REPORT/RECOMMENDATION TO THE BOARD OF SUPERVISORS
OF SAN BERNARDINO COUNTY
AND RECORD OF ACTION
November 3, 2026
FROM
REBECCA SUAREZ, Director, Department of Risk Management
SUBJECT
Title
Contract with MEDEX Managed Care, Inc., to provide Workers’ Compensation Utilization Review Services
End
RECOMMENDATION(S)
Recommendation
Approve Contract with MEDEX Managed Care, Inc., to provide Workers’ Compensation Utilization Review Services to San Bernardino County and other public entities’ workers’ compensation claims, in a not-to-exceed amount of $4,000,000, for the period of November 17, 2026 through November 16, 2031.
(Presenter: Rebecca Suarez, Director, 386-8723)
Body
COUNTY AND CHIEF EXECUTIVE OFFICER GOALS & OBJECTIVES
Operate in a Fiscally Responsible and Business-Like Manner.
FINANCIAL IMPACT
Approval of this item will not result in the use of Discretionary General Funding (Net County Cost). The Department of Risk Management’s (DRM’s) worker’s compensation program is financed by Board-approved rates charged to County departments, Board-governed Special Districts, and County Service Areas. The five-year not-to-exceed contract amount of $4,000,000 for workers’ compensation utilization review services is based on anticipated workers' compensation claim activity and historic service level provision and annual expenditures. Contract costs will be funded through the DRM’s workers’ compensation insurance funds (4082 and 4104) in accordance with the contracted fee schedule. Sufficient appropriation is available in the 2026-27 DRM budget and will be included in future recommended budgets.
BACKGROUND INFORMATION
San Bernardino County’s workers’ compensation program has been self-insured and self-administered since 1972 and manages workers’ compensation claims resulting from the operations of San Bernardino County (County), Board-governed Special Districts, County Service Areas, and other self-governed entities, including San Bernardino International Airport Authority and San Bernardino County Fire Protection District.
DRM has utilized various cost containment programs, including a medical utilization review (UR) process. UR services include review of requests for authorization of medical treatments and procedures on a case-by-case basis to assess their appropriateness, frequency, and duration prior to the provision of services. UR provides a structured process to determine whether requested medical services are medically necessary and reasonable based on professionally recognized standards and specialized nurse or physician (peer) reviews, as required by State regulations to manage costs and improve patient care.
On March 30, 2026, DRM released Request for Proposal (RFP) No. RMG126-RMADM-3601, soliciting proposals for workers’ compensation UR services. After a competitive bidding process that included submission of formal proposals and proposer presentations, MEDEX Managed Care, Inc. (MEDEX) was determined to rank the highest and was sent a request to enter negotiations.
DRM recommends approval of the contract with MEDEX to assist the department with its continuous efforts to ensure that claims meet California legal requirements by reviewing medical treatments against the Medical Treatment Utilization Schedule (MTUS) and other evidence-based guidelines that promote consistent medical decision-making statewide and to secure appropriate, timely, and cost-effective care for employees returning to work after injury.
PROCUREMENT
The County Administrative Office approved and authorized the release of Request for Proposals (RFP) RMG126-RMADM-3601 with DRM on March 30, 2026, to solicit proposals from interested and qualified agencies to provide Workers’ Compensation Utilization Review Services for a period of five years. The RFP was posted to the County’s Electronic Procurement Network (ePro).
Ten proposals were received by the established deadline in response to the RFP. Proposals from the ten firms listed below met the minimum requirements and continued through the evaluation process.
|
VENDOR NAME |
HEADQUARTERS LOCATION |
|
Arissa Cost Solutions DBA Arissa Cost Strategies |
Irvine, California |
|
Atlas Managed Care, LLC |
Corona, California |
|
CorVel Healthcare Corporation |
Irvine, California |
|
EK Health Services Inc. |
San Jose, California |
|
Medata, LLC |
Irvine, California |
|
MEDEX Managed Care, Inc |
Irvine, California |
|
Medovent Solutions LLC |
Petersburg, Florida |
|
Mitchell International, Inc. |
San Diego, California |
|
Rising Medical Solutions, LLC |
Chicago, Illinois |
|
USIS, Inc. DBA AmeriSys, a Davies Company |
San Diego, California |
The evaluation panel, with representation from Risk Management, Auditor Controller, and County Counsel, reviewed and evaluated the proposals based on the criteria listed in the RFP. The criteria included: Qualifications and Experience, Technical Specifications, Cost, References.
Based on the evaluation criteria, the evaluation panel determined that a fee for service contract with MEDEX best met the needs of the County. The contract includes a fee schedule with pricing for different review services to be provided. Subsequently, negotiations with MEDEX began on September 10, 2026. Award and denial letters were sent to all responsible and responsive proposers on September 26, 2026. No protests were received within the allowable period.
Purchasing supports this competitive procurement based on the formal solicitation described above.
REVIEW BY OTHERS
This item has been reviewed by County Counsel (G. Ross Trindle III, Chief Assistant County Counsel, 387-5455) on October 6, 2026; Purchasing (Alba Cortez, Buyer III, 387-3372) on October 7, 2026; Risk Management (Tamra DeMartini, Deputy Director, 386-9022) on October 8, 2026; and County Finance and Administration (Scott Bruckner, Administrative Analyst, 387-4020) on October 15, 2026.