Third Party Administration Services

The Vendor is required to provide a best-in-class Third Party Administrator (TPA) to partner in administering a custom-designed, self-funded health plan.
- Performance, full financial transparency, and the ability to support advanced strategies including custom networks, direct contracting, and alternative reimbursement methodologies.
- Network Strategy and Access
•    Provide a complete inventory of all contracted networks (base and wrap), including geographic coverage.
•    Provide access fees for each network and any tiered pricing structures.
•    Submit a disruption and discount analysis based on provided census and top providers for your top recommended network configuration.
•    Provide % of Medicare reimbursement benchmarks by IP, OP, ER, and Professional.
•    Describe ability to support direct contracting, domestic contracting, single case agreements directed by Consultant or Client, and custom network builds.
- Claims Administration
•    Claims adjudication platform and accuracy rates.
•    Provide financial accuracy metrics and audit methodology.
•    Handling of complex claims (e.g., dialysis, specialty).
•    Provide turnaround times for claims processing.
•    Escalation procedures for disputed claims.