior claims Per claim $Quoting flat`fee I
23 Per claim
Peer Revievd $270 + provider fee g
24 Attorney Fees - _- .. Per claim $At cost
25 Precertification : .-Per claim $Included. in UR Fee f
F
7Administrative Fee 12 months $Quoting flat fee
t ;
Optlonal Flat Annual Fee (in lieu of all costs $210,OOQ for items 1-9
and fees shown above)
Additional Cost Containment Services Offered
E-Intelemed Early Intervention $150.00 per call
Retrospective Review $165,00 per request
IRO $170.00 per request
DD's and RME's $375.00 per request
Liability Medical Assessments Cost as quoted above +2%of Medical Cost Savings Not to
Exceed$1,000)
Pharmacy Benefit Manager:9%of savings
*The assigned,adjuster will handle BRC and CCH hearings at no additional cost. For more E
complex cases that require and attorney, the file will be charged at cost.
*The majority of cases are handled in-house by the CAS Adjuster at no additional cost. For more
complex cases, an outside vendor or attorney may be hired at a percentage of-recovery,which I
is allocated to the file at cost.
II
I
r
i
i
f
i
1
i
i Page 2 of 3 i'
City of Corpus Christi I RFP 636014.22.2025
Option 1: With IMO
CAS is confident that we can provide your injured employees the best possible services while
4.0 simultaneously controlling costs by utilizing a comprehensive, custom-designed self-insured
program. GAS' efforts to accomplish this goal are driven by taking a preemptive approach to
safety and claims handling. This approach has resulted in the successful retention of 98%of
our clients since program inception.
Annual Flat Fee $210;00b: ,
Bill Review
per pill
Annual Administration Fee $15;000
...
$04 Healthcare Network $150 S4A8 per claim filed we
✓ Claim Setup ✓ Check stock&Issuing ✓ Answering WC legal
✓ Initial contact with checks questions
claimant ✓ Regular meetings with client ✓ Supervisor review of claims
✓ Initial contact with insured ✓ Reports ✓ Monitoring medical treatment
✓ Initial contact with doctor. ✓ Litigation management ✓ Reviewing claims with clients
✓ Faxes ✓ Travel expenses ✓ Excess carrier reporting
✓ Photocopying ✓ Communication with ✓ Compliance with EDI
✓ Photographs employee Requirements for insurance
✓ Telephone ✓ Mileage,except extraordinary Carrier
✓ Mail ✓ Express mail,except 504 Network Admin Includes: 1 I
✓ Filing of 1099's extraordinary ✓ Network Access I
✓ Airfare,except ✓ Obtain records,except ✓ TCM for Medical Only&Lost
} I extraordinary extraordinary Time Claims
✓ Loss runs- ✓ Communication with doctor ✓ Complaint Process
✓ Optimum Care Program ✓ Visits by adjuster ✓ Appeal Process {
• Setting.IME appointments ✓ Recorded statements ✓ TV Data Call
✓ Administering benefits ✓ Filing state forms timely ✓ Quality Improvement Plan
timely ✓ Subrogation management ✓ Provide Direct
✓ Annual re rts,. Credentialln Contractin
• Attorney fees ✓'Cost for obtaining/capying ✓ Extraordinary travel expenses
✓ 'Court costs of public/medical records Incurred by CAS
✓ Medial opinions ✓ Cost for photography, ✓ Cost associated with
✓ Independent Medical preparation of maps, occupational rehabilitation
Examination diagrams,or physical ✓ Medical case management
✓ Cost of surveillance analysis ✓ Pre-authorizatlon or
✓ Cast of employing experts' ✓ Cost for property damage utilization
testimony appraisal fees ✓ Peer Review
✓ Witness fees ✓ Cost for auto damage ✓.Risk Services
✓ Witness travel expenses appraisal fees ✓ Subrogation recovery(46 of
✓ Interest paid as result of ✓ Cost associated with bank recovery)
litigation account or Its'maintenance ✓ Specialty bill review
j
i
i
Page 3 of 3
Attachment C - Insurance Requirements
A. Contractor must not commence work under this agreement until all
insurance required herein has been obtained and approved by the
City's Risk Manager. Contractor must not allow any subcontractor to
commence work until all similar insurance required of the
subcontractor has been so obtained.
B. Contractor must furnish to the City's Risk Manager and Contract
Administrator, two (2) copies of Certificates of Insurance with
applicable policy endorsements showing the following minimum
coverage by an insurance company(s) acceptable to the City's Risk
Manager. The City must be listed as an additional insured for the
General Liability and Auto Liability policies by endorsement, and a
waiver of subrogation is required on all applicable policies.
Endorsements must be provided with Certificate of Insurance. Project
name and/or number must be listed in Description Box of COL
TYPE OF INSURANCE MINIMUM INSURANCE COVERAGE
30-written day notice of Bodily Injury and Property Damage
cancellation, required on all Per occurrence- aggregate
certificates or by applicable
policy endorsements.
PROFESSIONAL LIABILITY $1,000,000 Per Claim
(Errors and Omissions) (Defense costs not included in face
value of the policy) If claims made
policy, retro date must be prior to
inception of agreement, have
extended reporting period provisions
and identify any limitations regarding
who is insured.
CRIME/EMPLOYEE DISHONESTY $1,000,000 Per Occurrence
Contractor shall name the City of
Corpus Christi, Texas as Loss
Payee
Additional Requirements -
A. The Professional liability and Crime coverage through a licensed
insurance company must be written on a policy and endorsements
approved by the Texas Department of Insurance. The workers'
Page 1 of 3
compensation coverage provided must be in an amount sufficient to
assure that all workers' compensation obligations incurred by the
Contractor will be promptly met. An All States endorsement shall be
required if Contractor is not domiciled in the State of Texas.
B. Contractor shall obtain and maintain in full force and effect for the
duration of this Contract, and any extension hereof, at Contractor's
sole expense, insurance coverage written on an occurrence basis, by
companies authorized and admitted to do business in the State of
Texas and with an A.M. Best's rating of no less than A- VII.
C. Contractor shall be required to submit replacement Certificate of
Insurance to City at the address provided below within ten days of
any change made by the Contractor or as requested by the City.
Contractor shall pay any costs incurred resulting from said changes.
All notices under this Article shall be given to City at the following
address:
City of Corpus Christi
Attn: Risk Management
P.O. Box 9277
Corpus Christi, TX 78469-9277
D. Contractor agrees that with respect to the above required insurance,
all insurance policies are to contain or be endorsed to contain the
following required provisions:
1. List the City and its officers, officials, employees, and
volunteers, as additional insureds by endorsement with regard
to operations, completed operations and activities of or on
behalf of the named insured performed under contract with
the City, with the exception of the workers' compensation
policy.
2. Provide for an endorsement that the "other insurance" clause
shall not apply to the City of Corpus Christi where the City is an
additional insured shown on the policy;
3. Workers' compensation and employers' liability policies will
provide a waiver of subrogation in favor of the City; and
4. Provide 30 calendar days advance written notice directly to
City of any cancellation, non-renewal, material change or
Page 2 of 3
termination in coverage and not less than ten calendar days
advance written notice for nonpayment of premium.
E. Within five calendar days of a cancellation, non-renewal, material
change or termination of coverage, Contractor shall provide a
replacement Certificate of Insurance and applicable endorsements
to City. City shall have the option to suspend Contractor's
performance should there be a lapse in coverage at any time during
this contract. Failure to provide and to maintain the required
insurance shall constitute a material breach of this contract.
F. In addition to any other remedies the City may have upon
Contractor's failure to provide and maintain any insurance or policy
endorsements to the extent and within the time herein required, the
City shall have the right to order Contractor to stop work hereunder,
and/or withhold any payment(s) which become due to Contractor
hereunder until Contractor demonstrates compliance with the
requirements hereof.
G. Nothing herein contained shall be construed as limiting in anyway the
extent to which Contractor may be held responsible for payments of
damages to persons or property resulting from Contractor's or its
subcontractor's performance of the work covered under this
contract.
H. It is agreed that Contractor's insurance shall be deemed primary and
non-contributory with respect to any insurance or self-insurance
carried by the City of Corpus Christi for liability arising out of operations
under this contract.
I. It is understood and agreed that the insurance required is in addition
to and separate from any other obligation contained in this
agreement.
2025 Insurance Requirements Exhibit
Legal Dept./Risk Management
Worker's Compensation TPA Services
2/3/2025 Risk Management -Legal Dept,
Page 3 of 3
Attachment D - Warranty Requirements
"No warranty required for this Agreement."
Page 1 of 1