Third Party Administrator Services for the State's Public Sector Health Plans

The State of Tennessee is seeking up to two qualified third‑party administrators (TPAs) to provide comprehensive administration of three self‑funded public‑sector health plans covering roughly 306,000 members (employees, retirees, dependents). The scope includes provider‑network management (efficient and optional broad networks), utilization management, claims adjudication, 24/7 bilingual member‑service call‑center, member communications, web and mobile portal support, detailed reporting, quality‑assurance initiatives, and coordination with state‑selected pharmacy‑benefit and wellness contractors. Performance guarantees mandate network‑access standards (≥95 % of members meeting distance criteria), implementation milestones (Go‑Live 1 Jan 2028), NCQA accreditation, and a medical‑trend ceiling of ≤ 4 % annual increase, with substantial liquidated‑damage penalties for non‑compliance. The contract is valued on a per‑employee‑per‑month (PEPM) basis over a 87‑month term (including 9‑month implementation, 60‑month service, and 18‑month claims run‑out).