South Dakota State TPA Workers' Compensation

The State of South Dakota, Bureau of Human Resources and Administration is requesting proposals for Third Party Claims Administration services for the state's workers' compensation program under RFP #26RFP19880, with proposals due November 25, 2026 at 5:00 p.m. CST. The procurement carries mandatory compliance with South Dakota Bureau of Information and Technology security, data protection, and IT standards including SOC 2 Type II compliance or FedRAMP certification, AES-256 encryption, 12-hour security incident notification, multifactor authentication, single sign-on system integration, and fingerprint-based background investigations for personnel accessing sensitive data.

The scope includes third-party claims administration, medical case management, medical bill review, and Medicare, Medicaid, and SCHIP Extension Act (MMSEA) reporting for approximately 18,300 full-time equivalent state employees located throughout South Dakota and other U.S. sites. The selected vendor must provide 24/7 injury reporting and response capability, business-hours accessibility (8 a.m.–5 p.m. Central Time), secured email transmission for protected health information, disaster recovery planning, electronic claim payment processing, Department of Labor reporting, and complete electronic records custody. The vendor must comply with South Dakota Workers' Compensation statutes and HIPAA requirements, including a Business Associate Agreement establishing breach notification within 12 hours and detailed breach reporting within 10 business days.

The contract term spans three years (July 1, 2027 through June 30, 2030) with state option to renew for up to two additional one-year extensions. The state retains ownership of all data created under the agreement and requires itemized cost proposals detailing administration fees, implementation, legacy claim transfer, RMIS fees, claim life-of-contract fees, record fees, reporting fees, ISO index fees, subrogation recovery fees, medical triage fees, technical support, custom reports, data import/export, special projects, and safety/loss control services.

Proposals are evaluated on a 500-point scale: specialized expertise and technical competence (100 points), available resources (50 points), past performance (50 points), project locale availability and familiarity (50 points), claims management information systems with data, reporting, and analytics capabilities (100 points), risk management and cost containment methods (100 points), implementation and account management team (50 points), and cost proposal (100 points). Offerors must submit proposals electronically to Peggy.Canter@state.sd.us with an original plus five hardcopies and provide audited financial statements upon request, references from at least three current and three former clients, performance guarantees, and banned entity certifications. Written questions are due October 30, 2026; responses to offeror questions are due November 9, 2026. Anticipated award decision and contract negotiation is December 29, 2026.