Third Party Administrator and Prescription Benefit Manager Services
Location:
Texas, United States
Posted on:
Deadline:
Summary:
Seeking a provider for third party administrator and prescription benefit manager services, including claims processing, eligibility management, and audit reporting for a Texas government authority.
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The government authority in Texas is seeking a vendor to provide comprehensive third party administrator (TPA) and prescription benefit manager (PBM) services. The selected TPA will manage initial enrollment and ongoing maintenance of eligibility records, including detailed dependent data necessary for claim payments. Responsibilities include administering coordination of benefits, managing COBRA, and providing sufficient toll-free telephone support lines for employees and their dependents.
Vendors must offer electronic claims surveillance with cost management interventions prior to claim payments, and deliver monthly claim audit reports containing results. Sample audit reports are required as part of the proposal. Additional duties encompass monthly billing for medical, pharmaceutical, dental, and cafeteria plans, with pharmaceutical billing required on a weekly basis. The provider will handle claims processing for both basic and high-deductible health plans. The contract will cover a period of one year, with all vendor questions to be submitted by March 27, 2026.
Best-fit vendors:
• Extensive experience as a third party administrator and prescription benefit manager
• Proven track record in servicing government or large institutional accounts
• Ability to provide electronic claims management and audit reporting
• Capability to manage multiple benefit plans and handle COBRA administration
• Adequate staffing and support infrastructure within Texas or the surrounding region
