The Mississippi State Department of Health (MSDH) Ryan White Part B program plays a crucial role in providing medical and support services to individuals living with HIV/AIDS. As the program grows, the complexity of managing insurance benefits, pharmacy claims, rebate administration, clinical programs, and eligibility management increases. Implementing a Third-Party Administrator (TPA) can optimize program efficiency, reduce administrative burden, enhance compliance, and improve health outcomes for our clients. This proposal outlines the benefits of adopting a TPA and the scope of work required for its successful implementation. MSDH reserves the right to change the scope as required. (Option 1) Contractor shall perform and complete in a timely and satisfactory manner the services described in the “Scope of Work”, which is and made a part hereof by reference. The scope of work is from the procurement Invitation for Bid-Project 2025-IFB-208, which was issued by the Agency and incorporated herein by reference. (Option 2) Contractor shall provide services and otherwise do all things necessary for or incidental to the performance of work, as set forth below: Key Benefits of a TPA Implementation 1. Improved Efficiency and Cost Savings · A TPA will simplify insurance benefit management, including premium payments, medical claims processing, and reconciliation. · Pharmacy Benefit Management (PBM) services will guarantee accurate adjudication, coordination of benefits, and reimbursement. · Automated tracking and processing of rebates will maximize financial returns from drug manufacturers. 2. Enhanced Compliance and Accountability · The TPA will offer expert oversight in regulatory compliance for insurance, pharmacy, and 340B programs. · Monthly and quarterly reports on adherence, utilization, and performance will enhance data- driven decisionmaking. · The contractor will oversee all aspects of eligibility verification and documentation to ensure effective service delivery. 3. Reduction in Administrative Burden · Outsourcing complex administrative functions will enable MSDH staff to concentrate on direct client services and program development. · A dedicated help desk offered by the TPA will assist clients and healthcare providers with inquiries related to claims, benefits, and pharmacy. · The TPA will provide secure remote access to an integrated system for monitoring eligibility and processing claims. 4. Strengthened Provider and Client Support · The TPA will handle provider enrollment, claims payment, and network expansion to ensure comprehensive access to care. · Implementing client adherence programs, such as Medication Therapy Management (MTM) and Pre-Exposure Prophylaxis (PrEP) support, will enhance health outcomes. · The TPA will distribute and manage client ID cards to ensure streamlined access to covered services.
