Third-Party Administrator Services for Health Care Assistance Program
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 agency seeks a vendor to provide third-party administrator services for a Health Care Assistance Program in New Mexico. The selected contractor will support administration of cancer diagnostic service claims for individuals already enrolled in the program.
Responsibilities include contracting with providers that deliver cancer diagnostic services, receiving and adjudicating claims, and issuing payments in accordance with county policies, allowable services, and fee schedules. The contractor will also be expected to provide reporting on utilization, expenditures, and provider performance.
In addition, the vendor will manage eligibility determination and enrollment activities for the program. This includes applying county-defined eligibility criteria, conducting intake, screening, and verification of applicant information, enrolling eligible individuals, maintaining accurate enrollment records, and providing bilingual English/Spanish customer support during the eligibility process.
Source attribution
This Settle analysis is based on the issuing organization’s public RFP listing.