Worker's Compensation Third Party Administration Service

The City of Austin, Texas is requesting proposals for workers' compensation third party administration services under RFP 5800 SLW3033, with offers due July 23, 2026 at 2:00 PM. Questions must be submitted by July 2, 2026 at 12:00 PM.

Proposers must demonstrate public sector experience and capability to manage comprehensive claims administration. The scope includes claims administration for medical-only, indemnity, fatality, hearing loss, and cancer claims; dispute resolution services including benefits review conferences and contested case hearings; medical bill auditing and cost containment; utilization review and pre-authorizations; case management; Medicare Secondary Payer compliance; and management information systems infrastructure. Vendors must identify or designate dedicated claims supervisors, catastrophic and indemnity adjusters, medical management staff, and account managers. The City projects 532 new incident claims, 1,104 new medical-only claims, and 311 new indemnity claims in FY25, with a current open inventory averaging 788–926 claims monthly and approximately 18,000 medical bills audited annually. Workforce is distributed across Texas, with primary concentrations in Travis, Williamson, and Hays Counties. Performance guarantees include Performance Based Oversight ratings of 95 percent or higher, specific staffing vacancy fill times, recorded statement requirements, compensability determination timelines, and claimant contact protocols. The City's AI use policy prohibits AI in human decision-making related to claims and medical determinations, with penalties up to fifty thousand dollars per verified incident. Vendors must provide references from similar Texas public sector entities served as TPA within the past five years and disclose clients who did not renew contracts in the past three years.

Evaluation is scored on 100 points maximum: Claims Administration (25 points), Experience and Qualifications (20 points), Reporting Technology and Data Analytics (15 points), and Price (20 points). Local Business Preference and Small Business Preference may add up to 10 points each. The City retains the right to extend the initial contract term and require a holdover period not to exceed 180 days. Payment is due within 30 calendar days of invoice receipt or deliverable completion. No pre-offer conference or site visit is scheduled.