Third-Party Administrator Services

The buyer seeks a vendor to provide third-party administrator services for institutional medical needs. The requested scope includes processing and adjudicating off-site inmate medical claims and on-site ancillary medical services, such as mobile radiology, ultrasound, dialysis, vision, therapy, and laboratory services. The buyer requires the vendor to enforce prompt payment requirements, deny pre-booking claims, and integrate with jail medical and records management systems. The vendor must provide access to a contracted, credentialed correctional PPO provider network, manage utilization and precertification medical necessity reviews, and deliver financial administration using a Zero-Balance Account funding model. To qualify, the buyer mandates that the vendor is an onshore USA organization. The buyer requires the vendor to perform all work offsite at the vendor's own office premises. The buyer is currently looking for proposals and has not provided specific budget amounts or key dates in the description.