Third Party Administrator Services

Release and advertisement of RFP: April 24th, 2026

Deadline for submission of questions: May 1st, 2026, at 12:00 P.M. CDT

Proposal submission deadline: May 19th, 2026, at 12:00 P.M. CDT

A Missouri-based entity is seeking a vendor to provide comprehensive third party administrator services. These services encompass claims intake and administration, which include processing the First Notice of Loss, triage, claim setup, coverage verification, compensability decisions, reserve establishment and reviews, investigation, diary and supervisory oversight, statutory reporting and filings, and timely administration of indemnity and medical benefits. Strategic closure of cases is also required.

The scope extends to medical bill review and PPO/network access, applying Missouri fee schedules, conducting usual and customary reviews, detecting duplicates or unbundling, securing PPO/network discounts, negotiating out-of-network charges, and performing quality control audits. Furthermore, utilization review and nurse case management are necessary, covering prospective, concurrent, and retrospective reviews, medical coordination, return-to-work management, catastrophic claim protocols, independent medical exams, and peer reviews.

Additional services sought include pharmacy benefit coordination (PBM) with formulary management, opioid stewardship, prior authorizations, network integration, and fraud, waste, and abuse monitoring. Subrogation and recovery services involve identifying recovery opportunities, resolving subrogations/liens, tracking recoveries, and reporting outcomes. The vendor will also manage general liability, auto liability, and property damage claims as applicable, including evidence preservation, exposure evaluation, and settlement strategies.