Core Medical Third-Party Administration, Provider Network, and Medical Management Services

The buyer seeks a vendor to provide core medical third-party administration (TPA), provider network, and medical management services. The required scope includes core and wrap provider networks, member services with a dedicated toll-free number, ID card preparation and mailing, medical claims administration and payment, and coordination of benefits processing. Additional requirements encompass hospital and professional provider networks with negotiated payments, transplant and Centers of Excellence networks, precertification, concurrent review, disease management, case management, a nurseline, general health coaching, and a tobacco cessation program. The selected contractor will also handle tobacco use and non-use attestation administration for wellness incentives and deliver an innovative digital diabetes management platform. Eligibility is restricted to onshore USA organizations only, and the work will be performed offsite. All questions regarding this solicitation must be submitted no later than November 16, 2026.