Third-Party Administrator Services
Location:
Texas, United States
Posted on:
Deadline:
Summary:
Seeking a provider to deliver third-party administrator services for a self-funded health plan in Texas, including comprehensive administrative support, on-site staffing, and regular plan solvency reviews.
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The organization is seeking a vendor to provide third-party administrator (TPA) services for a self-funded health plan utilizing preferred provider organization (PPO) networks, as well as wellness and disease management program options. The selected provider will handle all aspects of administration, including banking arrangements, the provision of enrollment forms, identification cards, self-addressed envelopes, and custom claim forms.
Further responsibilities include supplying instructions and materials relating to claims procedures, appeals processes, and employee orientation. The vendor must also offer a database system for collecting dependent information and deliver balanced and reconciled statements at the end of each enrollment period and monthly, including reconciliation data files and necessary corrections.
Monthly updates and corrections to the district in a suitable media format are required, along with the placement of an on-site representative for a minimum of 40 hours per week, per an agreed schedule. Regular monthly meetings will be held to review the solvency of the plan with all health plan market partners.
Best-fit vendors:
• Experienced TPA firms with expertise in self-funded health plans
• Proven ability to manage PPO networks and wellness/disease management programs
• Capability to provide on-site staffing and responsive customer support
• Prior work with public sector or educational organizations in Texas
• Advanced database and claims reconciliation systems
