Workers' Compensation Benefits Third Party Administration Services for Self-Insured Program

The buyer seeks a third-party administrator to provide workers' compensation benefits administration services for its self-insured program. The requested scope includes claims administration, determining eligibility and authorizing medical benefit payments, reviewing billings against state medical fee schedules, and submitting bills to an approved bill review service for medical auditing. The selected vendor must supply a dedicated claims unit with assigned personnel, develop program policies and procedures, and provide guidance on specified claims. Under the attached PRISM Claims Administration Standards, examiners must maintain a targeted caseload of 150 claims (not to exceed 165), conduct regular file reviews, and manage litigated cases, subrogation, and excess coverage reporting. Eligibility is limited to onshore USA organizations, and work may be performed onsite or offsite over a three-year contract term. Applicants must submit all questions by November 19, 2026, and submit responses digitally via email or online.