Medical Claims Administration Service

The buyer needs a collaborative medical claims administrator to provide an integrated medical administration solution aligned to plan designs, member needs, and the public-sector environment. The requested scope includes adjudicating claims, maintaining a consolidated deliverables register, providing detailed account structure reporting, and supporting transparent funding processes. The buyer requires the vendor to provide and maintain medical and behavioral networks, manage out-of-network care, offer high-performance and variable-copay options, support virtual-care access, and administer evidence-based utilization management programs. Additionally, the vendor must proactively identify network management solutions. Eligibility restricts participation to USA organizations only. The buyer permits performance of work onsite or offsite, and the contract period spans five years. The buyer seeks proposals for the budget rather than stating a fixed amount. Key dates include a pre-proposal conference on September 22, 2026, and a deadline to submit all questions no later than September 23, 2026.