DAS Medical Plan Third-Party Administrator

The State of Ohio seeks a qualified Third‑Party Administrator (TPA) to manage its self‑insured medical plans—Ohio Med PPO, Ohio Med Select, and Ohio Med HDHP—covering state employees, retirees, dependents, and COBRA participants. The contractor will be responsible for end‑to‑end claims processing, eligibility verification, network management, member services, reporting, and a seamless transition from current TPAs. The work begins July 1 2027 and runs through June 30 2030, with performance‑based fees paid on a per‑member‑per‑month (PEPM) basis and a mandatory $75 K benefits fund per awarded region. Key requirements include HIPAA compliance, a signed Business Associate Agreement, adherence to Ohio’s IT policies, and strict service‑level agreements for claim turnaround, member‑complaint handling, and network stability. • Administer three existing health‑plan designs without alteration, processing all claims incurred on or after July 1 2027. • Provide comprehensive reporting (quarterly financials, DAS dashboard, provider‑discount data) and maintain required IT and security standards. • Meet stringent SLA targets (e.g., 94 % of claims processed within 10 business days, 24‑hour complaint acknowledgment, 99 % network‑access distance compliance).