The vendor required to provide workers compensation claims service categories include 24/7 services, telehealth services, nurse case management services, and return to work services.
- 24/7 services
1. 24/7 first report of injury reporting (FROI)
• This service shall require bidders to interface with agency toll-free telephone number(s) from which reports of injury shall be accepted from a agency -insured employer.
• This category shall be available and accessible to policyholders and agency 24 hours per day, 7 days per week (“24/7”).
• Calls received with respect to this service may pertain to a broad scope of injuries, ranging from minor first aid/incidents to injuries that are severe in nature.
2. 24/7 telephonic nurse triage (TNT)
• This service shall require bidders to interface with agency toll-free telephone number(s) from which the injured worker shall speak with a registered nurse who shall assist the injured worker in determining whether self-care or professional treatment is appropriate.
• This category shall be available and accessible to injured workers, policyholders and agency 24 hours per day, 7 days per week (“24/7”).
• Calls received with respect to this service may pertain to a broad scope of injuries, ranging from minor first aid/incidents to injuries that are severe in nature.
- Telehealth services
• This service shall require bidders to provide a telehealth service option to injured workers that have received FROI and TNT services (under category a described above) and require medical evaluation.
• Medical evaluation shall be performed by a state licensed and board-certified physician, delivered by 2- way, audio and video electronic communication, under the terms set forth under section 325-1.26 of title 12 agency, applicable sub-divisions, and state board bulletins and subject numbers pertaining to emergency medical aid and telemedicine.
- Nurse case management services
1. Nurse case management
• This service shall require bidders to provide workers’ compensation claim services related to nurse case management including, but not limited to, medical and supplemental documentation review, coordination of claimant hospitalization discharge, transportation, home health care and medically necessary equipment, medical cost containment, prescription medication review, periodic narrative reports and return-to-work services.
2. Managed care services for catastrophic claims
• This service shall require bidders to provide workers’ compensation claim services related to catastrophic claims including, but not limited to, services that achieve the highest quality of life and medical stability for the claimant with a return-to-work goal, if possible.
• Catastrophic claims result from sudden, traumatic occupational injuries that are severe in nature, occupational diseases incurred over time, or medical complications that are secondary to conditions originally allowed in a claim.
• Catastrophic injuries may result in, but are not limited to, quadriplegia, paraplegia, brain injury, major extremity or multiple extremity amputations, total industrial blindness, excessive hospitalizations and excessive burns.
• Servicing of catastrophic claims requires a multi-disciplinary approach that enables practitioners to assess the impact of injuries, the psychological implications of impact to income stream, the multifaceted health service delivery system, the medical treatment regimens, the disease management protocols and understanding the limitations of the workplace.
- Return to work services
• This service shall require bidders to provide workers’ compensation claim services related to a return-to-work program, including but not limited to: the review of medical and supplemental documentation, claim assessment, capability assessment, employer job assessment reviews, periodic narrative reports, working with the existing employer to identify job functions that can be modified, along with creating jobs for the future.
• It might also include providing testimony at hearings before the state board as may be necessary.
• This service shall also require bidders to provide workers’ compensation claim services to assist injured workers in identifying new jobs when they are unable to return to their previous employer, including but not limited to: skill analysis and improvement, providing career counseling and assistance to injured workers that includes resume drafting, job searches, interview preparation, interview follow-up and motivational support, conducting labor market surveys, loss of wage earning capacity reports, work search record checks.
- Contract Period/Term: 5 years
- Questions/Inquires Deadline: February 26, 2026
