Workers’ Compensation Medical Bill Repricing and Payment Services

The Regional Transportation District (RTD) seeks a vendor to review, reprice, and manage medical bills for workers’ compensation claims. This includes ensuring compliance with the Colorado Workers’ Compensation Fee Schedule and utilizing Preferred Provider Organization (PPO) discounts and other negotiated cost reductions. Join us in improving efficiency and reducing costs.

RTD is a political subdivision of the State of Colorado and manages its workers’ compensation claims through a self-insured and self-administered program. The required services are outlined below:

1. Claims data from RTD’s claims management system, Origami, will be provided to the selected vendor via a secure, encrypted interface.

2. Medical bills will be sent to the vendor directly by the medical provider, preferably through a clearinghouse.

3. The vendor must provide RTD with a secure method to transfer medical bills received by the RTD Risk Management department.

4. Claims specialists must have access to the vendor’s portal to authorize payment or deny payment for medical treatment invoices.

5. The vendor is required to reprice medical bills per the relevant Colorado Workers’ Compensation Fee Schedule, PPO discounts, or other negotiated cost reductions.

6. Payments must be made within 30 days of receipt, following the Colorado Rules of Procedure 16-10 Payment Requirements for Medical Bills.

7. A bank reconciliation must be performed monthly.

8. The vendor must identify duplicate billings to ensure duplicate payments are not made.

9. All provider inquiries regarding bill reductions must be handled within 24 hours.

10. An Explanation of Review (EOR) must be provided to all providers.

11. Payment data, images of medical invoices, and PDFs of EORs must be made available through an encrypted SFTP site for uploading into the individual claim records in Origami.

12. Form 1099s must be issued annually to all payees in compliance with Internal Revenue Service (IRS) deadlines.

13. The vendor must provide semi-annual reports outlining bill review activity, savings, and costs, as well as any ad hoc reports as necessary.

14. Monthly invoices must be submitted, including a detailed breakdown of costs and types of savings achieved.