Network, Claims Administration & Medical Management Serv for LSU First

The Louisiana State University and Agricultural & Mechanical College is seeking a qualified respondent to provide network, claims administration, and medical management services for its self-funded health plan, LSU First. The supplier will be responsible for all facets of the day-to-day operational administration of the plan, including implementation and delivery of third-party administration of health claims, creation and maintenance of a client-specific network, national network services, population health management, and general and advisory services regarding health plan design. The supplier must have the ability to prorate the HRA, deductible, and out-of-pocket accumulators based on the employee's effective date of coverage. The supplier must also be able to send and receive direct eligibility file feeds daily with the pharmacy benefit manager and have the ability to send and receive data to track individual or combined medical and prescription out-of-pocket maximums. • The supplier must provide innovative solutions for self-funded health program management, including efficient claims processing, network management, and population health management. • The supplier must drive health risk improvement and mitigation of rising healthcare costs. • The supplier must match the current plan design outlined in the summary plan document and summary of material modification. • The supplier must be able to support program offerings and initiatives and be able to support changes to these offerings and initiatives.