The Commonwealth is interested in receiving proposals from Vendors with proven experience in utilizing the most innovative, state-of-the-art services and technology available in the industry today to provide medical services, but also to drive healthier behaviors and outcomes for members while minimizing healthcare costs. The goal is to obtain TPA services that are “Best in Class” and that provide a value-based health benefits program for its members, while providing excellent plan member and client service support. The selected Vendor must be able to demonstrate the ability to process claims within plan designs that may include varying elements and programs, including Health Reimbursement Accounts with integrated medical/pharmacy plan deductibles, out-of-pocket maximums, and Flexible Spending Accounts. The ability to transfer claims information on a daily or real-time basis to other vendors for accumulation is desired. The ability to provide consumer service and education is also desired for all requested lines of services. The Technical Questionnaire in Appendix 5 will include specific questions about desired program elements.
