Medical Administrative Services Organization (ASO), Third Party Administration (TPA) and Pharmacy Benefit Manager (PBM)

The City of Omaha is seeking a qualified vendor to provide Medical Administrative Services Organization (ASO), Third Party Administration (TPA), and Pharmacy Benefit Manager (PBM) services. The selected vendor will be responsible for administering the City's self-funded medical and prescription drug plan, including integrated prescription drug administration or carve-out prescription drug administration. The vendor will be required to provide a competitive proposal, excellent network access, provider discounts, effective clinical/claims management programs, and superior customer service. The scope of work includes plan documents, plan design, network access, management reports, and performance guarantees. The City is looking for a vendor that can provide a high-quality service, meet the requirements of the Request for Proposal, and demonstrate experience and expertise in similar projects. Some key points to consider include: • The City's current plan design includes an HDHP and a PPO plan for retirees. • The vendor must provide access to a network of qualified providers, including those serving high-poverty areas. • The vendor must provide monthly claim reports, quarterly utilization and claim reports, and online reporting capabilities. • The vendor must furnish monthly eligibility and claims file extracts to the City's analytics reporting platform. • The vendor must provide performance guarantees, including client satisfaction surveys, customer service metrics, and claim target guarantees.