Third-Party Administration Services

The City is seeking a vendor to provide third-party administration services for eligible agency reimbursement claims. Required services include claims processing and adjudication for co-pays, coinsurance, deductibles, and premium or contribution reimbursements, along with participant reimbursement by direct deposit (ACH) or paper check. Vendors are expected to describe standard reimbursement turnaround times, claims adjudication accuracy, auto-adjudication capabilities, and audit history, with attestation or equivalent documentation encouraged.

The selected vendor must also provide reporting and financial analytics, including monthly reports on enrollment by tier, reimbursements by expense category, total claims paid, attestation status, and program cost summaries. The solution should include employer portal access to real-time enrollment, claims, and financial data, as well as a member portal for viewing account balances, submitting claims, and tracking claim status online. Mobile access and employee decision-support tools for comparing plan options and modeling out-of-pocket costs are also requested.

The contract term will be one year. A pre-submittal conference is scheduled for August 5, 2026, and all questions must be submitted by August 10, 2026. The successful vendor will also be expected to cooperate fully in any transition to a successor vendor.