The government authority located in Baton Rouge, Louisiana seeks a vendor to deliver comprehensive network, claims administration, and medical management services. Responsibilities include administering claims and network services for a self-funded health plan, managing provider credentialing, maintaining accurate provider data and directories, and ensuring provider networks meet rigorous access, quality, and cost standards.

The selected vendor will also implement and manage health and wellness programs aimed at improving health outcomes and reducing risks among participants. Additional requirements include ongoing account and customer service management, timely processing of claims and reimbursements, ensuring access to account information for participants, and utilizing data analytics to identify high-risk members and support targeted interventions. Coordination of benefits, subrogation, overpayment recovery, appeals processes, and operation of care management programs are also part of the expected services. The contract period will span five years.