Specifications include, but are not limited to: Medical Claims Administration and Member Services. Should the City elect
a new ASO carrier or TPA for July 1, 2020, the incumbent ASO carrier or TPA will be
responsible for payment of claims incurred prior to the contract effective date of July
1, 2020. The new ASO carrier or TPA will not be responsible for payment of “run-in”
claims incurred prior to July 1, 2020. Incumbent’s response to RFP must represent
their renewal for continued payment of claims without regard to service date. Nonincumbent responses to RFP will assume payment of claims under the administrative
services contract for services received on and after the proposed effective date. Nonincumbent administrative services responses will be evaluated in conjunction with
cost of current insurance provider’s payment of run out claims for services received
prior to proposed effective date.
Medical Provider Network. ASO carriers or TPAs must have an established
Medical provider network in the Rio Rancho / Albuquerque metropolitan areas.
Additionally, claim administrators must own their provider network arrangements in
New Mexico. Proposals from Offerors who do not have an existing medical provider
network will not be considered.
Claims Cost Management Services (medical management, catastrophic
case management, disease management, and wellness services.
a) Provide a list of disease management programs and wellness services, if any,
which are included in the proposed ASO fees and provided at no additional cost.
Also provide a list of optional disease management and wellness services that are
available at an additional cost. Offerors must complete Disease Management and
Wellness RFP Exhibits 1C and 1D.
b) Identify mechanisms used by your organization to assist with claims cost
management or to encourage cost savings by covered members.
c) It is important that the City’s ASO carrier / TPA can offer members an array of
health and wellness tools such as gym memberships, discounts on supplements,
or health coaching. Proposals should provide detail regarding any similar
programs and tools offered.