Third Party Administrator Services

The Vendor is required to provide third-party administrator (TPA) services and chronic disease management (CDM) services to the city’s self-funded medical benefit plans.
- Requirement:
• Claims processing and coordination of benefits management
• Data and reporting
• Data exchanges/vendor interfaces
• Network access and management
• Medical management including utilization management and case management
• Chronic disease management
• Wellness program administration and management
• Behavioral health management
• Member services
• On-site staffing
• Health information/nurse line
• Effective member communications and open enrollment support
• Participant satisfaction survey
• Focus groups
• Account management
• Website/web portal/mobile applications
• Member enrollment and eligibility maintenance
• Fraud deterrent, waste and abuse management
• Auditing rights
• Health reimbursement account or health savings account administration
• Effective implementation and transition support.