Workers Compensation Claims Third Party Administrator (TPA)

Background
The Department of Business and Industry, Division of Insurance, is soliciting bids from qualified and licensed workers' compensation third-party administrators (TPA) for claims administration services for the Insolvency Fund for Self-Insured Employers and the Insolvency Fund for Self-Insured Associations.

The Nevada Division of Insurance is responsible for certifying and regulating self-insured employers and associations, ensuring compliance with Nevada statutes.

Work Details
The TPA will administer workers' compensation claims of insolvent Self-Insured Employers (SIEs) and Self-Insured Associations (SIAs). This includes claim management, case management, bill review, excess insurance recovery, subrogation, payment, and settlement. Responsibilities include handling all open and reopened claims as well as new claims assigned by the Division.

The TPA must develop a Claims Handling Protocol document within 30 days of contract award. Additionally, the TPA will import historical data from a prior vendor into its electronic claims system within the first 30 days of contract start. Claims administration involves reviewing all claims for compensability, timely payment of benefits, establishing reserves based on various factors, coordinating with the Division on excess insurance recovery, and providing monthly loss runs and quarterly summary reports to the Division.

Period of Performance
The contract is expected to be effective for four years starting from January 1, 2026, subject to Board of Examiners approval.

Place of Performance
The services will be performed in Nevada as specified by the contracting agency.

Bidder Requirements
Bidders must be qualified and licensed workers' compensation third-party administrators. They must comply with all mandatory minimum requirements outlined in the solicitation. Vendors must also be registered at nevadaepro.com to respond to this solicitation.