Specifications include, but are not limited to:The selected organization(s) shall be required to provide the following services, at a minimum11: a. Accept, process and pay claims from medical providers as a third party administrator. b. Participant enrollment maintenance including the capability to accept and process enrollment files in the State’s various designated formats. c. Patient and provider education. d. Management of at least one network of medical facilities and professionals that will provide medical services at a lower negotiated rate in exchange for participation in the network. e. Minimal network disruption and adequate access to providers for traditional PPO, HMO, and consumer directed plans, or, if a narrow network is part of the selected organization’s proposal (and therefore network disruption is unavoidable), then the selected provider must ensure that the narrow network provides adequate access to providers according to the standards outlined in Appendix S: GeoAccess Open Access Network, Appendix T: GeoAccess HMO Network and Appendix U: GeoAccess Medicare Advantage Network Given the fact that this is an evolving area of the marketplace, bidders that propose a model which will not be available statewide by July 1, 2017 will still be considered.
