Third-Party Administrator and Pharmacy Benefit Management Services
Overview
Fit Score
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SUMMARY
DESCRIPTION
The School Board of a Florida district is seeking proposals for third-party administrator and pharmacy benefit management services that include comprehensive administrative functions related to medical and potentially integrated stop loss services. The selected vendor will be responsible for accepting, settling, or denying all reported claims, handling the adjudication of claims appeals, and furnishing electronic plan documents for the district’s website. The provider will also supply relevant benefits literature to employees and establish claims reporting and eligibility procedures tailored to district needs.
Additional responsibilities include attending meetings as requested, maintaining the confidentiality of personal health information per Florida law, preparing annual reports on loss data and administrative fees, and managing a toll-free customer service line with extended operational hours. The vendor must also coordinate billing details, audit activities, claim denial, and grievance procedures, ensuring compliance with applicable federal regulations. Optional services to support plan management—such as educational tools, custom plan outlines, narrower network options, and concierge services—are also requested.
A pre-bid conference is scheduled for April 16, 2026, and written questions must be submitted by April 20, 2026.
Source attribution
This Settle analysis is based on the issuing organization’s public RFP listing.