On behalf of a number of South West Victorian Health Services, South West Healthcare is asking for submissions from suitably qualified suppliers to provide services related to review of Workcover components.

The scope of work covers review of Workcover premiums focusing on achieving savings and recovery of outstanding monies.

Purpose of RFQ:

This RFQ specification outlines the requirements for the provision of services related to:

• Conducting a WorkCover Premium Review for the participating Health Services.

• Recovering outstanding monies owed by the Health Services' WorkCover insurer, including unpaid claims, reimbursements for medical expenses, compensation for work-related injuries, or any other financial obligations under the WorkCover agreement that have been overlooked, underpaid, or not yet processed.

Scope of Work:

WorkCover Premium Review (Focusing on Achieving Savings)

• Premium Audit and Analysis: Conduct a comprehensive review and audit of the WorkCover premiums paid by the participating Health Services over past years.

• Identification of Overpayments or Inefficiencies: Examine premium calculation methodologies to identify potential overpayments or inefficiencies in the existing premium structure. Focus on identifying areas where premiums may be disproportionately high due to incorrect classifications, industry grouping, claims experience rating errors, or any other factor that may result in excessive costs.

• Savings Identification: Identify opportunities for reducing future WorkCover premiums that may include but not be limited to:

•  Correcting classification errors, ensuring the Health Service is properly classified according to the most relevant category to minimise premium rates.

•  Optimising the application of any applicable discounts or rebates that may have been overlooked or underutilised.

•  Identifying and proposing adjustments to the insurer’s calculations, based on annual declared remuneration or other factors that may allow for a reduction in premiums.

•  Closely reviewing claims that could be impacting the premiums.

• Reporting and Recommendations: Submit a report that outlines the findings of the premium audit, identifies areas of potential savings, and provides clear recommendations for achieving cost savings. This should include:

•  A breakdown of overpayments or inefficiencies discovered.

•  Suggested steps to optimize premium payments and reduce future costs.

•  Recommendations for policy adjustments.

• Implementation Support: Where possible, assist with the negotiation of premium reductions or policy adjustments with the WorkCover insurer. This may involve liaising with the insurer on behalf of the Health Services to ensure that identified savings opportunities are realised.

Recovery of Outstanding Monies

• Identifying Outstanding Claims and Amounts:

•  Review of Claims and Payments: Conduct a comprehensive audit of all active and closed WorkCover claims that involve the Health Services. Identify any instances where payments from the insurer are missing, incomplete, or overdue.

•  Claim Discrepancies: Analyse claim records to detect discrepancies in payments, including underpayments, partial payments, or claims that have not been reimbursed as per the WorkCover agreement.

•  Cross-Check with Financial Records: Cross-reference WorkCover claims with financial and accounting records to identify any unpaid or forgotten amounts owed by the insurer.

•  Unpaid Invoices: Identify invoices for medical expenses, rehabilitation costs, compensation for injured employees, and any other outstanding amounts that have been paid by the Health Services but are owed by the insurer.

• Recovery Process:

•  Engage with WorkCover Insurer: resolve discrepancies, missing payments, or overlooked claims to confirm outstanding amounts owed.

•  Prepare and Submit Recovery Claims: Prepare detailed claims for recovery, providing all necessary supporting documentation to the insurer.

•  Negotiation and Settlement: Negotiate with the insurer to settle outstanding amounts owed promptly. Propose payment plans or settlements if needed that benefit both parties.

•  Legal Compliance: Ensure that all recovery actions comply with WorkCover legislation, relevant insurance laws, privacy regulations, and applicable contractual obligations.

•  Monitoring and Follow-up: Track the status of submitted claims and payments, following up regularly with the insurer to ensure timely resolution of outstanding payments. Address any delays or issues promptly.

•  Reporting and Documentation

• Premium Review Report: Provide a report, as described under section 2.1, covering the audit findings, identified discrepancies, and recommended actions.

• Final Report: Submit a final report summarising all outstanding monies identified, amounts recovered, and unresolved claims, including recommendations for future recovery actions.

•  Optional Value Add - Continuous Improvement and Advice

• Recovery Process Evaluation: Review the current processes for managing WorkCover claims and premiums and provide recommendations for improvement to avoid future discrepancies or payment issues.

• Training and Guidance: Provide guidance and training to internal staff on identifying and preventing overlooked or forgotten WorkCover claims and on maintaining accurate financial records related to premiums and claims