NIGP 94993: Worker's Comp., Indemnity Claims

NIGP 94993 Worker's Comp., Indemnity Claims, an Item code, encompasses third-party administration and claims management services that state and local governments procure to handle workers' compensation indemnity benefit payments, medical bill processing, subrogation recovery, and overall claims lifecycle management for self-insured or partially self-insured employee populations. Recent solicitations show that public employers—city and county governments, public hospital districts, and constitutional offices—contract with licensed third-party administrators (TPAs) to manage claims ranging from approximately 1,300 to 14,000 benefit-eligible employees, with comprehensive scopes that include initial claimant contact within 24 hours, compensability determinations, timely benefit and medical payments, third-party lien management, and Medicare Secondary Payer compliance. Issuing bodies across this code include city procurement offices (Phoenix), county purchasing departments (Monroe County, Sarasota County), and public healthcare districts (Central Health in Travis County, Texas). The majority of recent activity involves counties and cities soliciting three- to five-year TPA agreements with dedicated on-site or hybrid staffing requirements, performance guarantees tied to specific metrics (claims processing timelines, denial errors, data breaches), and structured pricing on a flat-fee or annual cost basis with no implementation fees beyond base administrative rates.

Geographic activity concentrates in Florida and Arizona, with Monroe County, Sarasota County, and the City of Phoenix driving the most recent competitive procurements. Monroe County, Florida posted RFP 629 (response due July 16, 2026) seeking TPA services for approximately 1,320 county employees with a three-year contract term and optional renewals, while Sarasota County issued RFP 262840MM (posted March 16, 2026, due April 3, 2026) for claims administration across all county departments serving a minimum of 2,000 employees over three years. The City of Phoenix released RFPPS270005 (due July 31, 2026) for a five-year TPA agreement covering approximately 14,000 benefit-eligible employees with stringent on-site staffing mandates, performance penalties, and a Most Favored Nations pricing clause. Central Health in Travis County, Texas solicited 2606001 (due July 13, 2026) for hospital indemnity insurance rather than pure TPA claims administration, though it reflects demand from healthcare employer entities. Florida TPAs must hold current licensure under Florida Statutes 626.88-626.8991; Arizona TPAs must be licensed by the Industrial Commission of Arizona. Set-aside programs vary by jurisdiction—Phoenix applies a DBE-N small-business participation requirement, while some Florida solicitations exclude local or disadvantaged-business preferences due to grant funding restrictions or apply local-business scoring preferences of up to 10 points.