NIGP 96116: Claims Processing Services

NIGP 96116 Claims Processing Services, an Item code, covers administrative processing of insurance claims, benefit claims, and payment disbursements for state and local government self-insured programs, employee benefit plans, and regulatory refund distributions. Recent state and local solicitations show demand for third-party workers' compensation claims administration, health insurance claims audits, child protective services payment processing, utility refund check distribution, DNA testing results coordination, and specialized claims preparation for complex losses. Issuing bodies include state agencies (health commissions, family services departments, utilities regulators, education systems), county governments (Chatham County, Monroe County, Fulton County, Travis County), city governments (Phoenix, Orlando, Louisville), school districts (Atlanta Public Schools), and healthcare districts (Central Health). The code draws repeat buyers, with multiple workers' compensation third-party administration procurements from municipalities and counties.

Work solicited under the code clusters around workers' compensation third-party administration (covering claim setup, compensability determinations, indemnity payments, medical bill review, subrogation recovery, and compliance reporting), payment and disbursement services (processing checks and online purchases for vulnerable populations, managing refund distributions), health plan administration support (claims audits against United Healthcare and other carriers, hospital indemnity insurance), and specialized advisory services (claim preparation for property damage, business interruption, and cyber incidents). Geographic activity spans Florida (Monroe County, City of Orlando), Georgia (Atlanta Public Schools, Fulton County, Chatham County), Texas (Central Health in Travis County, Public Utility Commission, University of Texas System, DFPS across ten regions), Arizona (City of Phoenix), Colorado (implied through Central Health operations), and Oregon (State Alcohol and Drug Policy Commission). Representative recent opportunities include the City of Phoenix requesting sealed offers for workers' compensation TPA claims management covering approximately 14,000 benefit-eligible employees with a July 31, 2026 response date (RFP RFPPS270005); the Health and Human Services Commission on behalf of Texas DFPS issuing an Invitation for Bid for claims processing services across ten DFPS regions with response due May 20, 2026 (IFB HHS0016921); Monroe County, Florida requesting proposals for workers' compensation third-party claims administration for approximately 1,320 employees with response due July 16, 2026 (RFP RFP629); and Chatham County Board of Commissioners soliciting health claims audit proposals covering medical and prescription drug plan claims with response due March 31, 2026 (RFP 2600285).