Description
The State of Tennessee is seeking a third‑party administrator (TPA) to manage its three self‑funded public‑sector health plans covering roughly 306,000 members (employees, retirees, dependents). The contract includes full administration of provider networks (efficient and optional broad), utilization management, claims processing, member services, communications, reporting, and quality‑assurance initiatives. Performance guarantees cover implementation milestones, network‑access standards, claim‑processing accuracy, NCQA accreditation, and a medical‑trend cap (≤ 4 % annual increase). Payments are PEPM‑based with at‑risk fees tied to trend guarantees, and the contract term is 87 months (effective 1 Apr 2027).
• Core services: provider‑network administration, prior‑authorization, claims adjudication, 24/7 bilingual call‑center, member portal, annual reporting, and sub‑rogation.
• Required deliverables: network‑access analysis, HIPAA Business Associate Assessment, NCQA accreditation, audited financials, credit references, and extensive reporting (monthly, quarterly, annual).
• Key dates: RFP posted 15 Sep 2026; pre‑response conference 21 Sep 2026; questions due 5 Oct 2026; final proposal due 18 Dec 2026; contract effective 1 Apr 2027; go‑live 1 Jan 2028.
• Liquidated‑damage clauses impose penalties for missed milestones, network‑access failures, and performance shortfalls, emphasizing strict compliance.