Description
The State of Tennessee is seeking up to two qualified Third‑Party Administrators (TPAs) to provide full‑service administration of its three self‑funded public‑sector health plans (State, Local‑Education, Local‑Government), covering roughly 306,000 members. The contract will run for 87 months (9 months implementation, 60 months service delivery, 18 months claim‑run‑out) with a mandated go‑live on 1 Jan 2028. Scope includes network development and management (required Efficient PPO network and optional Broad network), utilization management, claims adjudication and payment, 24/7 member call‑center, plan communications, reporting & analytics, sub‑rogation, fraud‑abuse detection, quality‑improvement initiatives, and coordination with State‑selected carve‑outs (pharmacy, behavioral health, wellness). The State will evaluate technical capability (60 points), cost (35 points), and qualifications (5 points), and may award up to two contracts. Performance guarantees and liquidated‑damage provisions cover implementation milestones, network‑access standards, reporting timeliness, and NCQA accreditation.
• Provide and manage an Efficient PPO network meeting 95 % geographic‑access standards (mandatory) and an optional Broad network.
• Deliver full TPA functions: claims processing, utilization management, member services, reporting, sub‑rogation, and value‑based care initiatives.
• Meet strict performance guarantees (e.g., $75 k liquidated‑damage for network‑access failures, $1 000‑$25 k per day for implementation delays).
• Submit technical and cost proposals by 18 Dec 2026; contract effective 1 Apr 2027 with a 1 Jan 2028 go‑live date.