Third-party Administrator to Process Payments for Claims/Invoices for Incarcerated Individual(s) Healthcare Services

The Nebraska Department of Correctional Services (NDCS) is procuring a third-party administrator to process medical and dental claims for incarcerated individuals across multiple correctional facilities. The contract, solicitation number 120174 O3, requires the selected vendor to provide comprehensive claims processing services, including electronic claims management, provider network administration, monthly reporting, and maintenance of an electronic analytics dashboard. The contractor will serve an estimated average daily population of 5,872 inmates and must process approximately 24,704 medical claims totaling $15.6 million and 250 dental claims totaling $51,454 annually. Evaluation criteria include a 100-point scoring system: 20 points for Corporate Overview, 60 points for Bidder Questionnaire/Technical Approach, and 20 points for Cost Proposal, with an additional 10 points possible for oral interviews. Key procurement dates include electronic bid submissions due January 22, 2025, at 2:00 PM Central Time, with an evaluation period scheduled from January 24 to February 19, 2025. Bidders must provide network coverage in specific Nebraska cities, including Omaha metro area, Lincoln, York, Tecumseh, and McCook, and process claims according to Nebraska Medicaid/Medicare rates or negotiated PPO rates.

No specific set-aside designations were identified in the documentation. Five companies submitted responses to the solicitation: Blue Cross and Blue Shield of Nebraska, Inc., Correctional Health Partners, LLC, Falling Colors Corporation, Innovative Claims Strategies LLC, and UMR, Inc. The incumbent's administrative fee term has been extended through September 30, 2025. The contract will have an initial four-year term with two optional two-year renewal periods, and pricing must remain fixed for the first four years with subsequent increases limited to 5% per period. Bidders must submit two pricing options: a monthly flat rate and a per-incarcerated individual rate, with the state reserving the right to select the most advantageous option. The contractor will be required to maintain various insurance coverages, including workers' compensation, commercial general liability, professional liability, commercial crime, and cyber liability, and may be required to post a $500,000 performance bond. While specific budget details are not explicitly stated, historical claims data suggests an annual claims processing volume of approximately $15.651 million for medical services and $51,454 for dental services.