(a) Administer, manage, and provide all equipment, personnel, and services necessary to deliver evidence-based medicine services through claims data analysis for the self-funded State Health Plan and the MUSC Health Plan. Payment for all equipment, personnel, and services necessary to deliver evidence-based medicine services through claims data analysis, as described in this RFP and the Offeror’s response thereto, shall be solely based on the fixed, all-inclusive per subscriber per month administrative fee proposed by the Contractor for the three (3) year initial contract term. Administrative fees will be calculated by PEBA, based on subscriber enrollment, and paid to the Contractor by the 15th working day of each month. Administrative fee payments will be processed via Automated Clearing House to the Contractor’s bank account (under one Federal Employer Identification Number). (b) Integrate claims data from multiple sources, and when appropriate, including PEBA’s Third Party Administrator (currently BlueCross BlueShield of South Carolina (BlueCross)) for both medical and dental claims, Pharmacy Benefits Manager (CVS Caremark effective January 1, 2026), PEBA’s fully-insured vision plan provider (currently EyeMed), as well as laboratory vendors, to identify participants for intervention recommendations according to the Contractor’s proposed clinical protocols. Clinical protocols shall be derived from evidence-based medicine or nationally accepted practice guidelines. Clinical protocols shall be derived in a manner that can be presented and defended to health care providers as promoting cost effective and quality care...
