Provide Workers’ Compensation Claims Admin.

Gwinnett County Board of Commissioners is requesting proposals for workers' compensation claims administration services under RFP RP032-22, with proposals due August 23, 2022 at 2:50 p.m. and a pre-proposal conference on August 9, 2022 at 10:00 a.m. The contract commences January 1, 2023, for one year with four optional one-year renewal periods. No set-asides or local-vendor preferences apply.

The scope encompasses comprehensive claims processing, adjudication, payment administration, loss reporting, and analytics for a self-insured program serving approximately 6,000 employees (5,000 full-time and 1,000 part-time) across 23 departments with a $1 million self-insured retention. The county has averaged 456 claims annually since 2016, with historical volumes ranging from 369 to 504 claims per year and 2,490 to 4,532 medical bills processed annually. Required services include an on-site, full-time claims examiner, telephonic and field nurse case management, medical bill review and utilization review, loss control support, and settlements requiring county pre-approval. The awardee must establish a full-service office in Georgia and perform all work within the United States; utilize their own claims management system with five read-only user access accounts provided to the county; and execute a Business Associate Agreement for HIPAA compliance. Proposers must carry Professional Liability Insurance of $1 million per claim or $1 million per occurrence/$2 million aggregate with an A.M. Best rating of A-5 or higher, provide E-Verify compliance affidavits, and submit Code of Ethics affidavits.

Evaluation comprises Phase I (responsiveness 10 points, vendor qualifications 35 points, proposed methodology 25 points, references 10 points), Phase II (cost 20 points), and optional Phase III interviews (10 points). Pricing proposals must include per-claim fees for new lost-time and medical-only claims, installation charges for assuming existing claims, and miscellaneous fees; pricing must remain firm during the initial term and each renewal period unless justified percentage increases are proposed. The incumbent is Davies Claims Solutions (Alternative Service Concepts, LLC), which has served since January 1, 2008. Award has been made to Davies Claims Solutions, LLC with a score of 88.11 points.