Worker's Compensation Claim and Medical Service

Luzerne County is seeking proposals from qualified Workers' Compensation Administrators for Claim and Medical Management Services for the effective date of January 01, 2027. As a self-insured public entity, the County contracts with a qualified third party administrator ("TPA") for workers' compensation claim and medical services. The qualified candidate selected by the County as the TPA for their workers compensation program will be expected to communicate with the County's risk management team members.

The successful proposal for third-party claims administrator shall provide consulting, operation, and administrative services, in connection with the operation of the WC claims fund. The successful proposal shall provide certain WC claims management services in connection with claims/dates of injury occurring during the term of the professional services agreement that are covered under the County's self-insured workers' compensation program.

TPAs must have personnel with specialized skills and certifications required to effectively and efficiently handle workers' compensation claims. [...] The TPA acts as the primary claims handler and serves in an advisory role to the County by making recommendations on the appropriate disposition (settlement or denial) of claims.

Obligations of the TPA (summary of listed requirements)

• To review all claim forms submitted by the County and provide a determination as to the compensability of each submitted claim based on applicable laws and as the circumstances of each claim dictates.
• To establish and maintain estimated reserves for each claim and to consult with the County with respect to payment of any claim, or any claim's related expenses, which exceeds TPA's Discretionary Payment Authority Limit.
• To complete and timely file all Pennsylvania Workers' Compensation Bureau Forms as required by law and/or state regulations on each submitted claim.
• To maintain a file for each submitted claim throughout the life of each claim; all closed claim files will be retained for a period of seven (7) years following claim closure.
• To furnish to the County statistical information consisting of a monthly check register of claim payments, a monthly statistical loss run, a monthly report of all checks destroyed or otherwise rendered "void", and a monthly bank account reconciliation of the County's WC claims fund.
• To prepare a biweekly "indemnity forecast" of all claims due indemnity payments and to fax/email the biweekly "indemnity forecast" to the County at least three (3) business days prior to the indemnity check run.
• To provide a written report to the County on any claim where subrogation should and is being pursued.
• To reprice all medical bills associated with County workers' compensation claims to the lesser of the mandated fee schedule or the negotiated discounts available through TPA's network of workers' compensation healthcare providers, if any.
• TPA will act as the reporting agent for the County and will file the required reports under the Medicare, Medicaid and SCHIP Extension Act of 2007 on the County's behalf.

**Submission method:** Hard copy (mail/delivery). Responses are accepted weekdays, 9:00 AM to 4:00 PM, excluding holidays. Each proposer must submit one (1) original unbound and two (2) copies of their proposal sealed with the attached label on or before **Tuesday, November 10, 2026 at 4:00 PM EST** to Luzerne County Purchasing Department, Attention: Mary Ann Amesbury, Penn Place Office Building, Suite 223A, 20 North Pennsylvania Avenue, Wilkes-Barre, PA 18711. Unlabeled responses will be rejected.

Scope of Work questions can be sent via email to Megan Stone, at megan.stone.ohs@luzernecounty.org. The deadline for questions is **Wednesday, November 4, 2026 at 4:00 PM EST**.

**Bid security:** No. **Performance bond:** No.

**Contract term:** The contract will be for one (1) year from date of contract award with two (2) one (1) year contract extensions to be done at the County's discretion. The anticipated initial contract period will be 01/01/2027 to 12/31/2027.

The County reserves the right to award the bid/proposal to a Responder other than the lowest Responder if deemed to be in the best interest of the County. The County shall consider the following criteria: 1) price; 2) reputation of Responder and of its goods and services; 3) quality of the Responder's goods and services; 4) extent to which the goods or services meet the County's needs; and 5) Responder's past relationship with the County.

TPA must maintain appropriate levels of Professional Liability Insurance and provide a current Certificate of Insurance to the County.