Okaloosa County Sealed Solicitation

Title: Third-Party Administration (TPA) of Property, Liability & Workers Compensation Claims

Deadline: 7/22/2025 3:00 PM   (UTC-06:00) Central Time (US & Canada)

Status: Deadline Expired

Solicitation Number: RFP RM 57-25

Description: The County endeavors to provide both equitable and efficient service in processing every claim presented to us. The County controls costs by aggressively managing claims. The Risk Management staff actively participates in investigations, depositions, hearings and trials. The County believes that a cooperative effort between the Risk Management Department and the third-party administrator is the most cost-effective way to manage claims. The Risk Management Department is looking for excellent communication in partnership with the employer/employee in order to get the injured worker back to work as soon as possible.

Documents:

Documents as of 6/13/2025
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Addition 1

Posted: 7/9/2025

Type of Addition: Addendum

Overview:  Addendum 1

Deadline: 7/22/2025 3:00 PM

Solicitation #: RFP RM 57-25

Documents:

Question 1

Posted: 6/18/2025

Question: Will the County please provide a 5-year loss run in excel format, including all open and closed claims by claim type and date of loss?

Response: See addendum 1

Question 2

Posted: 6/18/2025

Question: Please confirm what the anticipated effective date is? How many years has the County been with PMA? Will the new TPA assume responsibility for current open claim files? If so, how many will be taken over by what line and claim type? What is the County's current staffing structure of the claims team on the liability and WC side? What challenges do you have with your current program? What are your biggest concerns with moving the program to a new TPA? Can you please clarify the contract term, including the following? - Length of initial contract term - Number of renewal options available

Response: See addendum 1

Question 3

Posted: 6/18/2025

Question: Does the new TPA need to be approved by the Preferred Governmental Insurance Trust?

Response: See addendum 1

Question 4

Posted: 6/18/2025

Question: Has the County applied for self-insurer status?

Response: See addendum 1

Question 5

Posted: 6/20/2025

Question: Question Regarding Insurance Requirements – Cyber Liability – Attachment B (4) Under Attachment B, paragraph (4), the Draft Agreement requires the CONSULTANT to name the Okaloosa County as an additional insured on its Cyber Liability insurance. The Prospective Respondent respectfully requests clarification on this requirement, as it conflicts with standard insurance industry practice. Cyber Liability policies are fundamentally 'first-party' policies, designed to cover direct damages and costs incurred by the policyholder (the 'named insured') in the event of a data breach. Unlike general liability policies, where adding additional insureds is common, cyber carriers are almost universally unwilling to name a third party as an additional insured. The policy structure is not designed to extend coverage to a third party for their own potential losses. This is similar to workers’ compensation and professional liability policies which Okaloosa County already recognizes as not requiring that the County be named as an additional insured. To meet the Okaloosa County’s goal of ensuring that CONSULTANT’s insurance will not seek recovery from the County for CONSULTANT’s actions, the Prospective Respondent proposes an accepted industry alternative. Would Okaloosa County be willing to amend this requirement and accept a waiver of subrogation on CONSULTANT’s cyber liability policy in favor of the County. This approach provides financial protection to the County while aligning with the products available in the insurance market. Prospective Respondent is confident this solution addresses the intended risk.

Response: See addendum 1

Question 6

Posted: 7/2/2025

Question: Is it possible to get loss runs in an excel format showing the last 5 years?

Response: See addendum 1

Question 7

Posted: 7/3/2025

Question: Please provide a detailed 5-year loss run in excel format.

Response: See addendum 1

Question 8

Posted: 7/3/2025

Question: Please provide a copy of the current contract in place with your TPA and any amendments.

Response: See addendum 1

Question 9

Posted: 7/3/2025

Question: Can you specify the specific areas of program performance improvement sought by the County?

Response: See addendum 1

Question 10

Posted: 7/3/2025

Question: Could you please share any known service challenges, performance concerns, or areas for improvement related to the current TPA?

Response: See addendum 1

Question 11

Posted: 7/3/2025

Question: Additionally, are there any specific expectations or priorities the County has for the incoming TPA based on past experiences?

Response: See addendum 1

Question 12

Posted: 7/3/2025

Question: Does the incumbent pursue subrogation for the County, and is there an associated cost?

Response: See addendum 1

Question 13

Posted: 7/3/2025

Question: How many open claims are there for all years broken down by type?

Response: See addendum 1

Question 14

Posted: 7/3/2025

Question: Who is the current excess carrier? What is the reporting threshold?

Response: See addendum 1

Question 15

Posted: 7/3/2025

Question: We were unable to locate Response Documents #16, #17, and #18 within the RFP packet. Could you please confirm whether these documents are available, and if so, kindly provide them or direct us to where they can be accessed?

Response: See addendum 1

Question 16

Posted: 7/3/2025

Question: Is this an SIR? Amount?

Response: See addendum 1

Question 17

Posted: 7/3/2025

Question: Is there a Risk Manager in place who will interact with the TPA adjusters? Of not then who will be our contact?

Response: See addendum 1

Question 18

Posted: 7/3/2025

Question: Aside from Professional Liability and Cyber claims, would Deadly Weapons claims be included?

Response: See addendum 1

Question 19

Posted: 7/3/2025

Question: What is the expectation for claim reviews/stewardship? In-person/ virtual? How often?

Response: See addendum 1

Question 20

Posted: 7/3/2025

Question: What is the average number of first party subrogation matters handled by the TPA annually?

Response: See addendum 1

Question 21

Posted: 7/3/2025

Question: How many liability claims over the County handled threshold has the current TPA handled over the past 3 years?

Response: See addendum 1

Question 22

Posted: 7/3/2025

Question: How many litigated liability claims over the past 3 years?

Response: See addendum 1

Question 23

Posted: 7/3/2025

Question: How many nurse case managers are currently assigned to the County, and are they exclusively dedicated?

Response: See addendum 1

Question 24

Posted: 7/3/2025

Question: How many claims per year were assigned to Nurse Case Managers from 1/1/20–1/1/2025?

Response: See addendum 1

Question 25

Posted: 7/3/2025

Question: Are all new claims triaged by a nurse?

Response: See addendum 1

Question 26

Posted: 7/3/2025

Question: Is the assignment of Nurse Case Managers standard for all cases, or are there specific criteria for their assignment?

Response: See addendum 1

Question 27

Posted: 7/3/2025

Question: Does the County use Field Case Managers for medical management purposes, and if so, what criteria are used for their assignments?

Response: See addendum 1

Question 28

Posted: 7/3/2025

Question: What is the number of billed charges, bill review allowance, negotiated bill fees, hospital review fees, PPO savings for the past 3 years, and current fee structure?

Response: See addendum 1

Question 29

Posted: 7/3/2025

Question: What network does the County use for Medical Bill Review services?

Response: See addendum 1

Question 30

Posted: 7/3/2025

Question: Who is the County's current provider for Medical Bill Review Services?

Response: See addendum 1

Question 31

Posted: 7/3/2025

Question: Who does the County currently work with for Pharmacy Benefit Management Services, and what is the number of prescriptions filled from 1/1/20–1/1/2025?

Response: See addendum 1

Question 32

Posted: 7/3/2025

Question: Does the County have an EDI with its PBM vendor for pharmacy bills, or is this handled manually?

Response: See addendum 1

Question 33

Posted: 7/3/2025

Question: Is UR applied to this program in any way?

Response: See addendum 1

Question 34

Posted: 7/3/2025

Question: If so, how many referrals? What types of referrals?

Response: See addendum 1

Question 35

Posted: 7/3/2025

Question: In the County's workflow, do adjusters process their own prior authorizations?

Response: See addendum 1

Question 36

Posted: 7/3/2025

Question: Can the County provide detailed utilization review statistics for the past five years, including the number of assignments, gross annual expense, gross savings, net savings, and percentage of savings?

Response: See addendum 1

Posted: 6/18/2025

Question: Will the County please provide a 5-year loss run in excel format, including all open and closed claims by claim type and date of loss?

Response: See addendum 1

Posted: 6/18/2025

Question: Please confirm what the anticipated effective date is? How many years has the County been with PMA? Will the new TPA assume responsibility for current open claim files? If so, how many will be taken over by what line and claim type? What is the County's current staffing structure of the claims team on the liability and WC side? What challenges do you have with your current program? What are your biggest concerns with moving the program to a new TPA? Can you please clarify the contract term, including the following? - Length of initial contract term - Number of renewal options available

Response: See addendum 1

Posted: 6/18/2025

Question: Does the new TPA need to be approved by the Preferred Governmental Insurance Trust?

Response: See addendum 1

Posted: 6/18/2025

Question: Has the County applied for self-insurer status?

Response: See addendum 1

Posted: 6/20/2025

Question: Question Regarding Insurance Requirements – Cyber Liability – Attachment B (4) Under Attachment B, paragraph (4), the Draft Agreement requires the CONSULTANT to name the Okaloosa County as an additional insured on its Cyber Liability insurance. The Prospective Respondent respectfully requests clarification on this requirement, as it conflicts with standard insurance industry practice. Cyber Liability policies are fundamentally 'first-party' policies, designed to cover direct damages and costs incurred by the policyholder (the 'named insured') in the event of a data breach. Unlike general liability policies, where adding additional insureds is common, cyber carriers are almost universally unwilling to name a third party as an additional insured. The policy structure is not designed to extend coverage to a third party for their own potential losses. This is similar to workers’ compensation and professional liability policies which Okaloosa County already recognizes as not requiring that the County be named as an additional insured. To meet the Okaloosa County’s goal of ensuring that CONSULTANT’s insurance will not seek recovery from the County for CONSULTANT’s actions, the Prospective Respondent proposes an accepted industry alternative. Would Okaloosa County be willing to amend this requirement and accept a waiver of subrogation on CONSULTANT’s cyber liability policy in favor of the County. This approach provides financial protection to the County while aligning with the products available in the insurance market. Prospective Respondent is confident this solution addresses the intended risk.

Response: See addendum 1

Posted: 7/2/2025

Question: Is it possible to get loss runs in an excel format showing the last 5 years?

Response: See addendum 1

Posted: 7/3/2025

Question: Please provide a detailed 5-year loss run in excel format.

Response: See addendum 1

Posted: 7/3/2025

Question: Please provide a copy of the current contract in place with your TPA and any amendments.

Response: See addendum 1

Posted: 7/3/2025

Question: Can you specify the specific areas of program performance improvement sought by the County?

Response: See addendum 1

Posted: 7/3/2025

Question: Could you please share any known service challenges, performance concerns, or areas for improvement related to the current TPA?

Response: See addendum 1

Posted: 7/3/2025

Question: Additionally, are there any specific expectations or priorities the County has for the incoming TPA based on past experiences?

Response: See addendum 1

Posted: 7/3/2025

Question: Does the incumbent pursue subrogation for the County, and is there an associated cost?

Response: See addendum 1

Posted: 7/3/2025

Question: How many open claims are there for all years broken down by type?

Response: See addendum 1

Posted: 7/3/2025

Question: Who is the current excess carrier? What is the reporting threshold?

Response: See addendum 1

Posted: 7/3/2025

Question: We were unable to locate Response Documents #16, #17, and #18 within the RFP packet. Could you please confirm whether these documents are available, and if so, kindly provide them or direct us to where they can be accessed?

Response: See addendum 1

Posted: 7/3/2025

Question: Is this an SIR? Amount?

Response: See addendum 1

Posted: 7/3/2025

Question: Is there a Risk Manager in place who will interact with the TPA adjusters? Of not then who will be our contact?

Response: See addendum 1

Posted: 7/3/2025

Question: Aside from Professional Liability and Cyber claims, would Deadly Weapons claims be included?

Response: See addendum 1

Posted: 7/3/2025

Question: What is the expectation for claim reviews/stewardship? In-person/ virtual? How often?

Response: See addendum 1

Posted: 7/3/2025

Question: What is the average number of first party subrogation matters handled by the TPA annually?

Response: See addendum 1

Posted: 7/3/2025

Question: How many liability claims over the County handled threshold has the current TPA handled over the past 3 years?

Response: See addendum 1

Posted: 7/3/2025

Question: How many litigated liability claims over the past 3 years?

Response: See addendum 1

Posted: 7/3/2025

Question: How many nurse case managers are currently assigned to the County, and are they exclusively dedicated?

Response: See addendum 1

Posted: 7/3/2025

Question: How many claims per year were assigned to Nurse Case Managers from 1/1/20–1/1/2025?

Response: See addendum 1

Posted: 7/3/2025

Question: Are all new claims triaged by a nurse?

Response: See addendum 1

Posted: 7/3/2025

Question: Is the assignment of Nurse Case Managers standard for all cases, or are there specific criteria for their assignment?

Response: See addendum 1

Posted: 7/3/2025

Question: Does the County use Field Case Managers for medical management purposes, and if so, what criteria are used for their assignments?

Response: See addendum 1

Posted: 7/3/2025

Question: What is the number of billed charges, bill review allowance, negotiated bill fees, hospital review fees, PPO savings for the past 3 years, and current fee structure?

Response: See addendum 1

Posted: 7/3/2025

Question: What network does the County use for Medical Bill Review services?

Response: See addendum 1

Posted: 7/3/2025

Question: Who is the County's current provider for Medical Bill Review Services?

Response: See addendum 1

Posted: 7/3/2025

Question: Who does the County currently work with for Pharmacy Benefit Management Services, and what is the number of prescriptions filled from 1/1/20–1/1/2025?

Response: See addendum 1

Posted: 7/3/2025

Question: Does the County have an EDI with its PBM vendor for pharmacy bills, or is this handled manually?

Response: See addendum 1

Posted: 7/3/2025

Question: Is UR applied to this program in any way?

Response: See addendum 1

Posted: 7/3/2025

Question: If so, how many referrals? What types of referrals?

Response: See addendum 1

Posted: 7/3/2025

Question: In the County's workflow, do adjusters process their own prior authorizations?

Response: See addendum 1

Posted: 7/3/2025

Question: Can the County provide detailed utilization review statistics for the past five years, including the number of assignments, gross annual expense, gross savings, net savings, and percentage of savings?

Response: See addendum 1