Third Party Administrator Services
Overview
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SUMMARY
DESCRIPTION
The procuring organization seeks a vendor to provide third party administrator services for health benefits serving approximately 306,000 employees, retirees, and dependents. Required services include network administration, utilization management, prior authorization, claims adjudication, call center support, and member benefits communication materials.
The solicitation includes updated expectations for utilization management and prior authorization, including new reporting requirements. It also establishes requirements for processing and paying out-of-network claims, including a maximum allowable charge methodology and savings reporting. Additional provisions address pre-payment and post-payment activities, potential carve-out options, and detailed reporting.
Questions must be submitted by October 5, 2026. A pre-bid meeting is scheduled for September 21, 2026, and proposals are due December 18, 2026.
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Frequently asked questions
- When is the submission deadline?
- Submissions are due December 18, 2026.
- Who is a good fit for this opportunity?
- Experienced third-party administrator for large-scale employee and retiree health benefit programs
- Strong capabilities in network administration, utilization management, prior authorization, and claims adjudication
- Proven out-of-network claims pricing and maximum allowable charge methodology expertise
- Robust pre-payment, post-payment, reporting, and savings analysis systems
- Established member call center and benefits communications capabilities
- Experience serving public-sector or similarly large, complex populations
Analysis generated by Settle AI from the source RFP.
RFP Hunter shows what is open. Settle shows what is forming.
Settle pieces together buyer signals, budgets, contract activity, and the sources your team already monitors. See why an opportunity fits and what to do before the RFP posts.