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HomeMy WebLinkAbout2016-223 CONT Addendum #1 & Contract - Tristar Risk Mgmt v IRSTADDENDUM 'M CONTRACT 1"his First Addendum to Contract ("First Addendum-), effective.Tuly 1. 2016 is incorporated into and made part of that certain Contract for Workers' CoMpensation TPA Services effective July 1, 2016 ("Contract" by and between TR.ISTAR. Risk Management (hereinafter referred to as "Conti-actor" or "Third Party Administrator") and the City of Ashland (hereinafter referred to as "City" or "Self= Insurer"). WHEREAS, the Oregon Insurance :division regulates written agreements between service companies or third party administrators and self insurers render Oregon StatutCS Chapter 731; and WHEREAS, the Oregon Statutes require that agreements entered into between self-insurers and service companies be approved by the Director of the Workers Compensation Division and that such agreements contain a provision granting the service company or third party aldininistrator a power of attorney to act for self-insurer in wrorkers* compensation coverage and claims proceedings under ORS chapter 656, and NOW THEREFORE., in consideration of the covenants and agreements set forth herein and for other good and valuable consideration, the receipt and SUfficiency of which are hereby- acknowledged, the Self= Insurer and J'hird Party Administrator hereby agree as folli)Ws: 1. In accordance with Oregon Revised Statutes ((',)RS) Section 731.=f75(3)(b), Self-Insurer hereby grants Third Party Administrator a power of attorney for the limited purpose of acting on behalf of the Self= Insurer in workers' compensation coverage and claim proceedings under ORS chapter 656. 2. The specific terms and conditions for claaElTaS administrative, iiivestigativc and ad* lustinent services are memorialized in the Contract. Any services not allowed in Oregon will not be used and are not considered part ofthe Contract. 3. The Third Party Administrator shall retain and inake available at its office located at 10300 Ski' Greenburg Rd., 4440, 0, :Portland. OR. 97?23 copies of the following records as required by Oregon Administrative Rule 436-050-0120: a. Records used and relied upon in processing claims; and b. Complete records of all payments regUested by 'third Party Adininistrator to be made as aI result of any workers' compensation claim presented to the Sc lf-Insurer and arising Linder (:)reg{)Ia statute a. All other terins and conditions of the Contract not modified by this 1"irst Addendum are hereby ratified and affirmed. IN WITNESS WHEREOF, the parties hereto have caused this First Addendum to be executed in duplicate by their authorized representatives on the dates set forth below. City of Ashland TRISTAR-Risk Klan en_t.._. B y: . - µw-.._ f Tlzoams Veale } rint Namc: >Av~ t t'~ti c i Hiit Name: Title: 1 ii.(c: President Date: Date ' Contract for Workers' Compensation TPA Services CITY OF CONSULTANT: TRISTAR Risk Management -1S H LA N D CONTACT: Amy Stone, Branch Manager 20 East Main Street y Ashland, Oregon 97520 ADDRESS: 100 Oceangate, Suite 700 Telephone: 541/488-6002 Long Beach, CA 90802 Fax: 541/488-5311 TELEPHONE: 971-925-1300, Ext. 1920 DATE AGREEMENT PREPARED: June 25, 2016 EMAIL: amy.stone@tristargroup. net BEGINNING DATE: Jul 1, 2016 COMPLETION DATE: June 30, 2018 COMPENSATION: Cost Proposal is attached as Exhibit C SERVICES TO BE PROVIDED: Workers' Compensation Third Party Administration Services, Per RFP released April 24, 2016 and proposal submitted b TRISTAR Risk Management. ADDITIONAL TERMS: Contract may be extended annually for up to three (3) additional years for a maximum term of five (5) years. In the event of conflicts or discrepancies among the contract documents, the City of Ashland Contract for Personal Services will be primary and take precedence, and any exhibits or ancillary contracts or agreements having redundant or contrary provisions will be subordinate to and interpreted in a manner that will not conflict with the said primary City of Ashland Contract. FINDINGS: Pursuant to AMC 2.50.120, after reasonable inquiry and evaluation, the undersigned Department Head finds and determines that: (1) the services to be acquired are personal services; (2) the City does not have adequate personnel nor resources to perform the services; (3) the statement of work represents the department's plan for utilization of such personal services; (4) the undersigned consultant has specialized experience, education, training and capability sufficient to perform the quality, quantity and type of work requested in the scope of work within the time and financial constraints provided; (5) the consultant's proposal will best serve the needs of the City; and (6) the compensation negotiated herein is fair and reasonable. NOW THEREFORE, in consideration of the mutual covenants contained herein the CITY AND CONSULTANT AGREE as follows: 1. Findings / Recitations. The findings and recitations set forth above are true and correct and are incorporated herein by this reference. 2. All Costs by Consultant: Consultant shall, at its own risk and expense, perform the personal services described above and, unless otherwise specified, furnish all labor, equipment and materials required for the proper performance of such service. 3. Qualified Work: Consultant has represented, and by entering into this contract now represents, that all personnel assigned to the work required under this contract are fully qualified to perform the service to which they will be assigned in a skilled and worker-like manner and, if required to be registered, licensed or bonded by the State of Oregon, are so registered, licensed and bonded. 4. Completion Date: Consultant shall start performing the service under this contract by the beginning date indicated above and complete the service by the completion date indicated above. 5. Compensation: City shall pay Consultant for service performed, including costs and expenses, the sum specified above. Payments shall be made within 30 days of the date of the invoice. Should the contract be prematurely terminated, payments will be made for work completed and accepted to date of termination. 6. Ownership of Documents: All documents prepared by Consultant pursuant to this contract shall be the property of City. 7. Statutory Requirements: ORS 279C.505, 279C.515, 279C.520 and 279C.530 are made part of this contract. 8. Living Wage Requirements: If the amount of this contract is $20,283.20 or more, Consultant is required to comply with chapter 3.12 of the Ashland Municipal Code by paying a living wage, as defined in this chapter, to all employees performing work under this contract and to any Subcontractor who performs 50% or more of the service work under this contract. Consultant is also required to post the notice attached hereto as Exhibit B predominantly in areas where it will be seen by all employees. 9. Indemnification: Consultant agrees to defend, indemnify and save City, its officers, employees and agents harmless from any and all losses, claims, actions, costs, expenses, judgments, subrogations, or other damages resulting from injury to any person (including injury resulting in death), or damage (including loss or destruction) to property, of whatsoever nature arising out of or incident to the performance of this contract by Consultant (including but not limited to, Consultant's employees, agents, and others designated b Consultant to perform work or services Contract for Workers' Compensation TPA Services, Page 1 of 5 attendant to this contract). Consultant shall not be held responsible for any losses, expenses, claims, subrogations, actions, costs, judgments, or other damages, directly, solely, and proximately caused by the negligence of City. 10. Termination: a. Mutual Consent. This contract may be terminated at any time by mutual consent of both parties. b. City's Convenience. This contract may be terminated at any time by City upon 30 days' notice in writing and delivered by certified mail or in person. C. For Cause. City may terminate or modify this contract, in whole or in part, effective upon delivery of written notice to Consultant, or at such later date as may be established by City under any of the following conditions: i. If City funding from federal, state, county or other sources is not obtained and continued at levels sufficient to allow for the purchase of the indicated quantity of services; ii. If federal or state regulations or guidelines are modified, changed, or interpreted in such a way that the services are no longer allowable or appropriate for purchase under this contract or are no longer eligible for the funding proposed for payments authorized by this contract; or iii. If any license or certificate required by law or regulation to be held by Consultant to provide the services required by this contract is for any reason denied, revoked, suspended, or not renewed. d. For Default or Breach. i. Either City or Consultant may terminate this contract in the event of a breach of the contract by the other. Prior to such termination the party seeking termination shall give to the other party written notice of the breach and intent to terminate. If the party committing the breach has not entirely cured the breach within 15 days of the date of the notice, or within such other period as the party giving the notice may authorize or require, then the contract may be terminated at any time thereafter by a written notice of termination by the party giving notice. ii. Time is of the essence for Consultant's performance of each and every obligation and duty under this contract. City by written notice to Consultant of default or breach may at any time terminate the whole or any part of this contract if Consultant fails to provide services called for by this contract within the time specified herein or in any extension thereof. iii. The rights and remedies of City provided in this subsection (d) are not exclusive and are in addition to any other rights and remedies provided by law or under this contract. e. Obligation/Liability of Parties. Termination or modification of this contract pursuant to subsections a, b, or c above shall be without prejudice to any obligations or liabilities of either party already accrued prior to such termination or modification. However, upon receiving a notice of termination (regardless whether such notice is given pursuant to subsections a, b, c or d of this section, Consultant shall immediately cease all activities under this contract, unless expressly directed otherwise by City in the notice of termination. Further, upon termination, Consultant shall deliver to City all contract documents, information, works-in-progress and other property that are or would be deliverables had the contract been completed. City shall pay Consultant for work performed prior to the termination date if such work was performed in accordance with the Contract. 11. Independent Contractor Status: Consultant.is an independent contractor and not an employee of the City. Consultant shall have the complete responsibility for the performance of this contract. Consultant shall provide workers' compensation coverage as required in ORS Ch 656 for all persons employed to perform work pursuant to this contract. Consultant is a subject employer that will comply with ORS 656.017. 12. Assignment and Subcontracts: Consultant shall not assign this contract or subcontract any portion of the work without the written consent of City. Any attempted assignment or subcontract without written consent of City shall be void. Consultant shall be fully responsible for the acts or omissions of any assigns or Subcontractors and of all persons employed by them, and the approval by City of any assignment or subcontract shall not create any contractual relation between the assignee or subcontractor and City. 13. Default. The Consultant shall be in default of this agreement if Consultant: commits any material breach or default of any covenant, warranty, certification, or obligation it owes under the Contract; its QRF status pursuant to the QRF Rules or loses any license, certificate or certification that is required to perform the Services or to qualify as a QRF if consultant has qualified as a QRF for this agreement; institutes an action for relief in bankruptcy or has instituted against it an action for insolvency; makes a general assignment for the benefit of creditors; or ceases doing business on a regular basis of the type identified in its obligations under the Contract; or attempts to assign rights in, or delegate duties under, the Contract. 14. Insurance. Consultant shall at its own expense provide the following insurance: a. Worker's Compensation insurance in compliance with ORS 656.017, which requires subject employers to provide Oregon workers' compensation coverage for all their subject workers b. Professional Liability insurance with a combined single limit, or the equivalent, of not less than Enter one: $250,000, $500,000, $1,000,000, $2,000,000 or Not Applicable for each claim, incident or occurrence. This is to cover damages caused by error, omission or negligent acts related to the professional services to be provided under this contract. C. General Liability insurance with a combined single limit, or the equivalent, of not less than $2,000,000 for each occurrence for Bodily Injury and Property Damage. d. Automobile Liability insurance with a combined single limit, or the equivalent, of not less than Enter one: Contract for Workers' Compensation TPA Services, Page 2 of 5 mom" $100',000, $500,000, $1,000,000, or Not Applicable for each accident for Bodily Injury and Property Damage, ' including coverage for owned, hired or non-owned vehicles, as applicable. e. Notice of cancellation or change. There shall be no cancellation, material change, reduction of limits or intent not to renew the insurance coverage(s) without 30 days' written notice from the Consultant or its insurer(s) to the City. f. Additional Insured/Certificates of Insurance. Consultant shall name The City of Ashland, Oregon, and its elected officials, officers and employees as Additional Insureds on any insurance policies, excluding Professional Liability and Workers' Compensation, required herein, but only with respect to Consultant's services to be provided under this Contract. The consultant's insurance is primary and non-contributory. As evidence of the insurance coverages required by this Contract, the Consultant shall furnish acceptable insurance certificates prior to commencing work under this contract. The certificate will specify all of the parties who are Additional Insureds. Insuring companies or entities are subject to the City's acceptance. If requested, complete copies of insurance policies; trust agreements, etc. shall be provided to the City. The Consultant shall be financially responsible for all pertinent deductibles, self-insured retentions and/or self-insurance. 15. Governing Law; Jurisdiction; Venue: This contract shall be governed and construed in accordance with the laws of the State of Oregon without resort to any jurisdiction's conflict of laws, rules or doctrines. Any claim, action, suit or proceeding (collectively, "the claim") between the City (and/or any other or department of the State of Oregon) and the Consultant that arises from or relates to this contract shall be brought and conducted solely and exclusively within the Circuit Court of Jackson County for the State of Oregon. If, however, the claim must be brought in a federal forum, then it shall be brought and conducted solely and exclusively within the United States District Court for the District of Oregon filed in Jackson County, Oregon. Consultant, by the signature herein of its authorized representative, hereby consents to the in personam jurisdiction of said courts. In no event shall this section be construed as a waiver by City of any form of defense or immunity, based on the Eleventh Amendment to the United States Constitution, or otherwise, from any claim or from the jurisdiction. 16. THIS CONTRACT AND ATTACHED EXHIBITS CONSTITUTE THE ENTIRE AGREEMENT BETWEEN THE PARTIES. NO WAIVER, CONSENT, MODIFICATION OR CHANGE OF TERMS OF THIS CONTRACT SHALL BIND EITHER PARTY UNLESS IN WRITING AND SIGNED BY BOTH PARTIES. SUCH WAIVER, CONSENT, MODIFICATION OR CHANGE, IF MADE, SHALL BE EFFECTIVE ONLY IN THE SPECIFIC INSTANCE AND FOR THE SPECIFIC PURPOSE GIVEN. THERE ARE NO UNDERSTANDINGS, AGREEMENTS, OR REPRESENTATIONS, ORAL OR WRITTEN, NOT SPECIFIED HEREIN REGARDING THIS CONTRACT. CONSULTANT, BY SIGNATURE OF ITS AUTHORIZED REPRESENTATIVE, HEREBY ACKNOWLEDGES THAT HE/SHE HAS READ THIS CONTRACT, UNDERSTANDS IT, AND AGREES TO BE BOUND BY ITS TERMS AND CONDITIONS. 17. Nonappropriations Clause. Funds Available and Authorized: City has sufficient funds currently available and authorized for expenditure to finance the costs of this contract within the City's fiscal year budget. Consultant understands and agrees that City's payment of amounts under this contract attributable to work performed after the last day of the current fiscal year is contingent on City appropriations, or other expenditure authority sufficient to allow City in the exercise of its reasonable administrative discretion, to continue to make payments under this contract. In the event City has insufficient appropriations, limitations or other expenditure authority, City may terminate this contract without penalty or liability to City, effective upon the delivery of written notice to Consultant, with no further liability to Consultant. Certification. Consultant shall sign the certification attached hereto as Exhibit A, nd herein incorporated b reference. onsu ant: City o~Ashland By By Signature Depa ent Head Print Name Print Name tl Title Date W-9 One copy of a W-9 is to be submitted with the signed contract. Purchase Order No. AP S O FORD Ashlers . Q y Attorney net ~ Contract for Workers' Compensation TPA Services, Page 3 of 5 . EXHIBIT A CERTIFICATIONS/REPRESENTATIONS: Contractor, under penalty of perjury, certifies that (a) the number shown on the attached W-9 form is its correct taxpayer ID (or is waiting for the number to be issued to it and (b) Contractor is not subject to backup withholding because (i) it is exempt from backup withholding or (ii) it has not been notified by the Internal Revenue Service (IRS) that it is subject to backup withholding as a result of a failure to report all interest or dividends, or (iii) the IRS has notified it that it is no longer subject to backup withholding. Contractor further represents and warrants to City that (a) it has the power and authority to enter into and perform the work, (b) the Contract, when executed and delivered, shall be a valid and binding obligation of Contractor enforceable in accordance with its terms, (c) the work under the Contract shall be performed in accordance with the highest professional standards, and (d) Contractor is qualified, professionally competent and duly licensed to perform the work. Contractor also certifies under penalty of perjury that its business is not in violation of any Oregon tax laws, and it is a corporation authorized to act on behalf of the entity designated above and authorized to do business in Oregon or is an independent Contractor as defined in the contract documents, and has checked four or more of the following criteria: (1) 1 carry out the labor or services at a location separate from my residence or is in a specific portion of my residence, set aside as the location of the business. (2) Commercial advertising or business cards or a trade association membership are purchased for the business. (3) Telephone listing is used for the business separate from the personal residence listing. (4) Labor or services are performed only pursuant to written contracts. (5) Labor or services are performed for two or more different persons within a period of one year. (6) 1 assume financial responsibility for defective workmanship or for service not provided as evidenced by the ownership of performance bonds, warranties, errors and omission insurance or liability insurance relating to the labor or services to be provided. Contractor (Date) Contract for Workers' Compensation TPA Services, Page 4 of 5 t CITY OF ASHLAND, OREGO-N-____ EXHIBIT B City of Ashland LIVING per hour effective June 30, 2016 (Increases annually every June 30 by the Consumer Price Index) • - • - • . portion of business of their 401 K and IRS eligible - , _ employer, if the employer has cafeteria plans (including ten or more employees, and childcare) benefits to the has received financial amount of wages received by assistance for the project or the employee. For all hours worked under a business from the City of service contract between their Ashland in excess of ➢ Note: "Employee" does not employer and the City of $20,283.20. include temporary or part-time Ashland if the contract employees hired for less than exceeds $20,283.20 or more. ➢ If their employer is the City of 1040 hours in any twelve- Ashland including the Parks month period. For more ➢ For all hours worked in a and Recreation Department. details on applicability of this month if the employee spends policy, please see Ashland 50 /o or more of the ➢ In calculating the living wage, Municipal Code Section employee's time in that month employers may add the value 3.12.020. working on a project or of health care, retirement, For additional information: Call the Ashland City Administrator's office at 541-488-6002 or write to the City Administrator, City Hall, 20 East Main Street, Ashland, OR 97520 or visit the city's website at www.ashland.or.us. Notice to Employers: This notice must be posted predominantly in areas where it can be seen by all employees. CITY OF ASHLAND Contract for Workers' Compensation TPA Services, Page 5 of 5 Workers' Compensation Third Party Administration Services Cost Proposal Submission Deadline: 2:OOPM (PST) Tuesday, May 24, 2016 Presented To: Tina Gray Kari Olson Human Resources Director Purchasing Representative i1VV414F& 90 N. Mountain Avenue Ashland, OR 97520 CITY OF ^AS H LA N D Presented By: 0)A,7V"4-,- S*ryzc, Amy Stone Branch Manager TRISTAR Risk Management T: 971-925-1300 Ext.1920 F: 971-925-1565 M: 503-819-0055 E: Amy.Stone@tristargroup. net L ALI transforming risk into opportunity CITY OF -ASH LAN D Cost Proposal All of the information being requested in this section titled "Cost Proposal" must be included in the separate sealed envelope marked Cost Proposal and submitted separately from the proposal per the submission instructions on Page 25. Provide a detailed breakdown of costs to perform the services described in this RFP, including but not limited to : 1. Indemnity claims 2. Medical only claims 3. Complex medical claims Per Claim Fees - Newly Reported Claims: Life of File Handling Indemnity -All Other States $1050.00 Medical Only - $165.00 Complex Medical $370.00 Record Only- $35.00 Claims management fees presume use of TRISTAR Managed Care Services. Complex Medical claims which exceed the terms listed below will be converted to indemnity claims. Complex Medical Claims are defined as a claim where there is no Indemnity paid and: (i) Medical paid is greater than Three Thousand Dollars ($3,000.00) and it is a medical only claim open less than two hundred and seventy (270) days (ii) The claim is a denied or controverted claim that is open less than two hundred and seventy (270) days. 4. Annual administration fees: $2500.00 5. Annual RMIS fees: $500.00 6. Data conversion/transfer fees: Not applicable, as TRISTAR is the current TPA. 7. Fee for assuming claims management responsibility for claims incurred prior to January 31, 2010 No additional fees for open claims. Page 2 -dtf TRISTAR._ RISK MANAGEMENT transforming risk into opportunity CITY OF -ASHLAND 8. Fee for managing claims after expiration of contract TRISTAR has proposed Life of File pricing. TRISTAR will manage all claims until conclusion. 9. Fee for MMSEA reporting, etc. $8.20 per claim 10. Fee for State annual Report of Losses, Legal Expenses Paid, and Federal LS-513 and LS-274 reports, etc. No additional fees. Note: Proposed fees must cover the cost of handling to conclusion all claims incurred or reopened during the contract period. Provide a detailed breakdown of costs associated with photographs, tapes used for statements, appraisals, and any other anticipated ancillary expense, including but not limited to: 1. Costs for services requiring billing on a time and expense basis, including hourly billing rates of individuals performing the task: As described in the response to item 11, next page. 2. Cost associated with RMIS, if any, such as the cost of placing terminals in the City's offices, line or time charges: No additional fees. TRISTAR's system is accessible through the Internet and as such, we do not anticipate any hardware requirements. 3. Wire transfer, banking or other account charges No additional fees. 4. Cost of indexing claimants and injured workers: $8.95 per report, charged to the claim file as an allocated loss adjustment expense. Page 13 TRISTAR" RISK MANAGEMENT F* ' transforming risk into opportunity CI of ASHLAND 5. Cost of subrosa/surveillance work Subrosa/surveillance is an allocated expense billed at approved rates by outsourced vendors. TRISTAR does not supply these services in-house. 6. Cost to maintain/store files No additional fees. 7. Cost of program transition and implementation Not applicable, as TRISTAR is the incumbent TPA. 8. Costs for incidents (zero value claims) $35 per report 9. Costs for onsite visits by your staff First two visits: No additional fee Each additional visit: $750.00 10. Any charges for account executive/coordinator No additional fees. 11. Any additional charges not specifically commented on above or elsewhere in this proposal. Please see next page for Managed Care pricing. a. Include the methodology for extension of rates in subsequent contract years. TRISTAR will limit its increases to the greater of 2% or the US Consumer Price Index ("CPI"). Page 14 TRISTAR- RISK MANAGEMENT transforming risk into opportunity CITY OF ~x -ASH LAN D Services Fees Medical Bill Review. Provider/Ancillary Bill Review $8.50 per bill Hospital Bill Review (in and outpatient) 12% of savings PIUs Implantable Device Review 27% of Savings PPO/Specialty/Pharmacy/DME 27% of Savings (all savings is post fee schedule or U&C) Duplicate Bills Duplicate Line Items No Charge Monthly Savings Reporting Reconsiderations Utilization Review. In-Patient $125 per pre-certification plus $105 per hour for length of stay reviews and discharge planning, if any. Out-patient (flat fee) $125.00 per precertification Concurrent Review $105 per hour. Peer Review . Level 1: Includes review of medical records and $200 flat rate communication of decision in writing to all parties Level 2: includes review of medical records, $250 flat rate discussion with treating physician and communication of decision in writing to all parties Medical Case Management Enhanced FNOI - First Notice- injured employee $20.00 per intake call (waived if call moves to triage) with/without supervisor calls, speaks with medical assistant that helps with PPO direction, questions and referrals Early Intervention (Nurse Triage) - Nurse aids $120 per intake call injured worker in self-treatment or sets up appointment with appropriate provider utilizing medical triage guidelines/follow up calls Telephonic Case Management $105.00 per hour Field Case Management $105 per hour plus Mileage at IRS mileage rate Field Case Management Task pricing One time visit to provider $475 plus mileage Two visits to provider $750 plus mileage Medical record retrieval $135 plus mileage Job Analysis $475 plus mileage Catastrophic Case Management $130 per hour plus mileage Pharmacy Benefit Management (PBM): Medication costs: AWP -11% + dispense fee of $3.00 Retail: Brand AWP - 25% + dispense fee of $3.00 Generic AWP -19% + dispense fee of $3.00 Mail: Brand AWP - 42% + dispense fee of $3.00 Generic Page 1 5 ®'`r TRISTAR.. f RISK MANAGEMENT transforming risk into opportunity CITY OF _ ASHLAND Point of sale utilization review $105.00 per hour Complex Pharmacy management - weaning $125.00 per hour. protocols - nursing intervention Complex Pharmacy management - physician $125.00 per hour nursing intervention plus pass through of intervention and consultation with treating providers actual physician fees. to review treatment patterns and weaning options Other Special Investigations Outsourced Central Index Bureau $8.95 per report Claim Reporting: Telephonic $20 per report Claim Reporting: Fax or Internet $10 per report MMSEA Reporting $8.20 per claim Mileage IRS allowance rate Note: The City's intent is to award a contract to the successful proposer for a period of two years, with the option of three one-year extensions for a maximum term of five (5) years. At the time of each renewal, fees and expenses may be renegotiated. Contractor will be required to provide documentation demonstrating the escalation from an external source, such as a consumer price index, to substantiate any rate increases. If applicable, costs for any additional value added services are to be identified and included with the Cost Proposal. Definition of Allocated Loss Adjustment Expense(s): Allocated Loss Adjustment Expenses includes any fee or expense which is chargeable or attributable to the investigation, coverage analysis, adjustment, negotiation, settlement, defense or general handling of any Claim or action related thereto, or to the protection and/or perfection of the Customer and/or Carrier's right of subrogation, contribution or indemnification, all as reasonably determined by TRISTAR. They include, but are not limited to: • Attorney's fees and disbursements • Fees and expenses incurred for handling any legal actions, including trials or appeals including deposition fees; cost of appeal bonds; court reporter or stenographic services, filing fees, and other court costs, fees and expenses; transcript or printing services and all discovery expenses; service of process; witnesses' testimony and corresponding travel expenses, opinions, or attendance at hearings or trial; • Statutory fines or penalties • Pre- and post judgment interest paid as a result of litigation, unless regulatory or reporting requirements define such interest as loss or indemnity payments; • Subcontractors' fees and travel expenses, including independent adjusters, automobile and property appraisers. • Experts' fees and expenses, for advice, opinions, or testimony concerning claims under investigation or in litigation and costs of appraisals Page 16 -eTRI,S. f;R,- f RISK MAN,.,GEMEN T W111V transforming risk into opportunity CITY OF ASHLAND • Fees and expenses for surveillance, undercover operative and detective services or any other investigations • Costs of legal transcripts of testimony taken at coroner's inquests, criminal proceedings, or civil proceedings;* • Fees and expenses for medical examinations, or autopsies, including diagnostic services, and related transportation services; durable medical equipment; and medical reports and rehabilitation evaluations, unless regulatory or reporting requirements define such fees and expenses as loss or indemnity payments • Fees and expenses for any public records, medical records, credit bureau reports, index bureau reports • Costs of photographs and photocopy services • Medical or vocational rehabilitation fees and expenses, and all other medical cost containment services, including, but not limited to utilization review and management, pre-audit admission authorization, hospital bill audit or adjudication, provider bill audit or adjudication, Preferred Provider Organization, and medical case management, if applicable, unless regulatory or reporting requirements define such expenses as loss or indemnity payments • Costs of independent medical examinations and/or evaluations for rehabilitation and/or to determine the extent of the Customer's liability • State mandated electronic data interchange (EDI) costs, if applicable • Federal query/reporting fees for Section 111 of the Medicare, Medicaid and SCHIP Extension Act of 2007, and Medicare Set-Asides • Telephonic First Notice of Loss Intake • Extraordinary travel and related fees and expenses incurred by TRISTAR at the express request of Customer, which are not otherwise payable under this Agreement. [End of Document] Page 17 TRISTAR" RISK MANAGEMENT I p Aco CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 1/6/2016 THIS CERT".91CATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsements . CONTACT PRODUCER NAME_ Corbee Simoneau Arthur J. Gallaher & Co. PHONE FAX 818-539-1525 g (A1C, No, Ext): 818-539-1225 (A/C, No): Insurance Brokers of CA, Inc. License #0726293 E-MAIL ~?a 505 N. Brand Boulevard, Suite 600 ADDRESS: corbee_simoneaujg'com Glendale CA 91203 INSURER(S) AFFORDING COVERAGE NAIL a INSURER A:American Guarantee and Liability In 26247 INSURED TRISINS-03 INSURERB:ACE American Insurance Company .22667 TRISTAR Insurance Group, Inc. INSURER c:WESTCHESTER FIRE INS CO 21121 100 Oceangate Avenue, Suite 700 Long Beach, CA 90802 INSURER D :Zurich American Insurance Company 16535 INSURER E INSURER F : COVERAGES CERTIFICATE NUMBER: 1711843199 REVISION NUMBER: THIS IS 1-0 CERTIFY 1H AT THE POLICIES OF INSURANCE LISTED BELOW HAVE BLEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REOUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, I XCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSIR ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MM/DD/YYYY MM/DDIYYYY 1) X COMMERCIAL GENERAL LIABILITY CP05543602-03 1/112016 11112017 EACH OCCURRENCE $1,000,000 DAMAGE TO RENTED E 1,000,000 CLAIMS-MADE X OCCUR PREMISES (Ea Occurrence) MED EXP (Anyone person) $10,000 PERSONAL & ADV INJURY $1,000,000 X Contractual Liab GENT. AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE 62,000,000 POLICY PRO X t.OC PRODUCTS - COMP!OP AGG $ 2,000,000 JECT OTHER: $ COMBINED 5[Nrl E LIMIT l) AUTOMOBILE LIABILITY CP05543602-03 11112016 11'112017 (Ea accident) $1,000,000 X ANY AUTO BODILY INJURY (Per person) $ ALL OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS AUTOS X HIRED AUTOS X NON OWNED PROPERTY RTY DAMAGE $ AUTOS (Per Comp. & Coll Ded. $500 A UMBRELLA LIAB X OCCUR AHC5543479-03 11112016 1111Z017 EACH OCCURRENCE $7,000,000 X EXCESS LIAB CLAIMS MADE AGGREGATE $7,000,000 DED RETENTION $ $ WORKERS COMPENSATION PER OTH FIR AND EMPLOYERS' LIABILITY YIN N ANY PROPRIETOR/PARTNERiEXECOI1VE N/A E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCUJOED? L (Mandatory in NH) F I . DISEASE EA EMPLOYEE. $ It yes, describe urOer DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $ t: Crime 623670410 003 1/3112015 1/3112016 Limit of Liability $ 5,000,000 T" Errors & Omissions 625659223 003 3/212015 1131/2016 Aggregate $ 10,000,000 DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required) GI- Al FORM U-GL-1175-C CW (07/10) City of Ashland is named additional insured under General Liability as respects their interest in the operations of the Named Insured. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Ashland ACCORDANCE WITH THE POLICY PROVISIONS. 90 N. Mountain Ave. Ashland OR 97520 USA AUTHORIZED REPRESENTATIVE J 1 r (c) 1988-2014 ACORD CORPORATION. All rights reserved. arnan Ira 1?n14/011 The ACORD name and logo are registered marks of ACORD r Arthur J. Gallagher & Co. Insurance Brokers of CA., Inc. 505 N. Brand Boulevard, Suite 600 Glendale, CA 91203 3568 2 MB 0.436 CITY OF ASHLAND 90 N MOUNTAIN AVE C-3568 ASHLAND, OR 97520-2014 DATE (MM/DDNYYY) CERTIFICATE OF LIABILITY INSURANCE 12/21/2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER LIC #63238 1-610-941-7751 CONTACT NAME: Keystone Risk Partners, LLC PHONE FAX A/ N Ex A/C No : E-MAIL 604 E. Baltimore Pike ADDRESS: PRODUCER Media, PA 19063 CUSTOMER ID INSURERS AFFORDING COVERAGE NAIC # INSURED INSURERA: Ace American Insurance Company Tristar Insurance Group INSURER B 100 Oceangate INSURER C : Suite 700 INSURER D Long Beach, CA 90802 INSURER E INSURER F : COVERAGES CERTIFICATE NUMBER: 45658349 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE N R WV POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTED COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ CLAIMS-MADE 1:1 OCCUR MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ RO- LOC $ -1 POLICY P JECT AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ ANY AUTO BODILY INJURY (Per person) $ ALL OWNED AUTOS BODILY INJURY (Per accident) $ SCHEDULED AUTOS PROPERTY DAMAGE $ HIRED AUTOS (Per accident) NON-OWNED AUTOS $ UMBRELLA LIAB HOCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ A WORKERS COMPENSATION WLR 048593343 (AOS) 12/31/1 12/31/16 X WC STA ~U- OTH- AND EMPLOYERS' LIABILITY Y / N I FIR E.L. EACH ACCIDENT $ 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ N/A OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L. DISEASE - EA EMPLOYE $ 1,000,000 If yes, describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ WC-Agri Genera Insurance WLR 048593367 12/31/1 12/31/16 Tennessee WC-ACE Fire Underwriters SCF 048593355 12/31/1 12/31/16 Wisconsin DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Ashland THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. ATTN: Kari Olson, Purchasing Rep 90 N. Mountain Avenue AUTHORIZED REPRESENTATIVE Ashland, OR 97520 USA ljarvis © 1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD 45658349 City's Request for Proposal SCOPE OF WORK Note: Please. refer to complete Request for Proposal on file for remaining sections of RFP. SCOPE OF WORK General Information The City of Ashland is seeking a Third Party Claims Administrator to administer its Workers' Compensation claims. The City strives for best practices while utilizing a Third Party Administrator (TPA) in partnership for optimal service, compliance, and cost containment. The successful proposer will have the knowledge and experience to administer and manage all City claims. The City self-insures its Workers' Compensation exposure up to $450,000 for all class codes except electrical exposure up to $650,000 and purchases excess insurance above that amount. The City services include utilities (water, sewer, and electric), telecommunications, fire, police, public works, planning, parks and administrative services. A historical overview of the City's Workers' Compensation program is included in the RFP. The City of Ashland (City), a municipality of the State of Oregon is seeking a Third Party Claims Administrator (TPA) to administer its Workers' Compensation claims. The City is a municipality in Jackson County, Oregon and provides general municipal services while enhancing the region's quality of life. The City is directed by a six-member council and mayor, elected by City voters. The Council appoints the City's administrator, who is responsible for day-to-day management. The successful proposer will be expected to meet the highest standards prevalent in providing Workers' Compensation Third Party Administration Services. The City's intent is to award a contract to the successful proposer for a period of two years, with the option of extending the contract annually for up to three additional years for a maximum term of five (5) years. The City's most recent contract for Workers' Compensation Third Party Administrative Services with Tristar Risk Management had reached its full term, and now the City is required by law to once again competitively bid these services. Project Description The successful proposer will have the knowledge and experience to administer all City claims. If a partnership is being proposed, the partnership must respond to this RFP. For a historical overview of the City's WC program and payroll, please refer to Exhibits E and Exhibit F. Minimum Service Requirements Account Team The City requires a designated professional claims management team of appropriate experience and number to adequately manage the City's claims. Examiners adjusting lost time claims must have at least 3 years of Workers' Compensation (WC) time loss experience. Examiners adjusting Medical Only (MO) claims must have at least 1 year of experience adjusting MO claims. Exceptions to these standards must have prior approval from the City. Case Loads The City seeks to utilize a company that firmly adheres to a controlled caseload for its RFP - Workers' Compensation Third Party Administration Services Page 11 of 43 supervisors and examiners. Communication Polite, truthful and assertive communication with City employees and Risk Management staff is essential to a successful TPA partnership with the City. Meet with the City on a quarterly basis to review claim files. Investigation All claims will be thoroughly investigated to determine validity and compensability. Investigations that require the use of outside investigators shall only be conducted upon consultation with, and consent of, the City. Claims that require the use of an independent medical examination shall only be conducted after consultation with, and consent of, the City. The City shall be responsible for payment of these services. Reserve Management and Reporting All reserves shall be established, reviewed and updated using commonly accepted reserving practices and/or state requirements or guidelines. Medical/Disability Case Management The TPA shall recommend medical case management to the City on all claims where the TPA deems it appropriate. Litigation Management Promptly provide legal counsel (to be chosen by the City of Ashland) with copies of the complete claim file and assist in the defense of cases to be litigated. Represent the City of Ashland at the Workers' Compensation Board and at conferences with legal counsel, as necessary. Your company must be willing to accommodate the City in these instances. Settlements The City will require approval of all claim settlements. Determine proper benefits due and make timely payments of those benefits in accordance with payment procedures established by statute and administrative Rules. The City shall be responsible for providing such funds to the Contractor as is required for payments. Promptly close claims once they qualify for closure pursuant to statute and administrative rules. Maintain pertinent data on all claims payments in a manner agreeable to the City of Ashland. Recovery Management Investigate and pursue possible third party recoveries. The City is committed to the prompt pursuit of recovery from parties responsible for injuring its employees. RFP - Workers' Compensation Third Party Administration Services Page 12 of 43 Claims Information System (Risk ManalZement Information System) Information is a vital tool in the management of City claims. The accuracy and usefulness of the information you maintain about the City's claims and the ease of accessing the information is extremely important to the City. Your Risk Management Information System (RMIS) should allow the City to review the status and valuation of claims and run reports on a real-time basis as outlined below. There should be a method of importing data from your RMIS into the City's RMIS on a monthly basis. This information must be organized in a useable manner. Your proposal must clearly identify the location and characteristics of the computer system your company will use to service the City's RMIS needs. Reporting Requirements Provide monthly open and closed claims reports. The successful proposer will be required to prepare for the City's review and approval State annual Report of Losses, Provide information and assistance for the preparation and filing of all reports required by the State of Oregon in connection with the City of Ashland's self-insurance program, including but not limited to, the annual Report of Losses, Legal Expenses Paid, and Federal LS-513 and LS-274 reports. Provide information and assistance for the preparation and filing of all reports required to satisfy the mandatory CMS Section 111 Medicare Report per the Medicare, Medicaid, and SCRIP Extension Act (MMSEA). Provide excess insurers with required reports. File with the Workers' Compensation Division all information required for each claim. Prepare and submit Employer at Injury Program reimbursement requests to the Workers' Compensation Division. General Requirements Claim administration requirements that apply to all workers' compensation claims are: File retention The successful proposer is to retain all claim files assumed or generated during the contract period. Both electronic and hard copy files are to be maintained by the successful proposer. At the end of the contract, all files will be transferred back to the City in a cataloged, organized fashion. Audit The City maintains an aggressive claims and vendor oversight program that includes periodic audits of selected claim files. City Risk Management Department will provide a 14-day advance notice of any on-site audit. The City's Human Resource Director and/or Risk Management and/or Internal Audit personnel will be provided access to all claim files to include all paper files as well as all computer entries. Alternative audit procedures will be arranged upon agreement of both parties when City Human Resource Director does not feel an on-site audit is necessary. RFP - Workers' Compensation Third Party Administration Services Page 13 of 43 Annual certification will be required to confirm the successful proposer has adequate controls and accounting systems in place as attested to by one of more of the following: SAS 70 service auditor's report; audited financial report, the management letter, copy of the internal controls documents, and a copy of the accounting procedures. Disclosure The City requires disclosure of any financial arrangements or agreements between the TPA and all outside parties and/or subcontractors performing work on the City's account. RFP - Workers' Compensation Third Parry Administration Services Page 14 of 43 PROPOSAL SUBMITTED BY TRISTAR RISK MANAGEMENT Sections of proposal included with contract: • Proposed Service Plan • Claims Information system • Quality Control • Reports Note: Please refer to complete proposal on file for remaining sections of proposal. traristorrnirig risk into opportunity Proposed Service Plan and Ability to Perform Services Your proposal should describe your proposed service plan and your ability to perform the service obligations as required in the Scope of Work. Case Loads Describe the normal caseload for your company's claims examiners (total caseload, including City and any other client for whom the individual handles claims) and address how you will ensure the City that your company will comply with the City's total caseload limitations. If caseloads are to be segmented by task to multiple individuals, please outline that program, its benefits, normal caseloads handled, and how a high level of service will be assured. Note: City's total caseload limitations for Indemnity/Lost Time/Medical- Only - 175 claims. Examiners with a preponderance of high value, complex claims, should maintain an inventory considerably lower than the indemnity/lost time/medical-only caseloads listed above. TRISTAR believes that claim professionals must have appropriate workloads to achieve the best possible outcomes. Our best practice maximum caseloads listed below. Note that Supervisors and Managers do not carry personal caseloads, as they are dedicated to quality assurance, technical oversight and management support of their team. • Supervisors: 0, No personal caseloads • WC Indemnity: 125-150 pending, 16 new per month • WC Med Only: 250 pending, 80 new per month Supervisors Clearly indicate whether supervisory or management personnel will maintain an active caseload. The total caseload for supervisors and managers must be listed and a detailed description of their responsibilities must be provided. No, Supervisors and Managers do not carry personal caseloads. Page 1 20 T R I S TA ;;!kw I-'A.1,•f,c,ct2Ls<r C transfornning risk into opportunity -s:I7LYAD Communication Polite, truthful and assertive communication with City employees and Risk Management staff is essential to a successful TPA partnership with the City. Describe in detail your company's communication standards and practices and how you will conduct and/or communicate the following: 1. 3-Point contact (employee, City's designated representative and initial medical provider) within 72 hours of notification of claim. 2. Contact with employees in a no-work status. Follow up on treatment and assisting claimants in the return to work process 3. Denials of benefits or claims to employees. 4. Sufficient contact with the City's designated representative to ensure that the City is informed of all significant issues and that the claim is being appropriately administered. 5. Contact with physicians to appropriately manage claims. TRISTAR agrees that polite, truthful and assertive communications with City employees and Risk Management staff is essential. We also believe that the timeliness of initial communications, ongoing communications and prompt follow up of any outreach is crucial. Three Point Contact/Initial Investigation Three-point contact, (employee, employer and medical provider), is an important step in the initial investigation/verification of a claim. Within one business day of receipt of the claim, the examiner attempts three-point contact on all claims with an indemnity claim status. If needed, an additional attempt is made the next business day. If after two attempts the examiner is unable to reach any of the three contacts, a letter or e-mail follow up is sent. If the City does not want us to contact one or more of the contacts, documentation is entered in the claims system notepad stating the exception(s) to the three-point contact and the reason. These client exceptions should also be clearly stated in the individual Client Servicing Instructions. Completion of the three-point contact is not mandatory on claims set up with a medical only claim status; however, at least one contact is made to verify the claim, such as the employer. Three-point contacts are completed as necessary to appropriately manage the claim (such as RTW modified duty or multiple injuries to the same body part) or per the individual Client Servicing Instructions. A summary of the salient points of the three-point contact are entered in the claim notepad, which is accessible to the City via Client Portal. Return to Work: The City will have a variety of solutions to manage return to work. Page 21 A TRIST ,R) I f Pis K M A N' 1, G C W, CIN T m r•> transforn-iing risk into oiDportLMit~~ ~LA, Examiners work closely with their customers to assist in returning employees to work through a transitional work or "stay at work" program, utilizing the policies and procedures established by The City. This may involve the risk management department, the human resource department, the injured workers' supervisor, medical providers, and/or a nurse case manager, The examiner contacts the treating physician and injured employee at least every 30 days or more frequently when an employee is out of work. The examiner works with the physician to assure the injured worker obtains appropriate medical care and returns the injured worker to full or modified duty by providing injured worker's functional limitations. The examiner works with The City to help determine the availability of modified duty position(s), and communicates that information to the physician. TRISTAR understands the importance of communicating work status and changes in work status to The City's Risk Management department, Human Resources department, and the employee's supervisor. To the extent that they are available, documented job descriptions and modified/transitional duty programs aid our efforts to return employees to productivity. The objectives of the transitional work program are: Transition the injured employee to full duty through placement into available interim assignments. Mitigate the costs incurred for injuries by reducing the length of time, an employee must remain away from work. Minimize the negative impact of an injury or illness upon the affected department Improve the morale of the client staff. TRISTAR nurses can also work closely with all parties to assist with return to work opportunities utilizing medical treatment guidelines and predictive modeling based on severity of injury, occupation, age factors, etc. TRISTAR can customize all return to work activities in conjunction with the client return to work and transitional duty policies and procedures. TRISTAR also offers an employee wellness program that integrate workers' compensation and group health medical management, disease management, and return to work activities to help reduce absenteeism and obtain quality healthcare for most optical outcomes. Clients that have deployed this program have achieved great success. The City is able to track functional limitations and return to work status through TRISTAR's Client Portal, via: ➢ Return to Work Status Screens ➢ Access to Medical Reports ➢ Change of Work Status ➢ Work Status Reports TR1 `S T`A Page 22 f " 4 s T`. y . i 4 'Y OF tl-ansfcrrning risk into c~PI)Orturlity C~s~8~7Y LAccess to Managed Care Modules including: o Nurse Case Management Activities o Official Disability Guidelines/Medical Disability Guidelines and others o Bill Review Data including medical provider billing, reimbursement information, billing practices, infractions and more Our nurses utilize STAT, a TRISTAR proprietary system to help ensure compliance with utilization review and medical case management protocols, and additionally, our nurses and staff has access to various sophisticated software programs that provide tools to various jurisdictional or State medical treatment guidelines and predictive modeling tools. Compensability Determination & Denial Recommendations TRISTAR's responsibility to our clients is to determine if claims made by their employees for obtaining benefits are compensable under relevant jurisdictional statutes regardless of the type of claim. The process for determining whether a claim is compensable is to conduct a thorough investigation with regard to whether the claimed injury arose out of/or in the course of employment (AOE/COE). If either the City or TRISTAR questions the validity of a claim, the adjuster may initiate an investigation to include additional activity checks. The adjuster evaluates a claim to determine compensability based on facts gathered in conjunction with relevant statutes. The adjuster will accept or deny the claim within the required statutory timeframe, and will secure approval from the City prior to issue of a denial. Communication with the City TRISTAR adheres to the City's communication protocols, including adhering to authority thresholds for reserves, settlements, payments, assignment of specialists, etc. TRISTAR also provides pertinent updates regarding change of status for injured employees, aligned with the City's communication preferences. Investigation Describe and include your company's practices and procedures in conducting investigations including but not limited to determination of compensation, taking statements and investigating other agency reports. Subrosa/Surveillance. Clearly describe the criteria used to conduct surveillance of injured employees suspected of presenting a fraudulent claim. Prior approval must be obtained from the City for any assignment of subrosa/surveillance. T R a v e I 23 I TA P ' aD ti-ansfc►,rninc. risk into orPorturlib c Is~r o ~5~~L OD Note: Additional fees associated with subrosa/surveillance must be clearly identified in your Cost Proposal. Initial investigation of injuries is performed by the examiner. During our contact with the injured employee, we inquire as to the circumstances and facts of the injury. We also contact a client representative to obtain information about their knowledge of the injury. If, after these two interviews, there are any questions as to compensability, or subrogation potential, further investigation is initiated. TRISTAR develops, in partnership with the City, a limited and qualified panel of investigators for both general investigations as well as special investigations, (such as surveillance), who share our commitment to controlling costs and enhancing "the client's bottom line' . Objectives and a plan of action are discussed, and agreed upon, with the City. The investigation is assigned, directed and monitored by the examiner. The field or outside investigator's service fees are usually paid out of the claim file as an allocated expense, or as directed by the City. Many factors are taken into consideration to determine the need for any outside services. Checklist items that may indicate a need for additional investigation, either by the examiner, the City, or with assistance of an outside investigator, may include: • employee has only been on the job a short time • injury occurs just before a strike, layoff, seasonal work, or job termination, • employee has made similar claims in the past • employee's version of the accident is not credible • there are no witnesses to the incident • the alleged injury relates to a pre-existing problem • employee's physician/attorney has a history of filing suspect claims • employee failed to report the accident in a timely manner • accident occurred on a Monday, a Friday, or the first day after vacation • injured employees consistently use the same physicians and/or attorneys to handle their claims • history of frequent employment changes • fraud language on all indemnity checks • frequent changes of residence • employee cannot be reached during normal working hours • the witnesses know the injured employee • medical history differs from First Report of Injury • employee experiencing financial difficulties prior to submitting a claim • employee experiencing domestic difficulties prior to submitting a claim • employee tries to refuse and/or resist independent medical examination when it is required • indemnity exceeds eight weeks with no objective medical findings • research employee's previous history through national indexing system Page 24 .d TR i 'S-FA f E t. ANA, ;Lf,,. ;r i transfcrmirig risk into opportursit~/ -ASHL D Reserve Management and Reporting Identify: 1. Your methods of establishing initial case reserves and practices for making reserve changes. 2. Reserve authority levels routinely assigned to examiners, supervisors and managers. 3. Your willingness to accommodate prior approval by the City of initial reserves or reserve changes of $25,000 or greater as well as your ability to provide a reserve worksheet and/or report documenting the reason for the reserve. One of the most critical functions of claims management is to establish timely, accurate reserves. TRISTAR's reserve philosophy is consistent with Generally Accepted Accounting Principles, or GAAP. Certified Public Accountants use GAAP to review and comment on the accuracy of financial statements. GAAP requires that all assets and liabilities on an organization's balance sheet be carried at expected value. Under GAAP rules, reserves must be established at the estimated ultimate settlement value of the claim. To arrive at this number, claims examiners must use all available information to establish and continually evaluate reserves. A supervisor, manager, or designated adjuster reviews all claims immediately upon receipt of claim for the purpose of review and assignment of the claim. Once the type of claim is determined (record only, medical or indemnity), the claim is set up in the claim system within one (1) business day from receipt, and all known information is entered into the claims system. Information taken into consideration when establishing reserves may include but not necessarily be limited to the following: • Type of injury • Severity of injury • Age of the injured employee • Occupation • Local cost of treatment • Expected length of disability • General health and motivation of the injured employee • Jurisdiction • The experience of the claims examiner All of these factors are considered when reserving for the estimated ultimate probable cost of the claim. As new information is received about the claim, reserves are adjusted up or down in a timely fashion and as appropriate. The initial reserve is entered in claim file within five (5) business days of receipt of the claim. Page 25 TRI TAR A. NA GEf,;EN7 transforn°ring r=isk ir-ItO 01DP0rtLa1-itY L 0~ AND Reserves are re-evaluated at each diary review and when significant information is received that may alter the course of the claim. Reserves are adjusted (up or down) within 30 days of receipt of significant information or sooner if necessary. A reserve worksheet is completed for each reserve adjustment on an indemnity claim, an example is enclosed as Exhibit 5 Documentation is entered in the clam system notepad supporting the rationale of the reserves entered or adjusted. The claims examiner is responsible for reviewing and documenting the adequacy of the reserve at each diary review. The assigned adjuster completes the initial work-up and investigation. Reserves for medical only claims are auto-generated at an incurred amount as pre-determined by the City and TRISTAR. Initial reserves for indemnity claims are set within the first five (5) business days from receipt of the claim. The adjuster bases initial reserves on the information learned through the three-point contact investigation and from the claims adjuster's experience for exposure that may apply to that specific type of injury. The adjuster documents a plan of action and schedules appropriate future diaries, including, but not limited to the next diary and plan of action reviews. Should a claim require further investigation, the claims examiner has an appropriate diary to ensure a timely determination in accordance with all statutory timeframes. Reserves worksheets, supervisory reviews and payments are included in claims files. TRISTAR's Claims Examiners typically have authority levels up to $100,000; however they must fully comply with client-designated authority levels. TRI~~~~z Page 26 ~V'i% + l ' C I T Y OF transforryiing risk into oi?portunity -ASHLAND Medical/Disability Case Management Describe: 1. The criteria by which your company decides whether medical case management is necessary. 2. How you ensure the quality of service provided by the medical case manager, including your requirements for a written deposition strategy and plan of action. Nurse Case Management services bring a higher level of intervention to an injury by minimizing medical and indemnity costs in order to achieve the best recovery and return to work outcomes. The claims examiner is responsible for reviewing Client Handling Instructions and TRISTAR's recommended referral criteria, and determining the level of intervention required to achieve the best recovery outcome. Suggested Telephonic Case Management Referral Criteria: • Inpatient hospitalizations • Inconsistent medical findings, subjective complaints cannot be supported by objective findings • Multiple treating physicians • Frequent change of primary treating physicians • Pre-existing conditions that may prolong treatment (i.e., diabetes, hypertension, heart problems) • Patient with history of drug/alcohol abuse • Non-compliant treating physicians • Continued/prolonged modified duty, unchanged work restrictions • Continued treatment with no MMI in sight • Continually changing diagnosis (i.e., starts as carpal tunnel, changes to epicondylitis, changes to rotator cuff to cervical strain) Suggested Field Case Management Referral Criteria: • Inconsistent medical findings - subjective cannot be supported by objective findings • Multiple treating physicians • Head trauma/Loss of consciousness • Spinal cord injuries • Second/Third degree and electrical burns • Robberies/Assaults • Toxic exposures • "Repeat" claimants • Pre-existing conditions that may interfere with or prolong recovery • Inpatient hospitalizations • Amputations • Home modifications • Investigational or experimental treatment or devices • EE released to full duty with no MMI in sight • Task assignments ■ Obtaining information or medical records from medical provider Page ~ 27 f At TR ` transfori-ring risk into opportunity ASHLAND ® Attend an appointment to obtain MMI ® Attend an appointment to obtain RRTW - modified or regular The claims examiner will refer to the City's Client Servicing Instructions for information regarding: • The need to obtain authorization prior to utilizing Nurse Case Management services • The requirement to use Nurse Case Managers • The criteria for use of Nurse Case Managers The claims examiner documents the reason for the referral in the claim notepad. If the claims examiner determines that Nurse Case Management is not indicated on a claim, clear documentation supporting the decision is also entered into the claim notepad. Nurse Case Management progress is managed by the claims examiner. When the cost effectiveness for nurse case management is eliminated, the claims examiner requests the nurse to close their file. TRIYI A P a g e 28 t F,t~--. 9 WA F>'Ai=.EF?C F:T CITY of trar~szvr~r~rir~u risk iritU ()I ~K ~ortr_~r~ity -ASHLAND Litigation Management Describe your company's approach to assuring the quality and controlling the cost of litigation involved in workers' compensation claims. Describe: 1. Your company's ability to develop or secure formal litigation plans once legal proceedings are started. 2. Your company's methodology for assuring defense counsel is monitored. 3. Your company's willingness to work with counsel that is not a member of your panel. Note: Your company must be willing to accommodate the City in these instances. Litigation results in increased costs and delays the eventual resolution and closure of claims. Legal management begins with professional, timely, communicative claims handling. It is the policy of TRISTAR to handle all claims with honesty, fairness, and integrity. We exercise the highest degree of ethical and professional conduct while representing the City. If a claimant does obtain representation, the adjuster will continue to adjust the claim in a professional and pro-active manner. The adjuster will provide oversight of litigated claims as appropriate. Adjusters will assist the assigned legal defense attorneys to perform legal work only when necessary and only as authorized by the City. In partnership with the City, TRISTAR has developed a limited and qualified panel of defense attorneys, including Matthew Fischer and David Wilson with Reinisch Wilson and Weier PC, Dan Sato with MacColl Busch Sato, PC, and Brian Perko and Lauren Oda with Sather Byerly and Holloway LLP, who share our commitment to controlling costs and protecting the City's interests. TRISTAR adjusters assist legal counsel, and control legal costs, by handling claim activities such as: ✓ Setting up medical/legal evaluations ✓ Arranging for outside investigation, including Sub-Rosa ✓ Sharing medical and personnel records with all interested parties to avoid unnecessary subpoena and photocopy costs ✓ Arranging for independent medical evaluation (IME) ✓ Arranging for permanent disability evaluations ✓ Draft answers to interrogatories ✓ Provide medical organization and summaries ✓ Participate in hearings and settlement actions as requested If an employee retains an attorney and litigates their claim, where appropriate, TRISTAR will: ✓ Assign the case to a defense attorney selected, or agreed to, by the City .4 TRI TA Page 29 t P,EtV;Y A r 11: , t CITY of transforming rusk into opportunity -ASHLAND ✓ Assist and manage the defense attorney's activity ✓ Coordinate legal efforts between the City and the defense attorney ✓ Monitor legal costs To achieve the most efficient and cost effective results the adjuster will continue performing routine adjusting duties after a referral to defense counsel. When legal expertise is required the adjuster referrals to defense counsel in accordance with the City's client service instructions. The adjuster requests authorization for the referral from the supervisor/manager and the City (as may be required by client service Instructions). The adjuster completes a detailed referral form and maintains a copy in the claim file. The adjuster will assist by supplying detailed and necessary claim documentation, provide medical organization and analysis, and will participate in hearings and settlement actions as required. To achieve the most efficient and cost effective results the adjuster will to continue performing routine adjusting duties after a referral to defense counsel. When the adjuster refers a file to defense counsel, the adjuster is responsible for activities such as: ✓ Reason(s) for referral clearly outlined by the adjuster ✓ Clear instructions provided on the referral ✓ Providing all pertinent claim information and documents ✓ All normal tasks performed by the claims professional, e.g. setting medical appointments, sending mileage checks, requesting medical records, or referrals to any outside vendor ✓ Evaluation and monitoring of the litigation process throughout the life of the claim ✓ Moving the claim towards closure in a timely and cost effective manner ✓ Handle routine vocational rehabilitation issues including informal conferences as applicable. Defense counsel is involved if complex issues exist. ✓ Review all legal bills for accuracy and appropriateness Unless the City office has written agreements with outside counsel, adjusters will typically notify outside counsel representing TRISTAR clients of the following and request an agreement to the following guidelines: ✓ Within 14 days of receipt of referral, submit an initial report, which shall include an initial assessment and litigation plan. The litigation plan should include recommendations that outline the potential cost and estimated timeframes to bring the claim to conclusion. ✓ Send notice of representation to opposing counsel, the appropriate governing body (if applicable) and all other involved parties. ✓ Deposition reports submitted within ten (10) days. Salient points of the deposition should be summarized with the deposition transcript attached ✓ Hearing reports submitted within ten (10) days. If an order or award is issued at the hearing, it should be faxed to the adjuster within two (2) business days .r TRi IAI~ ~ Page 30 f tr nSforminCg, r3Sk into OPIDO!'WI-lit CITY Or -ASHLAND with a brief summary. ✓ Counsel shall notify the adjuster of any conferences or hearings as soon as they are set. ✓ Counsel shall copy the adjuster on all correspondence and client if required in the client service instructions. ✓ All medical reports sent directly to the adjuster. The adjuster will serve the medical report on the applicant attorney with a copy to the defense counsel. ✓ Supply concise status updates whenever events change any fact, judgment, or opinion bearing on the case. In general, defense counsel should be as brief as possible and report only significant activity; avoid routine status reports and re-stating factual summaries. All correspondence that does not add value to the case is discouraged and fees associated with the same may not be paid. ✓ All requests for settlement authority should be in writing, in the manner requested by TRISTAR and the client, at least 14 days in advance of any hearings or conferences. Requests made on the eve of a conference or hearings are not acceptable ✓ Where applicable, all settlement forms submitted to TRISTAR prior to presenting to the applicant attorney or injured worker, for approval, unless drawn up at the time of the hearing or conference with prior agreement of all pertinent facts, including dates of injury and parts of the body to be included. ✓ Provide minutes of trials and any other pertinent documents. ✓ Conduct witness interviews in preparation for hearings and trials. ✓ In preparation for a trial, the defense attorney should provide their opinion regarding the probability of prevailing in trial ✓ Submit itemized billing on a monthly basis. ✓ Detail options for proceeding with litigation through the course of the claim and clearly state their opinion on the one best course of action. Adjusters refer to counsel for legal advice, not just options. Page 31 T R I TA R transforrning risk, into opportunity CITY Of -ASHLAND Settlements Describe your company's methodology of. 1. Evaluating and recommending settlement to your clients. Describe the evaluation, analysis and supporting documentation you typically provide your clients in support of your recommendation. 2. Obtaining pre-settlement authority and the documentation that you will provide the City with a request for obtaining pre-settlement authority. The settlement of a claim often involves many different parties; TRISTAR, the City and/or insured, excess carriers, Medicare, defense and claimant attorneys and various lien claimants. Communication between all parties is essential to assure the adjuster addresses and resolves all issues. The adjuster will adhere to the Client Servicing Instructions for specific settlement authorization requirements. The adjuster will provide all supporting documents with the settlement authority request submitted to the Client. Once the adjuster receives settlement authorization from the City, settlement negotiations may proceed as authorized by the City. Settlement Authority The City establishes settlement authority levels; the Client Servicing Instructions detail authority limits. The adjuster must be aware of settlement authority levels for each self-insured or insurer client as well as TRISTAR's internal authority levels. The adjuster obtains settlement authority from the appropriate authorities on all settlements. The adjuster accomplishes this utilizing the Settlement Authority Request Form, which requires authorization in writing. When a claim has or will pierce the retention level, the adjuster must include the excess carrier in the settlement negotiations. Failure to do so may breach the client's contract with the excess carrier resulting in a reduced recovery. The adjuster documents all settlement negotiations and agreements in the in the claim system notepad. Page 1 32 f civv transforming riSk intG OPPOtAur-litV SHLog ~~D Recovery Management Clearly indicate: 1. Your methodology for identifying claims with subrogation potential and your methodology for pursuing and managing subrogation. 2. Discuss the criteria you use to involve legal counsel and vendors for subrogation activity. Note: If a separate subrogation unit will be utilized, the associated fees must be clearly identified in your Cost Proposal. Under workers' compensation law, the employer is responsible for payment of benefits to an injured employee even where there is another (or third) party at fault. The City is entitled to recover those expenditures by way of subrogation against the responsible party. The examiner, on behalf of the City, will diligently identify and pursue any claim where there is a possibility of recovering any or all moneys spent for such an injury. If on investigation, subrogation does not appear to be applicable to the claim, the examiner will document the claim system notepad indicating the basis for this determination. Situations in which subrogation opportunities may be present include, but are not limited to: Auto accident Product defect (e.g., defective chair, ladder, machinery) Premises liability - unsafe surfaces, safety equipment not installed, or poor maintenance The examiner will investigate to determine if a third person(s) or equipment dysfunction may have caused the incident to identify subrogation potential. There are also instances where subrogation is possible against the manufacturer of a defective piece of equipment or machinery. The examiner will work with the City to ensure that faulty equipment is secured and stored for use as evidence. An injury occurring away from the employer's premises may involve subrogation (e.g., a deliveryman at a client's place of business may have a slip and fall injury on foreign matter left on the floor. The examiner will secure the City's approval prior to pursuing subrogation. Various jurisdictions have different statutory timeframes for filing the appropriate paperwork to protect the client, and sometimes these timeframes differ for filing against private entities and public entities. TRISTAR's team is familiar with jurisdictional timeframes to assure recovery for our clients. ,ter T R i S IKA R Page 1 33 tt°nsrUrming risk into OPPettUrlitY -ASHLA Claims Information System (Disk Management Information System) Claim Status, Valuation and Tracking Will your RMIS allow the City to review the status and valuation of claims and run reports on a real-time basis? Is there a method of importing data from your RMIS into the City's RMIS on a monthly basis in an organized and useable manner? Will your system have the capability to code claims by: 1. Type of claim 2. Cause of loss, nature of injury, body part injured (Describe all the code- sets you use. The City system accommodates multiple code- sets.) 3. Status of claim - open and closed 4. Status when each payment and reserve change is made 5. Litigation status 6. State 7. Specific City location 8. Vocational rehabilitation status (if applicable) 9. Subrogation potential TRISTAR's Client Portal is paperless, web-based, and offers Android and Apple compatible mobile apps for employers and claimants. Client Portal provides access to a client dashboard, individual claim detail, and reports. • Dashboard: Our goal is deliver relevant, actionable information in a user-friendly dashboard view. There are three tabs within the dashboard, each sharing key metrics in presentation-ready format: Claim, Financial and Loss Control. Our claim view includes a Trial Calendar with a rolling two month view of upcoming hearing and trial dates. Each dashboard screen offers one-click drilldown to view the data populating the report, option to print or export, and many of the dashboard reports include "hot sites" where simply scrolling the mouse over the site will produce a pop-up with key detail on that data point. • Claim detail: Includes diary, notes, payment processing, reserves/reserve changes, litigation, medical management, policy management, correspondence, work status and restrictions, vendor tracking, correspondence and more. Users have the ability to open three separate claims simultaneously via independent tabs within the portal. • Report module: Standard management reports and customized, ad hoc reports are available to run, view, print, email, or download. We offer over 80 reports such as Loss Prevention, Loss Triangles, Claim Log, 1099's, and many others. Page 34 TRI TA~~ I f } ivK 41gNnc=F:W t T transforming t isk into o[)r>OrWllit~f "S Y O` -ASIALAND Reports may be programmed to run automatically on a user-designated schedule. • Alerts: Our tools allow for customized alerts based on client specific criteria, such as reserve changes in excess of a given amount, large payments, closing notices, and the like. • Access can be customized for individual users. TRISTAR is able to import/export data to the City's RMIS on a monthly basis, in a usable and organized manner. Claims detail includes, but are not limited to, the following coding: • Type of claim • Cause of loss, nature of injury, body part injured, job duty • Day of the week, time of day that injury occurred • Status of claim - open, closed, disability status • Status when each payment and reserve change is made • Five reserve categories: legal, medical, indemnity, vocational rehabilitation, and other • Litigation status • State • Specific City location code • Vocational rehabilitation status (if applicable) • Subrogation potential Does your system track reimbursements/recoveries; is it able to differentiate between refunds/overpayments and recoveries? Yes, TRISTAR's system tracks reimbursements and recoveries, and is able to differentiate between refunds/overpayments and recoveries. P a Uy e 35 ~ ' TRIST ~J I 7 e i K V. A N r: {`s E V E is 7 Vi - transforming risk into o~ ortUnitV "7v 09 I p -ASIArLAND Does your system provide daily data feeds to your RMIS system? Yes, TRISTAR's Claim System provides daily feeds to TRISTAR's RMIS, Client Portal. Your system must show amounts paid, reserved and incurred, by claim (for each payment type), for each of the following (Provide a list of standard loss payment codes): 1. Medical expense 2. Indemnity expense 3. Allocated loss adjustment expense 4. Legal expense 5. Vocational rehabilitation expense 6. Total TRISTAR's system shows amounts paid, reserved and incurred by claim for each of the following: • Legal • Medical • Indemnity • Vocational rehabilitation • Other • Total An example is shown on the following page. Page 36 err TR!4IAR I f J,fr. MAN'AGEM'L11T j 1 .2( tro-nsforming risk into opportunity `ITY O1 -ASHILAND INDEMNITY PRVixd,s ¢at'meratD~scriGtior: Medical Pavcode Payment Description mdr=mniri 6J1 TOMPORAPY DISABILITY Medical 031 ATTENDING PHYSICIAN inderrinir,° 002 PERMANENT DISABILITY Medical 032 SURGEM., Indem'-)Ay 014 YJAGEloss T AgpD4AlRy Medical 034 ANESTHESIOLOGIST Inderfinlr; 7Di PEPMANENTTOTR3D;5&xbl.li~' Medical 036 MEDICAL LEGAL EVAWATiOIZJI iEj Medical 710 (CHIROPRACTOR nriefrfwt~ U03 COPAPRONUSE & RELEASE Medical 711 ACUPUNCTURE fndemnire Cf*c WITHE5S FEES - DEPOST-nON Medical 736 INDEPENDENT MEDICAL EVALe (IME] 3fiueraari!ty 00 DEATH (DEPEUDENT511 Medical 744 DENTIST Indemwty @02 DEATH INO DEPERDENIT_) lndernnirr 703 BURIAL VtPiad5E Medical 050 FUTURE MEWCALJSUPPORTWE CARE indemnit} 1900 JNDEf ftM EXCESS RECOVERY Medical 033 HOSPITAL Indsrr Wiry 9D1 94DEMIt'ITY SUBRO RECOVERY Medical 7D6 HOSPITAL OUT PATIENT Indernn;t;~ gD2 fI~DE~r-r?:rll' CGxNT£i6SlTISf;I RgCOf:'I:I+: Medical 035 PRESCRIPTION DRUGS REHAB Pa code Paymerst Be-scriptior. Medical 049 PHYRCALTHERAPy Rehab GIs VOCATIONAL REHABILITATION Rehab 719 REHAB VENDOPJCOUNSELOR Medical 037 MEDICAL MILEAGE EXPENSE Rehab 721 QUALIFIED REHAEsCONSULTANT Medical 038 MED REMB CLMT; DRUGS, SUPPLIES !Medical 039 MEDICAL REIMBURS.GRP HEALTH LIENS Rehab 020 VOCATIORALREtiABIND'VRMA medical 041 MEDICAL SUPFUfS Medical 043 LANGUAGE TRr3USLATOR J 114TERPRETER Rehab; 021 VR TRAINING,- SCH001 EXPZRSES Medical 048 MEDICAL TRANSPORATiON Rehab 022 MILEAGE; SUPPLIES; BABY SIT"lING medical 051 EQUIPMEM APPLMNCES Medical 747 GYM MEMBERSHIPS Rehab 023 MMEAGE FOR REHAB SERVICES Rehab 720 IRMAB EQUIPMENT Medical 725 MEDICARE SET ASIDE J VE14DOR FM medical 733 MEDICARE SET ASIDE J CLUT PAYMENT Rehab 024 REHMATTriRNEVSFEE medical 737 C&RISFTTLEMENTFUTUREMEDICAL Medical 752 Medicare Conditional Payment Reimburse. Rehm 910 REHM EXCESS RECOVERY Rehab 911 REHM SURRO RECOVERY Medical 045 RADIOLOGY fi UCLEAR MEDICINE Rehab 912 REHAB CONTRIBUTION RECOVERY Medical 046 PATHOLOGY $ LABORATORY Medical 709 DIAGNOSTIC. TEST (CT/MRI) LE°GFiL PawcodE Payment De c6ption legal 055 LEGAL FEES [DEFENDANT) Medical 7D7 NLMSMG scaviCES thomE HE"TH; Legal 056 CLAIMANT DEPOSITION REIMB Medical 706 NURSWG HOME (CONVALESCENT) Legal 057 LEGAL INTERPRETER medical 714 DOMESTIC HELP .(HOUSEKEEPING) Legal 058 WITNESS FEES Medical 712 ERGONOMIC EVALUATION Medical 713 ERGONOMIC EQUIPMENT Lagel 059 COURT REPORUIUMMISERIIPT FEES Medical 7,33 FUNCFiONALCAPAU Y EVALUATION Legal 062 DEFENSE CIVILICIRIMINAL ATTORNEY medical 047 MEDICAIJNLIRSE MANAGEMENT Legal 5.47 IME EVALUATION B EXPENSES medical on UR,/Pre-pert Medical 099 R&Aerronly Legal 330 LEGAL EXCESS RECOVERY medical 724 PFO FEE Legal 931 LEGAL SUBAD ;RECOVERY Medical 734 FIELD NURSE CASE MANAGEMENT Legal 932 LEGAL CONTRIBUTION RECOVERY Medical 735 EARLY INTERVENTION medical 092 MEDICAL INTEREST PENALTY PP-zMcod-E Payment Des¢ripf4 . Medical 920 MEDICAL EXCESS RECOVERY mdemnilry 005 PENALTY/INTEREST- EMPLOYER FAULT medical 921 MEDICAL SUBRO RECOVERY InderntflLy 015 PENALTY/KFUZEST-TRISTAR FAULT medical 922 MEDICAL COfffRIBUTION RECOVERY Inderrlrfay 016 PRIOR TPA PERAALTY - INDIEMN]TY p2ymd? Paymafft noscriptior. Medical 044 10% PENALTY LATE PAY ML_D SILLS Other 066 PHOTOCOPY EXPENSE Medical 041 MEDICAL PE19ALTY DUE TO CLMT Other 057 INVESTIGATION Medical 052 PRIOR TPA PENALTY - MEDICAL other 068 SURVEILLANCE; ACT31fiT ( CHECY "er 059 SUfAOGATON FEES C3ttker 076 PENALTY other 070 LEGAL TRAVfL EXPENSES Other 071 SUBPOENA -1+,'TFEIESSES OTHER P vred~ P~vmerst [)e«riestior, other 091 CASE MANAGEMENT other 940 OTHER EXCESS RECOVERY Other 716 ADRTTRATORJARSITRATION Other 941 OTHER SUBRO RECOVERY Other 723 LIEF: FILING FEE © lier 942 OTHER CONTRIBUTION RECOVERY Other 448 IME Other 073 14LLREVIEW -OTHER other 951 RETURN TO WORK PROGRAM Daher 740 PPO FEE - OTHER OTHZP.. 743 MEDICARE RESEARCH Other 966 Deductible Recovery Page 37 - TR1 A' + y, f,.. 4 f.' A G i f:. r I r transforryiing i1sk into criportunity CITY OF IY F -ASHLAND Data Extracts for the City's RMIS List the RMIS vendors to whom you provide loss data on behalf of your clients and indicate whether you provide claim totals only or include individual transaction records (payments and reserve changes). TRISTAR has established interfaces with carriers and clients. The data transfer is customized for each vendor or client and may include only financial claim totals or individual transaction records. TRISTAR is approved by the following carriers: • AIG • Alliance Global Corporate & Specialty • Allied World Assurance Company • American Contractors Insurance Group • American Safety • Amerisafe • Amerisure • AmTrust • Arch Insurance Group • Benchmark • Catalina • Chubb/ACE • CNA • FW Crum • Hannover/AIX/Nova • The Hartford • Hortica Insurance Group • Houston International Insurance Group • ICW Group • Liberty International Underwriters • Midwest Employers Casualty CO • Munich American Reassurance • Navigators • New York Marine • North American Specialty • Old Republic • One Beacon • Pharmacists Mutual, • QBE • Safety National • Scottsdale • State Auto • State National • Telcom Insurance Group • Travelers Insurance • XL Catlin • Zurich Page 38 TRIG ~`.A ~y :sF' VANAGLt-,+c„r csa transforming risk: into off:}porturlitY -AScle.lt LYv AND TRISTAR has converted and supplies data for RMIS systems including, but not limited to: CS STARS, RiskMaster, @Global, ICE, Origami and other proprietary systems. This occurs both at the client and carrier level. TRISTAR supplies both summary and detailed reports to our RMIS partners. On-Line Report Generation The City requires on-line access to your RMIS. Data must be accessible by personal computer at the City. The City must have the ability to select from a menu of pre-defined reports that contain current claim information. The City must also have the ability to generate ad hoc reports combining any elements in your database, as the need arises. Confirm the City will have on-line access to your RMIS and provide samples of pre-defined reports. TRISTAR confirms that our RMIS, Client Portal, meets all of the requirements noted above. We have included samples of reports as Exhibit 7. We have also included samples of the reports that TRISTAR currently provides to the City on a regular basis as Exhibit 8. Periodic Loss Reports The City requires monthly loss data, including a check register detailing each individual payment broken out by injured worker. City must receive the data no later than the 10th working day of each month. Confirm the City will receive this data as specified and provide samples of your printed reports. TRISTAR confirms that we will provide monthly loss data, including a check register detailing individual payments broken out by claimant, by the 10th working day of each month. We have included samples as Exhibits 7 and 8. Page 1 39 tt~anSfCl'nllliC~ r`isl~ ir1CC) C) ~ ~crfil~C'~it I I -A S } -T L AN D Database Security The City's loss information is considered confidential and your proposal must clearly indicate methods used to ensure that access to information is gained only through identification numbers or passwords, which are provided only to individuals who are authorized to access the City's account. Describe your company's confidential records policies and the methods taken to ensure that backup media, if lost or stolen, would not be useable by any unauthorized party. The TRISTAR claim system is password protected at the network level and at the individual user level for the claim system. TRISTAR establishes unique passwords for each individual user. The system requires passwords be changed at established intervals. TRISTAR has an extensive authorization process to access to data within our system. Authority levels are determined by experience and job title and must be approved by the branch manager before access will be granted. Remote access is subject to the same security process as local access requests. All new information entered is subject to automated data integrity rules validation, such as required fields. Claims supervisors monitor the completeness of data entry on a claim-by-claim basis. TRISTAR's claim system is fully supported by authorized TRISTAR IT staff who have full rights to all aspects of TRISTAR database management. Security is control by Oracle/Unix administrators, and security settings within the application. TRISTAR's application provides secure real-time online access using SSL encryption on a 24-hour basis. This supplies full security for all data imported and or exported for the entire session. It is flexible and user-friendly and provided to all authorized users. TRI .AR Page 40 f C:i_K MANi,c-EMCC 7 t C I T Y Of transforrning risk into) opj-;ortunitY ASHLAND Illustration of Capability Provide sample RMIS screens for evaluation. Descriptions of the screens in relation to particular City requirements must accompany the actual illustrated screen. Will your system accommodate customer specific questions or screens to be completed either at the initial claim reporting or by subsequent entries by the city? What system capabilities are available for use by the City? TRISTAR has enclosed sample RMIS screens as Exhibit 6. TRISTAR's Client Portal accommodates client-specific questions and screens at claim intake. TRISTAR's Client Portal capability available to the City includes Android and Apple compatible mobile apps, paperless access to all claim documentation and correspondence, Claim, Financial and Loss Control dashboards with multi-layer functionality including print and presentation-ready graphics and drilldown, a rolling trial calendar, access to claim detail for up to three claims simultaneously, standard and ad hoc reporting, and customized alerts. Page ~ 41 ~ t • r transforriiinc risk into op ortUrlitV CITY of -ASHLAND On-Line Access/Adjuster Notes Provide sample RMIS screens for evaluation and descriptions of the data available when accessing and reviewing Adjuster notes, reserves and payments. Please see Exhibit 6. Support Outline dedicated systems support available to the City and any related charges. Confirm this area will be staffed adequately to assure timely response and resolution of systems. TRISTAR's claim system is fully supported by authorized, California- based in-house IT staff. Our Service Desk is available to the City of Ashland during normal business hours in all U.S. time zones. .d T R I I FA R~ Page 1 42 f k;s-1; f3AF;AGLf?L':T transfonrnirig risk into r~t3portllflity -ASHC17Y Off LAND State/Federal Compliance Reporting Outline system support available to the City for production of State and Federal required loss reporting. Proposer will need to ensure they have the ability to comply with any current or newly mandated state and federal reporting requirements. Note: The successful proposer will be required to prepare and file State annual Report of Losses, Legal Expenses Paid, and Federal LS-513 and LS-274 reports. City to review and approve report prior to the report being filed. TRISTAR provides State and Federal required loss reporting on behalf of the City. TRISTAR submits the following reports to DCBS's Workers Compensation Division annually: Annual Report of Losses, Payment Data for Annual Compliance Audits, and Defense Legal Costs. CMS Section 111 Medicare Mandatory Reporting Outline system support available to report City of Ashland claims per the Medicare, Medicaid, and SCHIP Extension Act (MMSEA). Note: The successful proposer will be required to prepare and file the mandatory CMS Section 111 Medicare Report. City to review and approve report prior to the report being filed. TRISTAR is compliant with all aspects of the Medicare, Medicaid and SCHIP Extension Act of 2007. As long as the City utilizes our claims software, the City (Responsible Reporting Entity) may designate TRISTAR as the Reporting Agent to report to CMS. TRISTAR prepares the report for the City's review, and files the report on behalf of the City. Page 43 TRITE a 4. Y t cevv ®transforming risk into (.}loportunity -ASHLAND Systems Reliability Provide the prior three (3) years' history of your online system's availability. TRISTAR has been utilizing our claims system for more than 14 years, and reliability and availability has remained intact since inception. Security ® Back Up - Recovery TRISTAR's claim system is fully supported by authorized TRISTAR IT staff who have full rights to all aspects of TRISTAR database management. Security is control by Oracle/Unix administrators, and security settings within the application. TRISTAR's application provides secure real-time online access using SSL encryption on a 24-hour basis. This supplies full security for all data imported and or exported for the entire session. It is flexible and user-friendly and provided to all authorized users. Internet based information systems are password protected at the network level and at the individual user level. Unique passwords are established for each individual user. The system requires passwords be changed at established intervals. Access to data within our system is established through an extensive authorization process. Authority levels are determined by experience and job title, and must be approved by the branch manager before access is granted. Remote access is subject to the same security process as local access requests. Our SSAE 16 annual audit performed by Deloitte and Touche documents our change management procedures including test controls that indicate the following policies/procedures, including but not limited to: v Network Services process for monitoring disk space capacity, system responsiveness and system usage daily, User access change policies and procedures limiting access to users User network sessions lock out after period of inactivity Standard server configuration conforming to current IT security standards Changes to configuration of firewall reviewed and authorized by CIO v User assigned access rights based on job responsibilities ~ Password policies Notification to clients Our information security controls are indicated in our SSAE 16 audit control objectives and provide assurance that access to the application, sensitive master files and data, and the computer network is restricted to authorized persons. We adhere to all regulatory statutes indicating required policies and procedures including notification to affected individuals in the event of a security breach, if any. P a TR1 S-FA~_ g e 44 f trcnsforn-ring risk into opr)ortunity CITY OF Our SSAE 16 compliance document includes review of policies and procedures related to protection personal information. Disaster Recovery/Back Up Strategy - TRISTAR provides physical access to our data center and computer systems controlled by a secured hydraulic arm and a badge reader. A limited number of authorized IT staff has access. The following items protect the computer from adverse environment conditions: Multiple uninterrupted power supplies ("UPS") - all UPS units are automatically tested each month end. In the event of failure, notifications are sent out to TRISTAR Networking Services group. UPS logs are reviewed and logged on quarterly bases. Two air conditioners control temperature and humidity. They are inspected and serviced bi-monthly. Fire suppressions system inspected every 6 months. Recovery is indicated in our backup system in addition to risk management policies for operations necessary in the event of unanticipated prolonged outage. Our SSAE 16 (SOC 1) Type II auditing performed by Deloitte and Touche provide reasonable assurance that application and system processing is complete; processing problems, deviations, and errors are identified and resolves; and backups of data and system files are performed regularly. As a brief overview: Backups of Oracle database transaction logs are performed automatically throughout each business day. A Windows task scheduler is configured to automatically backup the Oracle dataset archive logs through each business day and configured to automatically perform a full database back up nightly. Full disk-based backups are performed automatically every weeknight and disk-to tap backup once a week. Weekly and monthly backup tapes are rotated off-site to Cranbury, NJ and Signal Hill, CA offices to be stored in fire proof safes. The integrity of the tape backup is tested at month end by restoring files from the month end back up tape prior to its shipment offsite. Two backups of two backup types are recorded in the Oracle logs according to their respective schedules. The backup system generates automatic email and daily status report to the Network Administrator. Backups are monitored by management for successful and timely completion, and backup errors, if any, are reviewed by management, and promptly resolved. Although the retention period is 2 weeks, tapes are available for approximately 2 months - or 60 days - before reuse. On a weekly basis, a full copy of the system is backed up to tape and maintained on site with an additional copy made and sent offsite to TRISTAR's Signal Hill, CA office for storage. Backup reports are available. Page 45 .4 TRI GAR .P n ' N C4 l(L coly OF -ASHLAND transforn-iin risk irItO u:.; ortUniT r Production databases operate in archive log mode to minimize downtime in the event of recovery. Conversion activities occur in late evenings during non-office hours and regular maintenance activity is schedule for late evenings on the weekends and do not cause any regular disruption to typical users. Page 46 T R I TA u. r A W . •r: ~Ef1CRT C6TY of tiansfori-ning risk into opporturfity -ASHLAND Quality Control Describe your requirements for supervisory/management case review to ensure compliance with service agreement. TRISTAR recognizes the vital importance of quality in both the service provided to our clients and our technical claims product. Our robust Quality Assurance program helps assure consistent, high quality service in compliance with applicable statutes, rules and regulations. TRISTAR's quality control measurements include, but are not limited to, the following programs to ensure that we are consistently adhering to those practices and procedures established to move files to appropriate closure: Claims Services Summary: To assure that claims examiners can focus appropriately on the management and resolution of each claim file, TRISTAR supports our examiners by offering appropriate caseloads, clerical staff for non-technical, administrative duties, and oversight by experienced supervisors who do not carry a personal caseload. Our Best Practices are based upon proven claim management practices that deliver consistent, top quality results. Within our claim system, automated diaries and system requirements help assure that examiners and supervisors manage/oversee claims in compliance with our Best Practices and any applicable Client Handling Instructions. Supervisory Oversight & Review TRISTAR supervisors do not carry a caseload, allowing them to concentrate on their primary function, providing oversight and mentoring the examiners to ensure the best resolution for a claim. Files are reviewed by supervisors on both a random and systematic basis. Supervisors are required to review all new indemnity claims within 10 business days of TRISTAR's receipt of the claim. This is to verify all pertinent issues have been identified and addressed, appropriate compensability determination was made, reserves are appropriately set, diaries are in place, benefits have been accurately calculated and paid, benefit notices are complete and a thorough action plan is documented in the file. Supervisors review all indemnity claims at 90 days and complete a thorough review of the file. Subsequent supervisor diary is mandatory on active indemnity claims every 180 days or more frequently, the diary must be appropriately set for the specific claim. All claims where reserves, payments, or settlement authority exceeds that of the claims examiner are reviewed by the supervisor and proper documentation of the review is entered into the notepad. TRISTAR has established several quality control mechanisms to ensure satisfactory delivery and compliance with statutory mandates. Page 1 47 ~ T R I TA ri!t h `ar: .ci t E r IL CITY transforming risk into opportunity ASHLAND Systematic Audit TRISTAR conducts multiple audits throughout the year. There is an internal audit of each branch annually to evaluate the performance of each examiner and supervisor. Critical areas are audited such as diary review, plan of action, investigation, supervisor involvement and excess review. An audit report is published and distributed to management and senior management. For any score below 85% an action plan is required to be completed by the branch manager. In addition, quarterly audits are conducted to review our performance on 3 point contact, initial supervisor reviews and 90 day supervisor reviews. All results are delivered to the management of the office and the Regional Vice President. Self Audit The claims examiners perform self-audits on their files. Utilizing the Closure Checklist, this self-audit addresses items such as the processing of appropriate forms, correct calculation of payments, and any unpaid or disputed medical bills or liens. Client Procedural Compliance TRISTAR completes a new client implementation form for every account, which includes client specific requirements. Where appropriate, Client Instructions are automated via diary and system requirements. Compliance with Client-Specific Handling Instructions is reviewed during Supervisor Diaries, and audited as part of our QA Audit Program. Incentive for Quality Assurance Excellence: TRISTAR's President's Award for Claims Handling Excellence is awarded annually as incentive for examiners and supervisors to achieve outstanding audit results: examiners must score 95% or higher, and supervisors must have an individual audit score of 95% or higher, and their units must earn an overall score of 90% or higher. Team members who achieve these metrics earn a monetary prize, a plaque, and are mentioned in our internal newsletter. Page 1 48 TRI A transforming risk into epl)ortunity -ASHLAND Provide copies of one year (prior 4 quarters) of State quarterly claims processing reports for all clients (names omitted) managed by the proposed claims team. Please see Exhibit 9. Describe your process for ensuring accuracy of loss data generated either by the City or by TPA. All new information entered is subject to automated data integrity rules validation, such as required fields. Claims supervisors monitor the completeness of data entry on a claim-by-claim basis. During any data migration, TRISTAR's IT department performs reconciliation ensure data integrity. Claims are compared to detail and summary reports provided by the other party. How often do you conduct open claim reviews with your clients? TRISTAR conducts open claim reviews based upon each client's request. We currently conduct one claim review per year with the City. We can conduct up to two claim reviews per year at no additional charge if desired by the City. Explain your process for accommodating file audits and correction of deficiencies by your clients, their outside auditors and excess insurers. TRISTAR accommodates file audits from clients, their outside auditors and excess insurers with reasonable notice. We typically request 30 days' notice prior to an audit. All audits will be coordinated through our Portland Manager, Amy Stone. Following receipt of the final audit report, TRISTAR will provide its response with corrective action plans within 30 days, or dictated timeframe, to all involved parties. Audit results will be incorporated and discussed during claims review and stewardship meetings. This process will assist in identifying and addressing positive/negative trends for purposes of meeting and exceeding City program goals and objectives. Page 149 T R I TA !`ansfdi'm iII o cavv OS risk into G pCrtUf tli\ -ASHLAND In establishing a partnership with the City, what are the key elements that will build ongoing trust between the parties? TRISTAR values our partnership with the City. We view the key foundations to our long-term partnership as: • a stable, experienced team, ® a customized service program combined with proven best practices to control total loss costs, ® compliance with the City's required communication and authority thresholds, providing prompt and equitable claims management services to assure the satisfaction of the City and its injured employees, and • compliance with all appropriate statutory and regulatory guidelines. How do you propose to make the City's relatively low claim volume a handling priority? TRISTAR has demonstrated that the City's claims are a priority, by adhering to the City's customized handling instructions and communication protocols, providing required reports, participating in one claim review per year, and serving the City with an experienced and stable team of examiners. Outline your process for file retention; archiving and storing/maintaining closed files. Electronic and physical files are maintained as long as statutorily required and/or in accordance with the client's file retention and destruction criteria. There is no additional cost for claim file destruction or retention. Page I 50 f n;SY. it c.! jc; CF~EPfT w`S CITY aip 00-nsforrning r"Isle it-40 0PP01tU1`J1Y -ASHLAND Deports Describe the activity reports you typically provide to your clients on a monthly, quarterly or annual basis including: a. Financial reports such as cost paid, account reconciliation, reserve changes and cost recovery b. Claim status reports such as open, reopened, and closed, utilization, litigation Note: Costs for any additional value added services are to be identified and included with the Cost Proposal. TRISTAR's claim system, Client Portal, provides a myriad of reports designed to enable personnel to analyze data from the risk management perspective. Reports can be produced real time or for user defined reporting history periods. The system includes over 80 standard and customized reports, and ad-hoc reports. Examples include Claim Status Reports, Loss Prevention, Loss Triangles, Custom Claim reports, Lag Time reports, Policy and Fiscal Year Summary Report, SIR/Excess Reports, Litigation reports, Subrogation reports, Denial reports, Payment reports, Injury Matrix reports, Occupation/Body Part/Nature of Injury/Incident Type reports, 1099 forms, Service Year reports, Age at Injury reports, OSHA reports, and many others. Reports can be run based upon the City's location/organization hierarchy. The Report Module allows one window to query all reports. The user can add or delete reporting fields and selection criteria with ease. All terminology is common claims terminology; the end-user is isolated from the database or system language. The user selects the report group such as general, loss prevention, payment processing, etc. The user can then identify specific claims as well as valuation dates for the report. All reports appear first in a display window, which can also be previewed. Roll-ups are user-defined and are not pre-programmed. The end user can specify the sorting and grouping/totaling, as desired. The ability to sort, group, and total on any field of a report has been found by our clients to be very helpful. The user can export reports in common file formats, including Excel, ASCII CSV, and Adobe Acrobat (PDF). TRISTAFri Page 51 f RiE.. yCAWpG6F1.-r;T Purchase Order Fiscal Year 2017 Page: 1 of: 1 B City of Ashland ATTN: Accounts Payable Purchase L 20 E. Main 56 Ashland, OR 97520 Order # T O V TRISTAR RISK MANAGEMENT S C/O Human Resources Division E CITIZENS BUSINESS BANK H 20 East Main Street N TRM ITF CITY OF ASHLAND D 970 W. 190TH P Ashland, OR 97520 O TORRANCE, CA 90805 Phone: 541/552-2110 R TT Fax: 541/488-5311 lendQr_=Ph r I umbs r = l nsiQC:F !XNffingbe rattra k - - - 714 543-0700 Tina Gray mate Qrer~_~Qr Number- 08/05/2016 916 FOB ASHLAND OR Cit Accounts Pa able Workers Comp TPA Services FY17 The Above Purchase Order Number Must Appear On All Correspondence - Packing Sheets And Bills Of Lading 1 Workers' Compensation TPA Services 1.0 $25,000.00 $25,000.00 (Self Insured)*Based on actual claims incurred Approved by Council 07/19/2016 GL Account: $25,000.00 GL SUMMARY 030022 - 607240 $25,000.00 By: Date: Authorized Sign ure = _ - - _ $25,000.00 FORM #3 CITY OF ASHLAND REQUISITION Date of request: Required date for delivery: Vendor Name TI2(v--7 t~S}~'~~~1~T Address, City, State, Zip I r70 00VA N )kTO . S(ArTIF- _qX LOW >B~f~-GN C~ ~ oZ Contact Name & Telephone Number Pu my F ' ~'1(~Q ZS -1300 , C -)CE I qZD Fax Number SOURCING METHOD ❑ Exempt from Competitive Bidding ❑ Emergency ❑ Reason for exemption: nvitation to Bid (Copies on file) ❑ Form #13, Written findings and Authorization ❑ AMC 2.50 ate approved by Council: ❑ Written quote or proposal attached ❑ Written quote or proposal attached _(Attach co of council communication _(If council approval required, attach co of CC ❑ Small Procurement Cooperative Procurement Request for Proposal (Copies on file) Less than $5,000 El State of Oregon ❑ Direct Award ate approved by Council: 7/ l b Contract # ❑ Verbal/Written quote(s) or proposal(s) Attach copy of council communication) ❑ State of Washington Intermediate Procurement ❑ Sole Source Contract # GOODS & SERVICES ❑ Applicable Form (#5,6, 7 or 8) ❑ Other government agency contract $5,000 to $100,000 ❑ Written quote or proposal attached Agency ❑ (3) Written quotes and solicitation attached ❑ Form #4, Personal Services $5K to $75K Contract # PERSONAL SERVICES ❑ Special Procurement Intergovernmental Agreement $5,000 to $75,000 ❑ Form #9, Request for Approval ❑ Agency ❑ Less than $35,000, by direct appointment ❑ Written quote or proposal attached Date original contract approved by Council: ❑ (3) Written proposals/written solicitation Date approved by Council: (Date) ❑ Form #4, Personal Services $5K to $75K Valid until: Date - (Attach copy of council communication) Description of SERVICES Total Cost THI2D PARTY CLAIMS -Ab YI r N I STF,,+TI0N -;t;5k pi~pz y5,+k/9,%~s IDwo~K p4rckfim 5 0 ~o 65a r - c NSU AFb t 1b~-~a ON ACNA-G 04AI 7,; Item # Quantity Unit Description of MATERIALS Unit Price Total Cost TOTAL COST ❑ Per attached quotelproposal v . ~5, oDo Project Number _ _ _ _ _ _ - _ _ _ Account Number720_ _ 00 _ - _ oa _ - kI2_ ~ Account Number--- Account Number *Expenditure must be charged to the appropriate account numbers for the financials to accurately reflect the actual expenditures. IT Director in collaboration with department to approve all hardware and software purchases: IT Director Date Support -Yes/ No By signing this requisition form, I certify that the City's public contracting requirements have been satisfied. Employee: Department Head: (Equal to or greater th $5,000) Department Manager/Supervisor: #City Administrator: (Equal to or greater than $25,000) Funds appropriated for current fiscal year: YE / NO Finance Director- (Equal to orgreate an $5,000) Date Comments: Form #3 - Requisition CITY OF ASHLAND Council Communication July 19, 2016, Business Meeting Approval of a public contract exceeding $75,000 for Workers' Compensation Third Party Administration Services FROM Lee Tuneberg, administrative services director, lee.tuneberg( ,ashland.or.us Tina Gray, human resources manager, tina.grayn,ashland.or.us SUMMARY This is award of a contract for Workers' Compensation Third Party Administration Services to TRISTAR Risk Management. If approved by the Council, the contract will be awarded for a two-year term with the option of extending the contract annually for up to three (3) additional years for a maximum term of five (5) years. Estimated cost is $20,000 to $25,000 per year. BACKGROUND AND POLICY IMPLICATIONS: Ashland self insures for Worker's Compensation benefits and hires a third party administrator to administer the program. Third party administrator services are solicited via a formal Competitive ,Sealed Proposal (Request for Proposal). Public notices were mailed to 28 potential service providers, a public notice was published in the Daily Journal of Commerce and 13 prospective proposers accessed the solicitation documents on the City's website. The City received two (2) proposals in response to this RFP for Workers' Compensation Third Party Administration Services. The proposals were evaluated and scored by a two-person evaluation committee in accordance with the requirements and evaluation criteria set forth in the RFP. Upon the completion of the evaluation process, TRISTAR Risk Management was declared the highest ranked proposer. The evaluation summary is attached for review. Section 2.50.080 Formal Processes - Competitive Sealed Bidding and Proposals Except as otherwise expressly provided herein, in addition to the requirements of the Model Rules and the Oregon Public Contracting Code: C. The Local Contract Review Board shall approve the award of all contracts for which the Ashland Municipal Code or the Oregon Public Contracting Code require formal competitive solicitations or formal competitive bids. Section 2.50.070 Public Contracting Officer Authority A. Except as otherwise provided by this code, the Public Contracting Officer shall have authority to: 2. Contract for all personal services as long as the contract price does not exceed $75,000; and COUNCIL GOALS SUPPORTED: Administration and Governance Goal Page lof2 ~r CITY OF ASHLAND Provide high quality, effective, and efficient city services and governance in an accessible, collaborative, and fiscally responsible manner. FISCAL IMPLICATIONS: Funds for this contract are budgeted and available and are consistent with current costs. The annual administrative cost is $2,500 and claims are estimated at $17,500 per year. If the contract is extended to a full five years the total impact is estimated to be over $100,000. STAFF RECOMMENDATION AND REQUESTED ACTION: Staff recommends the public contract for Workers' Compensation Third Party Administration Services be awarded to the highest ranked proposer, TRISTAR Risk Management. SUGGESTED MOTION: The Council, acting as the Local Contract Review Board, moves to approve the public contract award to TRISTAR Risk Management for Workers' Compensation Third Party Administration Services. ATTACHMENTS: RFP - Evaluation Summary Contract Pa e 2 of 2