UNSPSC 84131613: Claims payment processing or administration

Services offered by suppliers (Third-Party Payers or Third-Party Administrators) who collect insurance premiums from various group clients, handle payment to service providers (health, dental, drug) and remit premiums collected back to insurance companies. In some cases, may act to pay on behalf of insurance company, and directly contact and maintain information with the group clients.

UNSPSC 84131613 Claims payment processing or administration, a Commodity code, encompasses the administration and processing of workers' compensation claims, third-party claim administration services, and related claims management functions that state and local governments procure to manage occupational injury, liability, and employee benefit claims. Recent solicitations show state and local issuers buying comprehensive third-party administration (TPA) services covering claims intake, adjuster services, medical and indemnity benefit processing, pharmacy benefit management, utilization review, bill review, litigation management, and risk management information system (RMIS) access. The issuing-body mix includes cities, counties, school districts, and transit authorities, with repeat activity from Arizona, Florida, Georgia, and Utah jurisdictions. Cities and counties represent the largest segment—Tucson, Phoenix, Orlando, Marion County (Florida), Forsyth County (Georgia), and Salt Lake City all posted workers' compensation TPA solicitations in the past eight weeks—while independent school districts (Northside ISD in Texas, Polk County Public Schools in Florida) and special-purpose entities (University of Texas System, Central Health in Travis County) also appear in the recent queue. The code also captures ancillary claims-related services such as medical bill review, pharmacy benefit management, and claims intake platforms, though these appear less frequently than core TPA work.

Geographic activity concentrates in Arizona (City of Tucson, City of Phoenix), Florida (Marion County, Polk County Public Schools, Brevard County, Collier County), Georgia (Forsyth County), and Utah (Salt Lake City, State of Utah Division of Purchasing), with additional activity in Texas (Northside ISD, Tarrant County College District, University of Texas System) and Oregon (State of Oregon Department of Consumer and Business Services). Representative recent opportunities include the City of Phoenix RFP for worker's compensation third-party administration claims management services (RFPPS270005, due July 31, 2026) covering approximately 14,000 benefit-eligible employees with a five-year term, on-site staffing requirements, performance guarantees with financial penalties, and DBE-N small-business participation tracking; Forsyth County, Georgia's solicitation for Workers' Compensation Third Party Claims Administration Services (PE65800NONST2027000000115, due October 15, 2026) covering approximately 2,681 employees with a four-year term, Georgia-licensed adjuster requirements, web-based RMIS integration, and evaluation on a 100-point scale across capabilities, experience, questionnaire responses, and case management; and Salt Lake City's Request for Information on workers' compensation third-party administrator services (SLCI27041, due November 9, 2026), an information-gathering exercise preceding a formal procurement that seeks vendor input on service delivery, staffing, fee structures, technology capabilities, and performance metrics for a city with approximately 450 annual claims historically ranging from $704,000 to $1.6 million in paid amounts.