The Vendor is required to provide medical third party administrator and pharmacy benefit manager services for include:
- Medical third party administrator TPA
• Claims administration & operations
• Provider network management
• Clinical & care management
• Customer service & member experience
• Eligibility, billing, and integrations
• Reporting & analytics
• Compliance, privacy & security
• Implementation
• Fees & performance guarantees (medical TPA)
- Pharmacy benefit manager (PBM)
• Company profile & operations
• Formulary, clinical programs & utilization management
• Network (retail, mail, specialty)
• Rebate & financial transparency
• Member experience & customer service
• Reporting, data & integrations
• Compliance, privacy & security
• Implementation.
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