Forsyth County Procurement Department 2435 Freedom Parkway, Suite 3100

Cumming, GA 30041 | Phone 770.888.8872

REQUEST FOR PROPOSAL

RFP NO. 27-20-0610

Workers’ Compensation Third Party Claims Administration Services

Forsyth County Board of Commissioners Cumming, GA

Closing Date and Time:

October 15, 2026 / 2:00 p.m.

FORSYTH COUNTY, GEORGIA

Request for Proposal No. 27-20-0610

Workers’ Compensation Third Party Claims Administration Services

1. PURPOSE OF THE REQUEST FOR PROPOSAL

Forsyth County, a political subdivision of the State of Georgia (“County”) is soliciting Proposals from qualified firms to provide Workers’ Compensation Third Party Claims Administration Services for the Forsyth County Department of Risk Management.

All interested qualified firms are invited to submit a formal proposal with pricing information to accomplish the Scope of Work described herein, in conformance with the prescribed format. The proposal is to be signed by a principal in the firm.

It is the County’s intent that this Request for Proposal (“RFP”) permit competition. It shall be the offeror’s responsibility to advise the Procurement Agent in writing, if any language, specification, etc., or any combination thereof, inadvertently restricts or limits the requirements stated in this RFP to a single source. Such notification must be received by the Procurement Agent not later than ten (10) days prior to the date set for acceptance of the proposal.

While every effort has been made to ensure the accuracy and completeness of information in the RFP, we recognize that the information may not be complete in every detail and that all work may not be expressly mentioned in these specifications. It is the responsibility of the proposing firm to include in their proposal all pertinent information in accordance with the objectives of the County.

2. GENERAL INFORMATION

Proposals MUST be submitted in the format prescribed herein. Failure to comply with the directions listed in this RFP, or omission of requested information could result in disqualification of your firm’s proposal.

Forsyth County uses a procurement portal powered by EUNA Procurement formerly Bonfire Interactive (“Bonfire”) for accepting and evaluating bids, statements of qualification, and proposals digitally, found by using the link:

https://www.forsythco.com/Departments-Offices/Procurement/Bids-Results

Proposals shall only be accepted online through the EUNA Portal.

Proposals are due 2:00 p.m., (EST) Thursday, October 15, 2026. Names of submitting firms will then be read aloud at 2:30 p.m. (EST), Thursday, October 15, 2026. All interested parties and the general public are invited.

ALL QUESTIONS are to be asked via EUNA under Opportunity Q&A. Responses to substantive questions will be provided as written Addenda and will be posted under Public Files in EUNA. The deadline for questions is October 6, 2026, 12:00 p.m. (EST).

https://www.forsythco.com/Departments-Offices/Procurement/Bids-Results

Proposals and Pricing Information received will become the property of Forsyth County and shall be used as the County sees fit. All information contained in the Proposals and Pricing Information will remain confidential until after the awarding and signing of the contract.

3. COST OF PROPOSAL

Forsyth County assumes no responsibility or liability for the costs incurred by the submitting firm to prepare and/or submit a proposal. The entire cost of preparing and submitting Proposals and Pricing Information, or any work in connection therewith will be borne by the submitting firm or team of firms.

4. RESPONSIBILITY OF PROPOSER

Proposals must be signed by an authorized official to bind the offeror, and it shall contain a statement to the effect that the Proposal is firm for a period of at least ninety (90) days from the closing date for submission.

5. CONNECTIVITY

The County shall not be responsible for errors of any kind or nature occurring in the transmission or downloading/uploading of any documents from the website. The County does not guarantee continuous, uninterrupted, or secure access to this or other related websites. Operation of this website may be affected from time to time by numerous factors outside of our control. Site problems, user problems, internet problems, power outages, or routine maintenance may interrupt or prevent access to information, documents, and/or submission capabilities.

6. PROHIBITION OF GRATUITIES

Firms shall not offer any gratuities, favors, or anything of monetary value to any official, employee, or agent of the Forsyth County Board of Commissioners for the purpose of influencing consideration of this proposal.

7. CONTACT

To ensure all prospective respondents have the same level of knowledge relative to the project, as well as ensuring any additional data is made available to all proposers, no vendor shall contact or discuss any aspect of this RFP with any County employee, elected official, evaluation/selection committee member, or project team member, during the RFP process up until award has been made. If contact is made, that vendor may be disqualified from the process. All questions in regard to this RFP are to be submitted via EUNA under Opportunity Q&A as detailed in the General Information section of this document. Any information obtained about this solicitation through any means other than the solicitation itself or the addendums thereunto is not valid and should not be considered in any response to this solicitation.

8. OWNERSHIP OF MATERIAL

Ownership of all data, material, and documentation originated and prepared for the County pursuant to the Contract shall belong exclusively to the County.

9. TERM

The Term of this Contract shall begin on January 1, 2027 and will end on December 31, 2031.

10. AGREEMENT

Attached to this RFP is a draft form of a General Services Agreement which contains terms and conditions of the contractual arrangement for the services. Such form of agreement will be modified as appropriate, in the County’s discretion, to include any additional specific terms related to the services being provided. Any questions regarding the form of the General Services Agreement must be submitted in writing by the deadline for questions specified in this RFP.

11. CHANGES

No change will be made to this RFP except by written modification by the County Procurement Department. Requests for interpretation or changes must be in writing and received at least seven (7) calendar days prior to the time set for opening of the proposals.

12. WITHDRAWAL OF PROPOSAL

Proposals may be withdrawn by written request only; if the request is received prior to the time and date set for the opening of proposals. Negligence on the part of the Proposer in preparing its proposal confers no right of withdrawal or modification of its proposal after proposal has been opened. No proposal may be withdrawn for a period of sixty (60) days after time has been called on the date of opening.

13. SUBSTITUTIONS

When references are made in these documents to trade names or to the brand names of manufacturers, such references are made solely to designate and identify the quality of materials or equipment to be furnished and are not intended to restrict proposals. If comparable materials or equipment of trade names or of manufacturers' names which are different from those mentioned in the RFP specifications are offered, the burden of proving equality of a proposed substitution rest on the submitting firm and must be provided with the proposal.

14. EXCEPTIONS TO SPECIFICATIONS

Any award resulting from this RFP shall bind the Proposer to all terms, conditions and specifications set forth in this RFP. Proposers whose proposals do not conform should so note on separate page if necessary. While the County reserves the right to make an award to a nonconforming proposer when in the best interest of the County, such awards will not be readily made, and proposers are urged to conform to the greatest extent possible.

No exceptions will be considered to have been taken by a Proposer unless it is properly set out as provided above. No exception will be deemed to have been taken by the County unless incorporated in an award resulting from this RFP and so stated.

15. RESERVATION OF REJECTION OR CANCELLATION

The County reserves the right to cancel the RFP or to reject any and all proposals submitted in response to any solicitation, to reject any portion thereof, or to waive any minor irregularity or administrative requirement, if it determines, in its sole discretion, that such cancellation, rejection, or waiver is in the best interests of the County.

16. AFFIDAVIT

The Proposer will be required to execute an Affidavit of Non-Collusion and submit it with the RFP Documents.

17. INSPECTION OF RECORDS

The records of the Procurement Department are open and accessible to the public in accordance with the provisions of the Georgia Open Records Act. Requests for inspection of records must be in writing, must be reasonable, must contain sufficient information to facilitate retrieval, and must not interfere with the orderly operation of the Procurement Department.

Proposers are cautioned that any documentation submitted with or in support of a bid or proposal will become subject to public inspection under the Georgia Open Records Act.

Labeling such information “Confidential,” “Proprietary,” or in any other manner will not protect this material from public inspection upon request.

18. TRADE SECRETS

Careful consideration should be given before submitting confidential information to the County. The County’s disclosure of records and documentation is governed by the Georgia’s Open Records Act, which permits public scrutiny of most materials collected as part of this process. If Proposer submits information that contains trade secret information and if Proposer wishes to keep such information confidential, Proposer must submit and attach to such information an affidavit affirmatively declaring that specific information constitutes trade secrets pursuant to the Georgia Trade Secrets Act of 1990, O.C.G.A. §10-1-760 et seq., and the Proposer and County will follow the requirements of O.C.G.A. § 50-18-72(a)(34) related thereto.

19. REGULATORY AGENCIES

Successful Proposer will be responsible for all required permits or license required by any regulatory agency of the city, county, state or federal governments. Further, successful proposer will be responsible for meeting all requirements of any regulation(s) or guideline(s) of any of the said governments or any independent agency recognized by said governments as publisher of any such regulation(s) or guideline(s).

20. INDEPENDENT CONTRACTORS

The Proposer represents to Forsyth County that it is fully experienced and properly qualified to perform the functions provided for herein and that it is properly equipped, organized and financed to perform such functions. The Proposer shall finance its own operations hereunder, shall operate as an independent contractor and not as the agent of Forsyth County and nothing contained in this RFP or a contract resulting from same shall be construed to constitute the Proposer or any of its employees, servants, or agents or subcontractors as a partner, employee, servant or agent of the County nor shall either party have any authority to bind the other in any respect, it being intended that each shall remain an independent contractor.

21. REQUIRED FORMS

All Proposing firms will be required to complete, execute, and submit with its proposal the following:

• Affidavit of Non-Collusion

• Contractor Affidavit and Agreement

• Subcontractor Affidavit (if applicable)

• Addendum Acknowledgement

22. EVALUATION METHOD AND CRITERIA

The County will evaluate all responsive proposals to determine which proposals best meet the needs of the County based on the evaluation criteria. Proposals deemed responsive advance; non-responsive proposal are disqualified. The County shall be the sole judge of its own best interest, the proposals, and the resulting agreement. Evaluation will be made by an evaluation committee established for this purpose. Award will be based on a review of all information submitted. Proposing firms may be asked to appear before the evaluation committee. Pricing information will be opened to all firms and the general public after the RFP submission deadline has passed.

The proposal is limited to forty (40) pages, formatted on 8 ½” x 11” paper, with a minimum 11 pt font size. The page count does not include mandatory required forms in paragraph 21 or Cost Proposal. Proposer must demonstrate their ability to satisfy all qualifications and requirements to perform the services detailed in this RFP.

Proposals determined to be Responsive and Responsible will be evaluated on the following criteria:

Cover/Transmittal Letter and Required Forms Pass/Fail Capabilities 20 points Experience and References 15 points Questionnaire 30 points Telephonic and Field Case Management Risk Management Information System

20 points 15 points

(REMAINDER OF THIS PAGE INTENTIONALLY LEFT BLANK)

SCOPE OF SERVICES

Background

Forsyth County (County) is seeking Third Party Workers’ Compensation Claims Administration Services (TPA) committed to excellence in the oversight and management of the County’s workers’ compensation claims through quality treatment of employees, timely service of all claims, and use of professional affiliations to maximize cost savings.

Forsyth County’s Risk Management Department is responsible for administering safety, loss control, and insurance programs for Forsyth County Government. Currently the County operates a self-insured workers’ compensation program which insures approximately 2,681 employees including: Sheriff’s Office, Firefighters (paid & volunteer), Water & Wastewater Operations, Street & Road Construction, Parks, Senior Center, Automotive Mechanics, and other general government services as well as the Forsyth County Public Library System. In 2025 the audited workers’ compensation payroll was $133,352,047.

The Risk Management Department has four (4) full-time employees consisting of a Risk & Safety Manager, a Risk Specialist, and two (2) Claims Administrators dedicated to the oversight of workers’ compensation claims and injury prevention. The County is dedicated to the safety and well-being of its employees and has adopted and recognized a comprehensive Loss Prevention Program with policies and oversight to continually monitor and improve upon any areas of concern.

Forsyth County has an aggressive Return-to-Work Program and is committed to making return-to work opportunities available as soon as medically reasonable through the use of transitional employment for all employees who are temporarily disabled due to an on-the-job injury.

Forsyth County Risk Management 5 Year WC Claims Summary

2021 2022 2023 2024 2025 5 Year

Summary

Lost Time 15 7 10 16 8 56

Medical Only 90 101 107 77 78 453

Record Only 0 0 0 0 1 1

Total Claims 105 108 117 93 87 510

Total Paid $1,144,694 $408,981 $600,001 $891,325 $501,112 $3,546,113

General Requirements

Forsyth County requires a team approach for quickly establishing and carrying through an aggressive claims resolution and injury management strategy on each claim. Forsyth County directors, managers, and supervisors have active roles in reporting and investigating injuries, communicating with employees, claimants, and adjusters; and in returning employees to work as soon as medically reasonable. Forsyth County expects the Contractor to facilitate a relationship with these individuals, as well as other contacts and resources in the claims management process. The Contractor should make every effort to understand and promote Forsyth County’s commitment to best practices and continuous improvement.

The third party claims administrator Contractor must have a physical office located within the state of Georgia and shall have a minimum of three currently active public entity (with fire or police operations) clients.

Settlement requests must include the following:

• Nature and extent of injury

• Reasons for recommendations to settle

• Subrogation potential

• Structured settlement potential

• SITF/apportionment potential

• Current reserves and paid to date

• Resolution plan and budget outline

• Detailed settlement evaluation including summary of state and case law that could impact the value and settlement

1. Reporting

The Contractor shall provide and maintain a secure, web based, browser agnostic Claims and Risk Management Information System (RMIS) that complies with all current federal and industry standards for data security, privacy, and interoperability. The system must not rely on any specific operating system or browser environment and shall be fully accessible via commonly supported browsers (e.g., Chrome, Edge, Safari, Firefox).

The platform must implement modern security controls, including but not limited to multi factor authentication (MFA), role-based access management, encryption of data both in transit and at rest, and full audit logging of all system activity. The Contractor shall ensure that all system functions and data handling practices comply with applicable CMS Medicare Secondary Payer (MSP) and MMSEA Section 111 reporting requirements and incorporate any future updates issued by CMS during the term of the contract.

The RMIS must support secure integration with Forsyth County’s existing systems, including Origami Risk. This shall include automated data imports/exports, API based interoperability where available, and error handling protocols that identify and communicate data transfer failures in real time. The Contractor shall provide timely system updates, patches, and version releases at no additional cost to Forsyth County and ensure continuity of operations during such updates.

The Contractor shall ensure the RMIS has fully supported, automated data integration capabilities, including:

• Automated Data Feeds: Scheduled imports and exports of claims data, financial transactions, medical updates, and historical data using secure data formats (such as API, SFTP, EDI, or encrypted file transfer).

• Origami Integration: Seamless interoperability with Forsyth County’s current RIMS platform (Origami) to support consolidated historical records, real time data flow, and automated reconciliation of claims information.

• Error Reporting & Resolution: Built in mechanisms to identify, flag, and notify Forsyth County of failed data transfers, data mismatches, or import/export interruptions within one (1) business day. The Contractor shall document all errors, corrective actions, and resolution timelines.

• Data Accuracy & Reconciliation: Ability to reconcile claim financials to the penny, support banking system tie ins, and provide audit ready transaction histories.

The RMIS must offer configurable reporting tools that allow Forsyth County and its broker to create, customize, and export:

• Loss runs

• Transaction registers

• Allocation reports

• Ad hoc analyses

• Performance dashboards

• Historical loss summaries

All reports must be exportable in standard formats, including spreadsheet formats, and the RMIS must allow customization of data fields such as department, location, shift, claim type, and RTW status. The system must support tracking of lost workdays, transitional duty days, medical only escalation triggers, and reserve changes with user defined fields.

The Contractor shall provide Forsyth County and its broker with secure, role based access to all data, reporting tools, adjuster notes, and case management documentation. Access must be available in real time, with all activity logged for audit purposes.

The Contractor shall ensure the RMIS produces monthly custom allocation reports and integrates historical data on a monthly basis at no additional cost to Forsyth County. All upgrades, patches, and version releases must also be provided at no additional cost and must not disrupt system access or data continuity.

If Forsyth County elects not to renew the contract, the Contractor shall provide a complete, usable data export of all claims, financials, notes, and historical records in a consistent, industry standard format. The Contractor shall also provide an option for continued system access for up to three designated County users for an indefinite period, with any associated fees itemized in advance.

The Contractor shall maintain detailed documentation describing all data integration processes, reporting capabilities, and system architecture. Forsyth County reserves the right to request additional data specifications, conduct RMIS audits, or require enhanced reporting elements as needed during the contract term.

The Contractor shall maintain communication standards that ensure timely, documented, and auditable engagement on all workers’ compensation claims. At a minimum, all telephone calls, emails, and electronic inquiries must be returned within one (1) business day, and three point contact with the injured employee, employer representative, and medical provider shall be completed within twenty four (24) hours of claim receipt.

All attempted contacts must be documented in the claim file, including time, date, method of contact, and outcome. The Contractor shall establish an internal escalation protocol for any instance in which required timeliness benchmarks are not met. This protocol shall include supervisory notification within twenty four (24) hours of the missed benchmark, corrective actions taken, and documentation of compliance following resolution.

The Contractor shall provide Forsyth County with monthly or quarterly compliance reports demonstrating performance against established communication standards. Such reports must identify:

• Timeliness compliance rates for required contact points

• Instances of missed benchmarks

• Root cause explanations

• Corrective actions implemented

• Any systemic issues affecting timeliness or communication

The Contractor shall ensure all communication, case notes, and contact documentation are recorded in the RMIS in real time or within the same business day. Forsyth County reserves the right to request additional documentation or review internal communication logs at any time to verify adherence to required service standards.

Failure to meet these timeliness and communication requirements on a recurring basis may trigger performance review, corrective action planning, and application of performance guarantee provisions as outlined in this Scope of Work.

2. Workers’ Compensation Telephonic and Field Case Management

Forsyth County believes management of the medical component is key to returning employees back to work and facilitation of WC claim resolution. They have the following expectations relating to medical:

a. A provider who actively and aggressively manages medical

b. A network of physicians specializing in Return to Work

c. A claims management team approach whereby the team understands and works as partners in the RTW/Transitional-duty efforts.

We are very interested in the claims adjuster’s philosophy on utilization of TCM & FCM within their claims management model with the understanding that Forsyth County may elect to use a separate managed care vendor.

3. Claim Escalation and Reserving Expectations

Forsyth County requires the Contractor to implement clear and timely claim escalation and reserving practices to ensure accurate financial forecasting, statutory compliance, and effective claim oversight. The Contractor shall adhere to the following minimum standards:

a. Initial Reserve Establishment

• Initial reserves shall be established within seven (7) calendar days of claim assignment and must reflect a reasonable projection of expected medical and indemnity exposure.

• Reserve levels must be documented with supporting rationale in the claim file, including injury severity, anticipated treatment plan, lost time potential, and known compensability issues.

• Reserves must comply with state workers’ compensation reserving requirements and accepted industry practices.

b. Reserve Reevaluation & Updating

• The Contractor shall reevaluate reserves at least every thirty (30) days for Lost

Time claims and every sixty (60) days for Medical Only claims unless conditions require earlier revision.

• Reserves must be updated immediately upon significant medical developments, changes in diagnosis, surgery recommendations, changes in modified duty status, litigation involvement, or newly identified cost drivers.

• Each reserve change shall include documented justification, financial impact, and a revised plan of action within the RMIS.

c. Escalation of Medical Only Claims

• The Contractor shall escalate any Medical Only claim to Indemnity status immediately upon the first day of lost time, receipt of a no work slip, or identification of medical treatment exceeding low severity thresholds established by Forsyth County.

• Escalation triggers include, but are not limited to:

− Work restrictions preventing full-duty return, − Multiple or escalating specialist referrals, − Recommended surgery, − Repeated or extended physical therapy beyond expected duration.

• The Contractor shall notify Forsyth County within one (1) business day whenever a Medical Only claim transitions to Indemnity or presents red flag indicators for escalation.

d. Notification Requirements

• The Contractor shall notify Forsyth County immediately, and no later than one (1) business day, upon:

− Any reserve increases equal to or greater than $10,000, − Any claim reaching a total reserve of $25,000 or more, consistent with County requirements for reserve consultation, − Identification of potential high risk or catastrophic exposure.

• Notifications shall include the basis for the change, supporting medical information, projected future exposure, and recommended strategies for controlling claim development.

e. Supervisory Review & Oversight

• Supervisory review is required for all newly established indemnity claims, high severity claims, or claims assigned to litigation.

• Supervisors shall document review outcomes, reserve adequacy, and any direction given to adjusters.

• Forsyth County reserves the right to require supervisory intervention when adjuster diary practices, reserving patterns, or contact protocols fall below expected standards.

f. Integration with RMIS & Reporting

• All reserve activities, escalation events, and supervisory reviews must be entered into the RMIS within the same business day.

• Monthly stewardship reports shall include reserve accuracy metrics, number of escalated claims, timeliness of escalation, reserve volatility trends, and identification of claims exceeding benchmarks.

Failure to meet Forsyth County’s claim escalation or reserving standards may trigger corrective action, performance guarantee review, or additional oversight measures as outlined within this Scope of Work.

4. Return-to-Work Coordination

The Contractor shall actively support and enhance Forsyth County’s Return to Work (RTW) and Transitional Duty Program, as described in the County’s Loss Prevention Program and RTW framework. The Contractor shall implement RTW coordination practices consistent with the County’s commitment to seeking and providing transitional employment opportunities as soon as medically reasonable.

The Contractor shall maintain a structured RTW workflow that includes:

a. RTW Assessment & Documentation

• Documenting the injured employee’s medical restrictions within one (1) business day of receipt of medical information.

• Recording all RTW assessments, physician restrictions, transitional duty recommendations, and communications in the RMIS in real time or by the close of business each day.

• Providing clear written RTW recommendations to Forsyth County, including identification of barriers that may delay placement into transitional duty.

b. RTW Communication Standards

• Communicating medical status changes to the employee, Forsyth County Risk

Management, and department supervisors within twenty-four (24) hours.

• Coordinating with treating providers to obtain timely work status reports and scheduling follow up appointments consistent with best practices for early RTW.

• Ensuring adjusters and nurse case managers work collaboratively with County personnel to support early RTW efforts, per the program expectations.

c. RTW Tracking Requirements

• Tracking all lost time days, modified duty days, transitional duty assignments, and return to full duty dates in the RMIS using standardized fields and formats.

• Monitoring claim progression to identify cases where RTW delays occur and documenting specific reasons for delay, medical justification, and planned interventions.

• Updating Forsyth County on RTW status during scheduled claim reviews, and immediately for any cases where RTW regression or work status changes occur.

d. Performance Metrics & Reporting

• Providing Forsyth County with monthly or quarterly RTW performance reports containing:

– Percentage of employees returned to transitional duty within defined timeframes.

– Average duration of transitional duty assignments.

– Identification of cases exceeding expected RTW benchmarks and rationale.

– Recommendations for improving RTW outcomes or reducing unnecessary lost time.

• Demonstrating compliance with RTW expectations during audits, claim reviews, and stewardship reporting.

e. Escalation Protocol for Delayed RTW

• Implementing an escalation process when RTW does not occur within expected timeframes, including supervisory review, consultation with the nurse case manager, and detailed documentation of actions taken.

• Notifying Forsyth County within twenty-four (24) hours when an employee’s RTW status is impacted by medical noncompliance, provider delays, or administrative issues.

The Contractor’s failure to meet Return to Work coordination standards may trigger performance review and application of the County’s performance guarantee provisions. The Contractor shall work collaboratively with Forsyth County Risk Management and County departments to support early, medically appropriate return to work outcomes.

5. Medicare Secondary Payer Mandatory Reporting

The Contractor shall perform all Medicare Secondary Payer Section 111 reporting in accordance with the Medicare, Medicaid, and SCHIP Extension Act of 2007 (MMSEA), as amended. Reporting shall comply with all current CMS NGHP User Guide requirements, including WCMSA data reporting (effective April 2025) and compliance procedures associated with CMS’s civil monetary penalties and quarterly audit processes initiated in 2026.

6. Subcontractor and Vendor Transparency

The Contractor shall fully disclose all subcontractors, vendor partners, and third party service providers involved in any aspect of claims administration, medical management, bill review, PPO services, case management, investigative activities, data hosting, or RMIS operation. For each subcontractor or vendor, the Contractor shall provide the entity’s legal name, physical address, contact information, areas of expertise, and description of services performed.

The Contractor shall ensure that all subcontractors and vendor partners comply with the same contractual, regulatory, performance, security, and privacy standards required of the Contractor, including requirements related to Medicare Secondary Payer (MSP) and MMSEA Section 111 reporting, workers’ compensation jurisdictional filings, and all applicable federal and state data protection obligations.

The Contractor shall maintain written agreements with all subcontractors that include, at minimum:

• Confidentiality and data security obligations consistent with Forsyth County’s standards.

• Requirements for encryption of data in transit and at rest.

• Real time breach reporting protocols.

• Service-level performance standards.

• Audit rights allowing Forsyth County to review subcontractor performance when necessary.

The Contractor shall provide Forsyth County with written notice at least thirty (30) days prior to any change in subcontractor or vendor relationships, including termination, replacement, addition of new vendor partners, or material modification of services performed. No subcontractor or vendor may be added or removed without prior written approval from Forsyth County.

In cases where the Contractor uses subcontractors for specialty services—such as medical management vendors, PPO networks, bill review services, field investigation providers, managed care organizations, or entities pursuing subrogation or SITF recoveries; the Contractor shall furnish copies of existing agreements or service descriptions, fee schedules, and performance metrics. Subcontracted work may only be performed by qualified entities with demonstrated experience in workers’ compensation claims administration.

The Contractor shall remain fully responsible and accountable for the performance of all subcontractors and vendor partners. Failure of any subcontractor to meet contractual standards shall constitute failure by the Contractor. Forsyth County reserves the right to require removal or replacement of any subcontractor or vendor for performance deficiencies, security concerns, or non-compliance.

The Contractor shall ensure that subcontractors participate, when requested, in claim reviews, audits, stewardship reporting, and any compliance activities necessary to verify service quality, data accuracy, and adherence to Forsyth County expectations.

7. Credential Requirements

Forsyth County requires that all personnel assigned to the County’s Workers’ Compensation program possess appropriate professional credentials, experience, and licensure to ensure competent and compliant delivery of services. The Contractor shall ensure the following minimum standards are met:

a. Claims Adjusters (Medical-Only and Lost-Time)

• All adjusters assigned to Forsyth County must hold current Georgia Workers’

Compensation Adjuster Licensure or equivalent authorization permitted under Georgia law.

• Adjusters must have a minimum of three (3) years of direct workers’ compensation adjusting experience, with preference given to public-entity or public-safety exposure (fire, law enforcement).

• Adjusters must demonstrate competency in investigation procedures, fraud identification, reserve methodology, diary management, and medical management coordination as referenced in the Scope.

• Supervisory-level adjusters overseeing County claims must have at least five (5) years of experience and prior responsibility for complex or litigated claims.

b. Nurse Case Managers (Telephonic and Field)

• All nurse case managers shall be currently licensed Registered Nurses (RN) in the

State of Georgia.

• Certification in case management (e.g., CCM, COHN, CRRN) is preferred and may be required for complex or catastrophic claims.

• Nurse case managers must possess experience with return-to-work coordination, medical cost containment strategies, and documentation standards consistent with County expectations.

• Field case managers must hold credentials appropriate to the services they provide, including experience with complex medical conditions and functional capacity evaluations.

c. Account Manager / Account Executive

• The assigned Account Manager must have a minimum of five (5) years of experience in workers’ compensation account management or claims leadership.

• Must possess demonstrated analytical capabilities, proficiency with RMIS platforms, and expertise in public-entity claims administration as referenced in the Scope (including auditing, quality compliance, and coordination of medical and field case management services).

• The Account Manager must have authority within the Contractor’s organizational structure to implement operational changes, address performance deficiencies, and oversee service delivery in accordance with County expectations.

d. Vendor and Subcontractor Personnel

• All subcontractors providing medical management, bill review, PPO services, investigative work, or technical/RMIS support must maintain professional licenses, certifications, and credentials appropriate to their discipline.

• The Contractor shall ensure subcontractor personnel meet or exceed the same qualification standards required of the Contractor’s own employees.

e. Documentation & Verification

• The Contractor shall provide Forsyth County with a credential summary for all personnel assigned to the account, including licensure verification, certifications, and relevant experience.

• Forsyth County reserves the right to request updated credential documentation at any time and may require replacement of personnel who fail to meet the established standards.

f. Training & Continuing Competency

• The Contractor shall provide ongoing training to all personnel in areas including

Georgia workers’ compensation regulations, Medicare Secondary Payer compliance, fraud identification, RTW coordination, and RMIS proficiency.

• Documentation of annual continuing education or training relevant to assigned job duties must be provided upon request.

Failure to meet these credential requirements may result in removal of assigned personnel, corrective action, or additional oversight as outlined in Forsyth County’s performance standards.

8. KPI and Performance Expectations

Forsyth County requires the Contractor to meet defined performance standards supported by measurable Key Performance Indicators (KPIs). These KPIs ensure accountability, consistency, and quality of service throughout the duration of the contract. The Contractor shall agree to the following minimum requirements:

a. Timeliness KPIs

• Three-Point Contact Compliance:

Completed within twenty-four (24) hours in at least 95% of all new claims.

Documentation must be entered into the RMIS the same business day.

• Return Communication Standard:

All calls and written inquiries must be returned within one (1) business day, with a compliance target of 98%.

• Claim Assignment:

All claims must be assigned to an adjuster within 4 business hours of receipt.

b. Claim Management KPIs

• Reserve Timeliness:

Initial reserves must be set within seven (7) calendar days of claim assignment.

Reserve reviews must occur at least every 30 days for indemnity claims and every 60 days for medical-only claims.

• Reserve Accuracy:

Reserve inaccuracies greater than ±20% identified during audits must be corrected within 5 business days, with a compliance target of 95%.

• Medical-Only Escalation:

Escalation to indemnity must occur within one (1) business day of lost time or when escalation triggers are met (e.g., surgical recommendation, extended treatment).

c. Claim Closure KPIs

• Timely Closure of Medical-Only Claims:

At least 85% of medical-only claims shall be closed within ninety (90) days unless medical conditions justify continued care.

• Timely Closure of Indemnity Claims:

At least 75% of indemnity claims shall reach closure within twelve (12) months unless litigation, surgery, or catastrophic conditions require extension.

d. Quality & Documentation KPIs

• Diary Management:

Adjuster diaries must be current, with entries made every 14 days for indemnity claims and every 30 days for medical-only claims.

• File Quality Audit Scores:

Quarterly audit scores must meet or exceed 90% of County quality standards, including accuracy, documentation completeness, timeliness, and compliance.

• Supervisor Review Compliance:

Supervisory oversight must occur on all new indemnity claims and complex claims, with documentation entered in the RMIS.

e. Reporting KPIs

• Monthly Reports:

All required monthly reports (loss runs, transaction summaries, allocation reports) must be submitted no later than the fifth (5th) business day of each month.

• Historical Data Integration:

Monthly historical data integration must reach 99% accuracy with zero missing fields in transfers.

f. Performance Guarantee Framework

• If KPIs fall below stated targets for any quarter, the Contractor shall prepare and implement a written corrective action plan within ten (10) business days.

• Repeated KPI deficiencies across two consecutive quarters may trigger additional oversight, withholding of performance fees, or escalation to contract review.

• Forsyth County reserves the right to request enhanced reporting, additional audit sampling, or replacement of claims personnel when KPIs consistently fall below defined thresholds.

g. Annual Stewardship Review

• The Contractor shall present annual stewardship reports detailing KPI results, trend analysis, cost-containment outcomes, claim closure metrics, and corrective action performance.

• These stewardship results will form part of the County’s evaluation of contract renewal or continuation.

Failure to meet the defined KPIs or performance guarantee provisions may result in corrective action, fee adjustments, or other remedies outlined in the County’s performance requirements.

PROPOSAL CONTENT

Forsyth County is seeking qualified firms to provide Third Party Workers’ Compensation Claims Administration Services.

The proposals must be organized and provided in a clear, concise format:

1. Cover/Transmittal Letter and Required Forms: (Pass/Fail)

Provide the full name and legal form of the firm, the state of incorporation (if applicable), the business office location(s) and primary address; the contact name, telephone number, and email address for submittal questions/clarifications; a list of any exceptions to the RFP and/or the attached draft Services Agreement; all required forms completed and executed; a statement as to whether your firm has been involved in any litigation within the past five (5) years arising out of your performance (explain fully).

Litigation: The Proposer must disclose any involvement by the proposing firm, its subsidiaries, or any officer or principal of the firm or subsidiary in any material business litigation within the last five (5) years. The disclosure will include an explanation as well as the current status and/or disposition. Failure to fully disclose or accurately report any litigation may result in disqualification of the firm’s proposal.

2. Capabilities (20 points)

Define your expertise within the government sector.

Provide a proposed organizational structure for client claim handling and list the experience and qualifications of the key individuals who would be involved in the account.

Provide a flowchart of your claims management process, indicating in detail the flow of information, decision points, supervisor intervention, etc. for Workers’ Compensation. Include those claims that are reported as questionable or reported to the employer late.

Specifically state the location of your claim operations that would be handling claims for the County, the number of employees in each office and when the respective offices were established.

Describe investigation procedures.

Describe how you identify and investigate claims having fraud potential. Describe the identification parameters and processes, and the services employed. Describe how we could monitor the activity and performance.

Describe your quality assurance policy and procedures and provide copies. Include:

• Internal process and reporting used to monitor quality

• System edits that prompt supervisor attention

• Criteria for supervisor claims intervention

• Criteria for measuring adjuster performance

What data will be required from the County prior to the implementation of this contract, and in what format?

Implementation Plan number of days, resources, staffing.

3. Experience and References: (15 points)

Provide three (3) references from current governmental entities utilizing your services for Third Party Workers’ Compensation Claims Administration Services.

4. Questionnaire (30 points)

Provide responses to the Questionnaire attached.

5. Telephonic and Field Case Management (20 points)

Please outline and discuss the following:

1. Organization and work/flow process for the provision of medical management care services including but not limited to the processing of claims, processes for bill review, field case , management of providers, decision criteria and flow charts.

2. Examples of reports (either ad hoc or standard) that have been generated from your claims management system

3. Detailed outline of medical management and medical cost containment fees for services proposed to Forsyth County include the following:

a. List all of the medical cost containment services included in your claim service fee.

b. List all of the medical cost containment services provided by you or your vendor partners that are not included in the claim service fee with the itemized charges.

4. Outline all medical cost containment services provided to you by an outside vendor, including PPO, and provide the name address and contact of the vendor and please also:

a. Advise your willingness to allow Forsyth County to select and utilize a separate managed care vendor

b. Outline your philosophy on field medical case management versus telephonic case management

c. Provide a sample of quarterly reports detailing savings realized as a result of your cost containment/medical management programs including the ability to view savings below fee schedule.

d. Outline any association you may have with a managed care organization or PPO including the network you utilize.

6. Risk Management Information System (15 points)

Elaborate and describe your RMIS setup and workflow. Show any applicable dashboards and reporting functions.

7. Cost Proposal (provided separately sealed)

The Cost Proposal must be submitted separately in Euna under the area titled Cost Proposal. Provide a detailed cost for each task in attached Cost Proposal Form. Please add any other costs that may be associated with the required services.

QUESTIONNAIRE

Forsyth County requires a team approach for quickly establishing and carrying through an aggressive claims resolution and injury management strategy on each claim. Forsyth County directors, managers, and supervisors have active roles in reporting and investigating injuries, communicating with employees, claimants, and adjusters; and in returning employees to work as soon as medically reasonable. Forsyth County expects the Contractor to facilitate a relationship with these individuals, as well as other contacts and resources in the claims management process. The Contractor should understand Forsyth County’s commitment to best practices and continuous improvement.

Internal Procedures

1. What is your claims handling philosophy?

2. How often do you perform internal audits?

3. How do you communicate the results of those audits?

4. Please state your average adjuster and supervisor pending case load and their average new assignments per month.

5. What is the annual turnover ratio for adjusters?

6. Is there the availability of designated adjusters for the account? Lost Time claims and Medical Only claims?

Investigation/Reserving /Settlement

7. Are recorded interviews on all lost time cases the standard?

8. Are prior medical records requested on all cumulative trauma cases?

9. Explain your three point contact standards.

10. How often are the claims notes updated?

11. How do your adjusters ensure that medical records are obtained in a timely fashion?

12. Please describe supervisory involvement in the claim files.

13. What are your requirements as regards adjuster diaries?

14. What is your file reserving philosophy?

15. What method do you use to establish reserves?

16. What is the timeframe in which a file must be reserved?

17. Are medical only claims turned into indemnity claims at a certain threshold? What is the threshold and charges associated?

18. Indicate your agreement to obtain settlement authority prior to any settlement.

19. Indicate your agreement to provide a written evaluation on all settlement requests including the below:

➢ Nature and extent of injury

➢ Reasons for recommendations to settle

➢ Subrogation potential

➢ Structured settlement potential

➢ SITF/apportionment potential

➢ Current reserves and paid to date

➢ Resolution plan and budget outline

➢ Detailed settlement evaluation including summary of state and case law that could impact the value and settlement

Medical Management

20. What is your philosophy on medical management of claim files?

21. Do you provide medical management services? If so, are the services proprietary or contracted to a vendor?

22. Do you provide ancillary services? If services are provided, please specify if they are owned by the third party administrator or are these services contracted through an in network contracted vendor? Please provide contracted vendors if applicable.

23. Please state the associated costs, explain how they are billed to Forsyth County, and attach a sample medical cost savings report. Include the following services:

➢ Consult a Nurse Services

➢ Hospital Bill Audits

➢ Medical case management and vocational rehabilitation

➢ PPO Services

➢ State Fee Scheduling Services

➢ Usual and Customary bill review

➢ Average PPO Savings

➢ PPO Charges

➢ Number of PPO Networks

➢ Nurse Staff consultants

➢ How much of fee goes to TPA?

➢ How much to the provider?

➢ How much of savings goes to Forsyth County?

24. Please provide the PPO network used for all services. What is the percentage of savings to Forsyth County /PPO penetration?

Litigation Management

25. Will Forsyth County have the ability to choose the firm(s) assigned for litigation management?

26. What are your guidelines for assigning cases to legal counsel?

27. How do you select legal counsel?

28. Please attach a copy of your Litigation Management Plan.

29. Indicate your agreement to notify Forsyth County of all legal dates including hearings, trial dates, settlement conferences, deposition, etc.

30. Define your legal bill review process.

External Procedure

31. How do you recommend that Forsyth County report claims? What services do you provide for the reporting of claims?

32. Do you provide a toll-free number for telephonic claims reporting?

33. If so, do your own employees staff the service, or is it contracted to a vendor?

34. What are your standards for your vendor or employees?

35. Do you complete jurisdictional workers’ compensation reporting requirements on behalf of Forsyth County?

36. Do you provide copies of claims reports to Forsyth County? If so, how?

37.