Administrative Services Only to Perform as Third-Party Administrator for the State's The Tennessee Plan (a self-insured supplemental medical insurance plan for retirees with Medicare)

The State of Tennessee is seeking a qualified firm to serve as the sole Third‑Party Administrator (TPA) for the Tennessee Plan, a self‑insured supplemental Medicare (Medigap Model D) program for retired state employees, their dependents and survivors. The contractor will assume full administrative responsibility for claims processing, call‑center operations, member communications, enrollment data integration, reporting, fraud detection, sub‑rogation, and all required HIPAA‑compliant security measures. The contract runs for 87 months, beginning with an eight‑month implementation period and followed by a five‑year benefits‑coverage phase and an 18‑month run‑out phase. Key deliverables include a toll‑free call‑center, a public microsite, a mobile app, a marketing plan, and a comprehensive security‑risk assessment, all to be live by the Jan 1 2027 go‑live date. • Full TPA services: claims adjudication, payment, enrollment file processing (ANSI 834), and member‑service call‑center (ASA ≤ 30 sec, FCR ≥ 85 %). • Mandatory technology deliverables: public landing page, fully operational microsite (by Sep 2026), mobile application (by Jan 2027), and secure data‑hosting within the continental U.S. with SOC 2 Type II and penetration‑test compliance. • Extensive reporting & SLA requirements: weekly, monthly, quarterly, and annual reports; liquidated‑damage penalties for missed milestones; per‑member‑per‑month (PMPM) compensation model.