Self-Funded Medical Third-Party Administration Services

The Vendor is required to provide self-funded medical third-party administrator (TPA) providers for the City.
- Provide for self-funded medical administration to include, but not limited to, network access, disease management, and utilization/case management service.
- Online resources can members’ access to help them make informed choices in providers, cost of services and care
- Customer service representatives make outbound phone calls to members to follow up on issue resolution
- Be sure to include a summary page that clearly denotes the total number of providers disrupted as well as the corresponding claims.
- Network arrangements offer:
•    Accountable Care Organization (ACO)
•    Patient Centered Medical Home (PCMH)
•    Other “New Models of Care
- The flexibility to allow a dialysis carve-out at a percentage of Medicare regardless of network status
- The following services and whether they are on a PEPM basis or Per Occurrence basis.
•    Medical claims adjudication
•    Medical network access fees
•    Utilization management
•    Disease management
•    Maternity management
•    HIPAA services (if included)
•    COBRA services