Medical Claims Third Party Administrator and Provider Network Services

The agency is seeking proposals for insurance-related and self-funded health plan administration services, specifically for a Third Party Administrator (TPA) and provider network services organization. The selected vendor will be expected to support medical claims administration and provider network access for covered health plan benefits, which may include primary care, specialty care, outpatient laboratory, outpatient radiology, mental health services, and inpatient and outpatient care.

Proposals will be evaluated based on the material submitted, with emphasis on technical and managerial capability. Respondents are expected to demonstrate use of a modernized claims processing system, substantial industry expertise, the ability to process claims and related financial obligations efficiently, and a strong management team with relevant experience. Proposers should also provide an organizational chart identifying key personnel associated with the engagement.

The solicitation requests information on the implementation timeline for benefit changes, including any restrictions such as changes requiring manual claims processing. Vendors must also confirm their ability to process out-of-network claims using various reimbursement methodologies, such as percentages of Fair Health or Medicare, and identify any alternate fee schedules or networks used for out-of-network services. The contract term is anticipated to be three years, and questions are due by May 15, 2026.