Managed Care for Workers' Compensation

The Arkansas Department of Transformation and Shared Services, on behalf of the Arkansas Insurance Department Public Employee Claims Division, is soliciting proposals for a comprehensive Managed Care for Workers' Compensation services contract. The solicitation (S000000390) seeks a contractor to provide preferred provider organization (PPO) access, bill review, utilization review, precertification of medical services, medical charge negotiation, peer review, nurse case management, and medical payment pass-through options. The state currently manages approximately 2,600 workers' compensation claims annually across state agencies, colleges, universities, and local government entities, with 1,621 total open claims as of December 2024. Proposals are due February 12, 2025, at 11:00 AM Central Time through the ARBuy eProcurement system, with a live proposal opening conducted via Microsoft Teams. The evaluation will be based on a 1,000-point scale, with 700 points allocated to technical criteria (30% experience, 40% solution, 10% risk, 20% interview) and 300 points for cost. Critically, the contractor must be certified as a Managed Care Organization by the Arkansas Workers' Compensation Commission and maintain that certification throughout the contract term.

The procurement does not specify explicit set-aside designations for disadvantaged enterprises, though the Technical Proposal Packet includes a section for contractors to declare minority or women-owned business designations. The incumbent vendors are USABLE (primary contractor), with CompBR handling bill review and Systemedic, Inc. providing nurse case management and precertification services, utilizing the USABLE True Blue network. The contract will have an initial two-year term with up to five one-year renewal options, for a maximum potential term of seven years beginning July 1, 2025. Historical spending data indicates the current contractor processed 13,997 medical bills in fiscal year 2024, totaling $15,068,684.11, with estimated annual savings of $4.3 million. The pricing structure includes a PPO access fee calculated as a percentage of savings, capped at $15,000 per individual medical bill, with additional pricing for services including bill review, peer review, pre-certification, and medical case management. Contractors must provide PPO provider coverage in all Arkansas counties, Memphis, Tennessee, and Texarkana, Texas, with additional coverage areas encouraged but not required.