NIGP 95327: Claims Processing Services

NIGP 95327 Claims Processing Services, an Item code, encompasses comprehensive administrative processing of insurance and government benefit claims — including workers' compensation third-party administration, pharmacy benefit management, health claims auditing, and claims adjustment services — as state and local governments currently procure it. Recent solicitations reveal a market dominated by self-insured municipalities and counties managing workers' compensation, Medicaid health plans processing pharmacy and dental claims, university systems administering employee benefits, school districts, transit authorities, and special healthcare districts seeking specialized claims administration across property damage, auto liability, behavioral health, and medical necessity determinations.

State and local issuing bodies span city procurement offices (Phoenix, Orlando, Salt Lake City), county risk management divisions (Chatham County, Collier County, Cook County), school districts (Atlanta Public Schools, Beaver County, Tarrant County College District), university systems (University of Texas System, UT Health Science Center), state agencies (Oregon Department of Consumer and Business Services, South Dakota Department of Health, Utah Division of Purchasing), health plans (CareOregon, Cook County Health's CountyCare, Central Health), and special districts (Tohopekaliga Water Authority, Cooperative Information Services). Recent high-activity jurisdictions include Arizona (City of Phoenix, July 2026 RFP for $14,000 annually across five-year TPA term with 43,000 claims transition), Georgia (Atlanta Public Schools, Chatham County, with historical annual claims ranging $1.2–$4.2 million), Oregon (State of Oregon, $70 million estimated five-year contract; CareOregon processing 9 million claims annually), and Utah (State of Utah, multiple RFPs for claims handling and RFI for costing models). Representative recent opportunities include the City of Phoenix's worker's compensation TPA procurement (RFPPS270005, RFP, due July 31, 2026) covering 14,000 employees and 43,000 claim transition with performance guarantees; State of Oregon's Assigned Claims Processing Agent Services (RFP S-44000-00017296, due July 30, 2026) for $70 million across up to ten years managing noncomplying employer claims; Salt Lake City's Claims Adjustment Services (SLCI26001, RFP, due May 12, 2026) for five-year term covering property damage and bodily injury claims; the University of Texas System's Claim Preparation Services (RFP 720-2604, due May 20, 2026) for a non-exclusive $2 million cumulative cap spanning fourteen UT institutions; and Cook County Health's Condition Management Services for Medicaid (H2625060, RFP, due June 19, 2026) and Dental and Vision Benefit Management (H2625140, RFP, due May 13, 2026 with MBE/WBE participation requirements). Qualification patterns across recent solicitations emphasize state licensure as claims adjusters or TPAs, minimum five to ten years of government or similar-entity experience, local operational presence or onsite staffing, HIPAA and cyber liability compliance with insurance minimums frequently $1–$10 million aggregate, and data security certifications (SOC 2, HITRUST). Set-asides and preferences appear in select jurisdictions: Arizona DBE-N participation for Phoenix; Texas HUB subcontracting plans for UT System and UT Health Science Center; MBE/WBE requirements for Cook County Health, Chatham County, and Atlanta Public Schools; and local business preferences for Salt Lake City and select Georgia jurisdictions. Activity is currently active across most states, with particular procurement concentration in the Southwest, Southeast, and Pacific Northwest regions through mid-2026.