Third Party Administrator Services

The vendor is required to provide third party administrator services for adjudicating claims, performing medical underwriting, and providing other services.
- Staffing
•    Provide and maintain qualified staff at a level that enables the contractor to meet the requirements of this contract.
•    Provide an ongoing, designated account team that can provide daily operational support as well as strategic planning and analysis. 
•    All members of the account team shall have previous experience administering medical benefits for large employers. 
•    The account team shall be available for consultation with the state during the hours of 8:00 a.m. to 4:30 p.m. central time, Monday through Friday.
o    The account team shall include a full-time account manager and a back-up with the responsibility and authority to manage the entire range of services required by the contractor. 
o    The account manager will meet periodically with the state as determined by the state to discuss operational, plan performance, and planning activities. 
o    Provide a detailed staffing chart by the date key personnel and their job functions to be used for this contract as of the go-live date.
•    Ensure all staff members receive initial and ongoing training regarding all applicable requirements of this contract and the plan.
•    Core services are defined as those that touch or affect the member, specifically member customer services, member call center, mail services, and appeals processing at all levels.
- Call center
1. Call center requirements
•    A call center(s) that uses a dedicated toll–free number as the “front-end” entry point for callers. 
•    Call center(s) shall have designated representatives and operators to respond to inquiries from members. 
•    Call center(s) and staff shall be located in the contiguous united states
•    Call center(s) shall accept calls, at a minimum, from 7:00 a.m. to 4:30 p.m. central time (CT), Monday through Friday, except on holidays.
2. Call center processes
•    Call center(s) shall maintain a quarterly ASA rate of thirty (30) seconds or less. quarterly results will be calculated for a quarterly score as shown
•    The quarterly average speed of answer (ASA) rate shall be calculated by determining the mean ASA rate of each day of the quarter. 
•    Call center(s) shall maintain a quarterly average first call resolution (FCR) rate of eighty-five (85%) or greater. 
•    Quarterly results will be calculated for a quarterly score as shown.
•    Automated interactive voice response (IVR) system for managing inbound calls, provided that the caller always has the ability to leave the IVR system and wait in the queue in order to speak directly with a live-voice call center staff member rather than continuing through additional prompts.
•    The ability to make outbound calls without interrupting the ability of callers to continue to access the call center.
•    The call management system shall maintain a history of correspondence and call transactions for performance management, quality management, and audit purposes.
•    Related correspondence and calls shall be indexed and properly recorded such that they can be treated in reporting and analysis as part of a distinct transaction
- General communications
•    Marketing and communications plan will reflect a thoughtful, proactive approach to drive engagement and utilization of applicable services and programs.
•    This assistance may include but not be limited to:
o    Written information; 
o    Audio and video and webinar presentations; 
o    Member and agency outreach: with notification in writing to the state, attendance at virtual and in-person meetings, workshops, benefits fairs, marketing events and conferences.

- Contract Period/Term: 5 years
- Pre-response Conference Date: September 30, 2025
- Questions/Inquires Deadline: October 8, 2025