Third Party Insurance Administrator Services

The Vendor is required to provide a third-party administrator like our current practice or utilizing a TPA with a self-funded insurance program to take advantage of existing negotiated discounts.
- TPA that may meet our need to assist in managing medical claims for health care provided to student-athletes.
- Third Party Administrator Requirements:
•    Ability for athletics staff to manage enrollment of patients into a “plan” with each patient assigned a unique identifier. Including athletics establishing activation and termination dates for each patient. (about 900 total patients)
•    Ability to receive medical claims via paper or electronically for each patient enrolled in the “plan.”
•    Ability to evaluate medical claim and board from patient’s primary insurance to assure that patient’s primary insurance has processed the claim.
•    Ability to evaluate athletics responsibility for paying the medical claim utilizing athletics electronic health record.
•    Ability to apply agreed discounts to medical claims submitted by university, agency, and other providers with existing agreements with university.
•    Ability to provide athletics with weekly reports indicating payment responsibility for individual medical claims from each medical provider.
•    Ability to provide regular reports of pending medical claims and claims seeking board from primary insurance.
•    Ability to verify primary insurance for patients enrolled in the “plan” at least 4 time yearly. 
•    Ability to provide a “per member” fee structure that would structure the fee to include:
o    Eligibility maintenance
o    Coordination of benefits 
1.    Collection of primary insurance information annually
2.    Updating of primary insurance information quarterly
o    Claim payment processing
1.    Collection of claims (electronic or paper format)
2.    Approval of agency staff for all claim payments
3.    Adjudication of claims (includes application of correct coding audits)
4.    Application of approved discounts (via athletics established agreements)
5.    Application of primary insurance on each claim paid
6.    Payment of claim/mailing of all paid claims from university funding source
7.    Customer service related to payment of claims (with athletics staff)
o    Reporting 
1.    Monthly list of all claims paid, including cob and discount data
2.    Monthly list of all unpaid claims
3.    Monthly check register for all paid claims
- Third Party Administrator with Self-Funded Insurance Program
•    Ability for athletics staff to manage enrollment of patients into a “plan” with each patient assigned a unique identifier. Including athletics establishing activation and termination dates for each patient. (about 900 total patients)
•    Ability to receive medical claims via paper or electronically for each patient enrolled in the “plan.”
•    Ability to evaluate medical claim and board from patient’s primary insurance to assure that patient’s primary insurance has processed the claim.
•    Ability to evaluate athletics responsibility for paying the medical claim utilizing athletics electronic health record.
•    Ability to apply insurance company negotiated rates to any claims submitted for patients enrolled in the “plan.”
•    Ability to apply agreed discounts to medical claims submitted by university, agency, and other providers with existing agreements with university.
•    Ability to pay claims directly to medical providers utilizing university funding account and provide university with weekly report of individual medical claim payments.
•    Ability to provide regular reports of pending medical claims and claims seeking board from primary insurance.
•    Ability to verify primary insurance for patients enrolled in the “plan” at least 4 time yearly.
•    Ability to provide a “per member” fee structure that would structure the fee to include:
o    Eligibility maintenance
o    Coordination of benefits
1.    Collection of primary insurance information annually
2.    Updating of primary insurance information quarterly
o    Claim payment processing
1.    Collection of claims (electronic or paper format)
2.    Approval of university staff for all claim payments
3.    Adjudication of claims (includes application of correct coding audits)
4.    Application of discounts available to TPA/insurance company as secondary insurer
5.    Application of primary insurance on each claim paid
6.    Payment of claim/mailing of all paid claims from university funding source
7.    Customer service related to payment of claims (with athletics staff)
o    Reporting 
1.    Monthly list of all claims paid, including cob and discount data
2.    Monthly list of all unpaid claims
3.    Monthly check register for all paid claims

- Contract Period/Term: 5 years