NIGP 96116: Claims Processing Services

NIGP 96116 Claims Processing Services, an Item code, encompasses third-party administration of workers' compensation claims, management and distribution of utility refund checks, processing of pharmacy claims switches, and child protective services payment disbursements—work state and local governments solicit when they need external contractors to handle high-volume transactional processing, regulatory compliance, and customer-facing operations that exceed internal staffing capacity. State agencies, counties, cities, school districts, and public hospital districts all issue solicitations under this code. Recent opportunities show Florida counties and cities (Monroe County, City of Orlando) requesting workers' compensation TPA services; Texas entities including the Health and Human Services Commission, Public Utility Commission, Travis County Healthcare District, and Northside Independent School District requesting workers' compensation TPA, pharmacy claims switching, utility refund distribution, and hospital indemnity administration; and the University of Texas System requesting claims processing services.

Geographic activity concentrates in Texas and Florida, with scattered activity in Arizona, Kentucky, and other states. Recent representative opportunities include Monroe County, Florida issuing RFP 629 for Workers' Compensation Third Party Claims Administration Services covering 1,320 employees with proposals due July 16, 2026; the City of Phoenix issuing RFPPS270005 for Worker's Compensation Third Party Administration Claims Management Services for approximately 14,000 employees under a five-year agreement starting July 1, 2027, with sealed offers due July 31, 2026 and a DBE-N small-business participation plan requirement; the Texas Health and Human Services Commission issuing IFB HHS0016921 for FY27 Claims Processing for DFPS across ten regions with bids due May 20, 2026 and performance starting September 1, 2026 through August 31, 2031; and Northside Independent School District issuing RFP2026128 for Workers' Compensation TPA and Related Services with sealed bids due October 22, 2026, replacing an expiring contract with mandatory vendor resubmission.