Workers’ Compensation TPA and Managed Care Program

The City of Huntington Beach is seeking a qualified consultant to provide Third‑Party Administrator (TPA) services for workers’ compensation claims and to operate a Managed Care Program (MCP) that may be delivered as bundled or separate components. The TPA must handle claim intake, investigation, adjudication, reporting, and trust‑account administration, while the MCP components (Utilization Review, Medical Bill Review, and Pharmacy Benefits Management) must meet California statutory requirements, provide timely authorizations, and generate cost‑saving reports. • TPA Services – single‑vendor award; 24‑hour claim opening, certified examiners, weekly trust‑account reconciliation, extensive monthly/annual reporting. • Managed Care – three optional components (UR, MBR, PBM) that can be awarded to one or more vendors; URAC certification required, bill‑review turnaround ≤ 5 business days, pharmacy network compliance with OMFS. • Contract term – three‑year agreement (auto‑terminate unless extended), with insurance requirements (minimum $1 M limits, A‑M Best A:VII carrier). • Submission – electronic PDF via PlanetBids by 4 PM PST, 1 June 2026; questions due 12 May 2026; award expected 15 June 2026.