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NAICS Code· 524292

Pharmacy Benefit Management and Other Third Party Administration of Insurance and Pension Funds

This U.S. industry comprises establishments primarily engaged in providing pharmacy benefit management (PBM) services and other third party administration services of insurance and pension funds, such as claims processing and other administrative services to insurance carriers, employee benefit plans, and self-insurance funds. Cross-References. Establishments primarily engaged in--Show more

NAICS 524292 — Pharmacy Benefit Management and Other Third Party Administration of Insurance and Pension Funds — encompasses the administration of complex health benefit programs, including pharmacy claims processing, formulary management, prior authorization, drug utilization review, and rebate negotiation for public health plans. It also covers third-party administration of pension and insurance funds, including enrollment management, benefit calculation, payment processing, and compliance reporting under federal statutes such as ERISA and the Affordable Care Act.

35
Active Contracts
$657.6M
Total Obligations (12mo)
107
Awarded Contracts (12mo)
29
Contractors Awarded (12mo)
-22.3%
YoY Growth

Awarded Contractors

Companies that have received federal awards classified under NAICS 524292.

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NAICS 524292 FAQ

Frequently Asked Questions

NAICS code 524292 covers Pharmacy Benefit Management and Other Third Party Administration of Insurance and Pension Funds. This U.S. industry comprises establishments primarily engaged in providing pharmacy benefit management (PBM) services and other third party administration services of insurance and pension funds, such as claims processing and other administrative services to insurance carriers, employee benefit plans, and self-insurance funds. Cross-References. Establishments primarily engaged in--

Recently Posted in Pharmacy Benefit Management and Other Third Party Administration of Insurance and Pension Funds

NAICS: 524292
New
SLED
Third-Party Claims Administration & Workers CompensationThe City of Hialeah is inviting qualified, licensed firms to submit proposals for a comprehensive, bundled Workers’ Compensation and Third-Party Liability Claims Administration program under solicitation number 2025-26-033. The goal is to partner with a single Third-Party Administrator that integrates all critical functions—including claims adjusting, medical management, telephonic case management, and provider network access—into one cohesive service model. The selected vendor must demonstrate a clear commitment to ensuring injured workers receive only reasonable, necessary, and work-related medical care while actively promoting a swift and healthy return to duty and minimizing the City’s overall liability exposure. Proposals must be submitted by the deadline of August 12, 2026, and will be evaluated based on the vendor’s ability to deliver efficient, cost-effective, and compliant claims administration under Florida law. The contract will be managed by the Human Resources, Risk Management Division, with primary point of contact Franklin Duharte, Risk Administrator, and secondary contact Marilin Gutierrez, Purchasing Aide. The City expects the TPA to operate with transparency, accountability, and a results-driven approach tailored to the needs of a municipal workforce, with all services performed within the State of Florida. The opportunity is open to all eligible firms without specific set-aside restrictions, and detailed information can be accessed through the online procurement portal.
Human Resources, Risk Management Division

POSTED

2 days ago

DEADLINE

in 29 days
View Details
NAICS: 524292
New
Federal
R710--Third Party BillingThe Department of Veterans Affairs is conducting market research to identify capable third-party vendors for outpatient medical claims billing services through the Consolidated Patient Account Center Revenue Operations, specifically for VA Care in the Community and related outpatient claims. This initiative, governed by Revolutionary FAR Overhaul and VAAR market research guidelines, is not a solicitation or binding obligation but aims to assess industry capabilities, commercial practices, and potential sources for a contract under NAICS code 524292 with a small business size standard of $45.5 million. Respondents must demonstrate experience in medical billing, including DME and dental claims, claim rejections, and customer service, using legacy DOS-based systems without modern GUI integration, with an expected capacity to process 250,000 to 350,000 claim encounters monthly and meet strict timeliness standards for claim generation and rejection resolution. Companies must provide detailed evidence of staffing competence, including managers with five years of outpatient billing experience and supervisors with three years, and confirm they can onboard within 60 days of award, maintain 30% permanent staff not employed at CPAC, and scale rapidly to handle workload surges. Responses must be submitted via email to designated VA contacts by July 20, 2026, no later than 2:00 p.m. Eastern Time, and cannot exceed ten pages single-spaced in 11-point Calibri font. Required information includes company details, SAM UEI number, small business certifications, and answers to technical questions on staffing, claims processing workflows, compliance with HIPAA and PII/PHI protocols, dispute resolution procedures, and training mechanisms for Medicare and CMS updates. Vendors are also invited to provide feedback on the draft Performance Work Statement to clarify ambiguities or suggest improvements to the scope. Participation requires prior registration in SAM and, for eligible veteran-owned firms, certification in the SBA’s Small Business Search portal. The VA will use responses to evaluate market readiness, determine potential competition, and inform future acquisition strategies, with no guarantee of subsequent procurement.
Pcac (36C776)

POSTED

5 days ago

DEADLINE

in 6 days
View Details
NAICS: 524292
New
SLED
Title and Escrow Services for Parcel TransferThe contract entails the provision of title insurance, escrow, and closing services necessary for the transfer and recording of seven newly created parcels within the City of Elk Grove. These services are critical to ensuring legal clarity, financial security, and proper documentation during the real estate transaction process for each parcel. The work is structured as a subcontract under the NAICS code 524292, which designates other title services, and is managed by the City of Elk Grove in California. All activities must be performed locally in Elk Grove, aligning with municipal requirements for land development and property recordation. The solicitation was posted on July 10, 2026, indicating an upcoming procurement timeline aimed at securing qualified providers to facilitate seamless parcel transfers.
City of Elk Grove

POSTED

5 days ago

DEADLINE

N/A
View Details
NAICS: 524292
New
SLED
Insurance & Risk Management ServicesThe contract requires the provision of liability insurance with the State of Hawaii designated as an additional insured, ensuring that the state is protected under the policy for any claims arising from the contractor’s activities. The contractor must also maintain excess liability coverage that meets or exceeds the specific thresholds outlined in the agreement to safeguard against potential financial exposures beyond standard coverage limits. All insurance provisions must comply fully with the State's risk management standards and contractual obligations, with documentation submitted as required to verify continuous and adequate coverage during the performance period. This subcontract under the Department of Commerce & Consumer Affairs in Hawaii is open for responses until August 11, 2026, with a NAICS code of 524292 indicating it relates to insurance and risk management services. Performance is expected to occur within the State of Hawaii, and the contracting entity seeks qualified providers capable of delivering robust, compliant insurance solutions aligned with state requirements. The solicitation is publicly accessible through the Hawaii eProcurement portal, and interested parties are expected to ensure their proposals address all insurance specifications, including coverage amounts, policy terms, and the inclusion of the State of Hawaii as an additional insured party.
Department of Commerce & Consumer Affairs

POSTED

5 days ago

DEADLINE

in 27 days
View Details
NAICS: 524292
New
SLED
2000004335 Pension Administration System (PAS) ModernizationFairfax County Public Schools is seeking proposals to modernize its Pension Administration System for the Educational Employees’ Supplementary Retirement System, which serves eligible employees of the school district in Fairfax County, Virginia. The solicitation, identified as RFP-123225 and titled 2000004335 Pension Administration System (PAS) Modernization, aims to secure a vendor capable of delivering a comprehensive, secure, and efficient system to manage pension benefits administration. Proposals must be submitted by the deadline of August 7, 2026, and will be evaluated through a competitive negotiation process to ensure the selection of a solution that meets the operational, technical, and compliance needs of the retirement system. The system must support accurate benefit calculations, participant communications, reporting, and integration with existing infrastructure. The procurement falls under NAICS code 524292 and is issued by the Virginia state and local government entity, with all performance expected to occur at the Fairfax County Public Schools administrative location in Falls Church, Virginia. Jeremy Stern of FCPS serves as the designated point of contact for inquiries and can be reached via email or phone provided in the solicitation details. The RFP is published on the vendor portal linked in the document, and responses must be submitted as sealed proposals in accordance with the formal requirements outlined by Fairfax County Schools. This modernization initiative is critical to ensuring continued reliable pension service delivery to educational employees and aligning with current technological and regulatory standards.
Fairfax County Schools

POSTED

6 days ago

DEADLINE

in 24 days
View Details
NAICS: 524292
SLED
MoDOT and MSHP Medical Plan and Pharmacy ConsultingThe Missouri Department of Transportation and the Missouri State Highway Patrol Medical and Life Insurance Plan are soliciting proposals from qualified offerors to provide comprehensive Pharmacy Consulting services under Solicitation Number MODOT 0000000196SL. The contract term spans three years from January 1, 2027, through December 31, 2029, with two optional one-year renewal periods available at the discretion of the state. All proposals must be submitted electronically through the MissouriBUYS platform powered by MOVERS; submissions via email or other methods will not be accepted. The solicitation was posted on July 7, 2026, with a mandatory response deadline of July 20, 2026, at 7:00 PM Central Time. The performance of services will be statewide in Missouri, and all inquiries and communications should be directed to Lori Tackett, the designated buyer, at lori.tackett@modot.mo.gov.
MODOT TRANSPORTATION

POSTED

8 days ago

DEADLINE

in 6 days
View Details
NAICS: 524292
SLED
Health Insurance Program Design & Actuarial AnalysisTexas Woman’s University is seeking a subcontractor to design comprehensive student health insurance plans, perform detailed actuarial analysis, and recommend benefit structures that meet all federal Affordable Care Act requirements and applicable Texas state regulations. The work involves developing insurance products tailored to the needs of a student population, ensuring financial sustainability through rigorous modeling and analysis, and aligning plan features with legal and regulatory standards to guarantee compliance and affordability. The contract, categorized under NAICS code 524292, is posted with a response deadline of July 28, 2026, and is open for bidding through the Texas SmartBuy procurement portal, with performance expected to support the university’s student health services and insurance offerings.
Texas Woman's University

POSTED

13 days ago

DEADLINE

in 14 days
View Details
NAICS: 524292
SLED
Workers' Compensation Third-Party Administrator ServicesThe Nebraska Public Power District is seeking proposals for Workers' Compensation Third-Party Administrator Services through Request for Proposal (RFP) No. 26065, which remains open for bidding with a closing deadline of July 30, 2026, at 5:00 PM Central Time. Bidders must provide services related to the administration of workers’ compensation claims, with detailed requirements outlined in the documents available under the “Documents” tab. The procurement is categorized under Professional Services, specifically Actuarial Services and Consulting Services - Non-Nuclear, indicating the need for expert analytical and advisory capabilities in claims management, loss control, and regulatory compliance. The contract will be awarded on an offline basis in U.S. dollars, and no pre-bid meeting has been scheduled. All inquiries should be directed to Rachel Shafer, Procurement Specialist, via email at rlshafe@nppd.com or by phone at 402-563-5096. The solicitation is issued by the Nebraska Public Power District, a state-level entity, and performance of the contracted services is expected to support operations within Nebraska. Prospective bidders are encouraged to review all available materials thoroughly, as responses must demonstrate expertise in handling workers’ compensation programs with compliance, efficiency, and cost-effectiveness. The opportunity is currently active, with approximately 28 days remaining until the submission deadline.
Nebraska Public Power District

POSTED

13 days ago

DEADLINE

in 16 days
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NAICS: 524292
SLED
Subcontractor Insurance and Compliance ManagementThe contract requires a third-party service to manage and verify insurance compliance for subcontractors working under KYTC Highway District 5, ensuring all documentation meets Kentucky Transportation Cabinet requirements. Core responsibilities include tracking Certificates of Insurance, confirming proper additional insured status, and maintaining accurate, up-to-date records to support regulatory and contractual obligations. The service must provide reliable, auditable documentation that aligns with state standards for risk management and contractor oversight. This subcontract-focused opportunity is open to providers with expertise in insurance compliance automation and documentation verification, with a response deadline of July 24, 2026. The work will be performed across all locations under KYTC Highway District 5 jurisdiction, with no specific city designated, indicating statewide or multi-site applicability. The NAICS code 524292 confirms the scope centers on other insurance related activities, and while no set-aside provisions are listed, the opportunity is open to all eligible entities capable of fulfilling the insurance tracking and verification needs of the agency.
KYTC Highway District 5

POSTED

14 days ago

DEADLINE

in 10 days
View Details
NAICS: 524292
SLED
Provide Third-Party Claims Admin Services for Laibility, Worker's Comp SELA/Property, & Other Claims for JP Hosp. Dist. 1 & 2 ParishwideJefferson Parish is seeking a qualified third-party administrator to provide comprehensive claims administration services for liability, workers’ compensation, SELA/property, and other related claims across Jefferson Parish and its two hospital service districts. The solicitation, identified as JPP-SOQ#26-018, targets firms with demonstrated expertise in managing a broad portfolio of claim types including general liability, professional liability, employment practices liability, public officials and employee liability, automobile liability, and workers’ compensation, while explicitly excluding services such as PPO networks, medical case management, vocational rehabilitation, medical bill re-pricing, life care planning, private investigations, and litigation management. The contractor must operate as an independent entity, maintain a dedicated office within the Jefferson Parish Department of Risk Management, assign adjusters exclusively to this account, and strictly adhere to generally accepted industry practices, ensuring all cases are reviewed at least every 30 days and claimants are contacted within 24 hours of incident reporting. The contract requires full compliance with Jefferson Parish’s procurement ordinances, including rigorous documentation standards, mandatory affidavits that must be notarized and submitted prior to contract approval, and thorough disclosures regarding campaign contributions, debts, subcontractor relationships, and any prior adverse legal proceedings involving the Parish. Evaluation will be based on a weighted scoring system totaling 90 points across four key areas: scope of services (30 points), specific experience (25 points), personnel and firm size (20 points), and location of principal office (15 points), with preference given to firms headquartered in Jefferson Parish, followed by other parishes in the Greater New Orleans region, then Louisiana, and finally out-of-state providers. Direct experience of adjusting staff is a determining factor in selection, and the Parish reserves the right to approve or reject key personnel. Contractors must also commit to full cooperation with audits, secure and safeguard all Parish records, and return them upon contract termination or replacement. Proposals must be submitted electronically through www.jeffparishbids.net or www.centralauctionhouse.com by 3:30 p.m. on July 13, 2026, with registrants required to complete free vendor registration. All submissions must follow the exact order of the General Professional Services Questionnaire, include signed and notarized affidavits, complete documentation for all subcontractors, and carry no disqualifying disclosures; late, incomplete, or improperly formatted responses will be rejected. While the contract value is not specified, financial reporting must include an unqualified audit opinion
Jefferson Parish Purchasing Department

POSTED

14 days ago

DEADLINE

in 2 days
View Details
NAICS: 524292
SLED
RFP SD25-00019 Health Care Provider Network and Prior Authorization ServicesThe California Department of Corrections and Rehabilitation / California Correctional Health Care Services is seeking qualified entities to establish and manage a comprehensive Health Care Provider Network delivering community-based specialty medical services to incarcerated individuals across California and in select bordering counties of Oregon, Nevada, and Arizona. The contract requires the successful proposer to provide full-service provider network management, prior authorization systems, and related administrative support on a cost-per-claim basis, with pricing structured separately for laboratory and non-laboratory services. The network must be 80% operational within six months of contract execution and include access to hospital-level care with 24-hour emergency services, intensive care, tertiary and transplant services, medical imaging, clinical laboratory and pathology services, and telehealth. All providers must be fully licensed and capable of adhering to CDCR/CCHCS operational protocols, including strict security policies, infection control standards, Cal/OSHA requirements, and zero-tolerance policies for sexual harassment and workplace violence. Personnel must comply with institutional rules, undergo background checks and fingerprinting, carry proper identification, and participate in mandatory orientations, including Prison Rape Elimination Act training. The contractor is obligated to comply with a broad range of legal, financial, and operational requirements, including certification under the Fair Employment and Housing Act and the Unruh Civil Rights Act, adherence to conflict of interest statutes such as GC Sections 1090 and 81000 et seq., and full alignment with HIPAA and information security protocols outlined in Exhibits F and G. Payment terms are governed by the California Prompt Payment Act, with undisputed invoices paid within 45 days, and invoicing must follow strict formatting rules including use of correct revenue codes and accompanying forms such as ADJ-01 for administrative days. The contract has a five-year initial term with five optional one-year extensions, and proposers must include amortized implementation costs over the initial period. Proposals are evaluated for best overall value based on technical approach weighting (1,189 points), additional criteria (305 points), cost (750 points), and deliverables (95 points), with responsiveness as a mandatory threshold. Submissions must be electronic PDFs delivered via email by August 18, 2026, and include mandatory certifications on DVBE status, conflict of interest, generative AI usage, good standing, tax compliance, and ethical conduct. The contractor must also supply all laboratory supplies, shipping containers, and facility labels at no additional charge to the thirty-one designated CDC
California Department of Corrections & Rehabilitation

POSTED

14 days ago

DEADLINE

in about 1 month
View Details
NAICS: 524292
Closed
Federal
WTCHP Pharmacy Benefits Manager ServicesThe Centers for Disease Control and Prevention’s Office of Acquisition Services plans to award a sole source contract to Evernorth Federal Services for Pharmacy Benefits Management services supporting the World Trade Center Health Program. This statutory program, established under the James Zadroga 9/11 Health and Compensation Act, provides no-cost prescription coverage to certified responders and survivors of the 9/11 attacks for conditions related to their exposure. The Pharmacy Benefits Manager will be responsible for administering the program’s limited formulary, ensuring appropriate access to medications prescribed by authorized providers and coordinating pharmacy services tailored to each member’s certified health condition. The contract is structured with a one-year base period from September 20, 2026, to September 19, 2027, and includes two one-year option periods extending through September 19, 2029, exercisable at the government’s discretion under standard far provisions. The solicitation is being conducted under a sole source authority due to the belief that only one source can meet the program’s specific requirements. This is not a competitive procurement, but interested parties may submit documentation of their capability by July 14, 2026, to the Contracting Officer, Serina Allingham, for consideration in the government's final determinations. The contract falls under NAICS code 524292 and is managed by the CDC on behalf of the Department of Health and Human Services, with performance centered in Atlanta, Georgia. Responses will be evaluated solely to inform whether a competitive process is warranted, and the government retains full discretion over the award method.
CDC Office Of Acquisition Services

POSTED

15 days ago

CLOSED

about 12 hours ago
View Details

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