Specifications include, but are not limited to: The selected TPA would be expected to perform any functions reasonably required to support administration of the program, including but not limited to following: a. Customer Service and Call Center Management Activities and developing and distributing member plan information. b. Clinical Data analytics and reporting for member populations. c. Disease Management information reporting d. Financial Reporting e. Claims management and processing and payment of claims. f. Financial auditing and monitoring g. Risk Stratification for members h. Development of Plan Benefit Design i. Coordination of benefits and third-party liability. j. Network Management functions k. Population Health and ability to address Social Determinants of Health. l. Quality Improvement activities and performance measurement through comprehensive quality dashboard.
