Third Party Administrator Services
Overview
Fit Score
Settle Intelligence
Settle helps teams find, evaluate, and respond to public RFPs. We continuously surface new opportunities, score them against your company strengths, and draft proposal responses so you can focus on the work that wins business.
SUMMARY
DESCRIPTION
The procuring entity is seeking a vendor to provide third party administrator services for a county health care assistance program. The selected provider will receive, adjudicate, and pay claims in accordance with county policies, allowable services, and fee schedules. Services also include conducting intake, screening, and verification of applicant information, verifying eligible individuals into HCAP, and maintaining accurate enrollment records.
The contractor will be responsible for utilization, expenditure, and provider performance reporting, as well as issuing payments to individuals for monthly premiums. Additional requirements include tracking payment history, verifying continued eligibility, preventing duplication of benefits, and providing monthly reconciliation reports to the county.
The scope also requires bilingual English and Spanish customer support during the eligibility process and secure systems for handling protected health information. The vendor should maintain policies for breach notification, data retention, and secure transmission of sensitive data.
Source attribution
This Settle analysis is based on the issuing organization’s public RFP listing.