Specifications include, but are not limited to: Contractor shall provide the following administrative services: a. Coordinate the payment of deductibles, co-payments, and coinsurance for participants enrolled in a THMP insurance assistance program. b. Coordinate the payment of insurance premiums to multiple insurance companies for participants enrolled in a THMP insurance assistance program who are approved by DSHS for insurance premium assistance. c. Provide claims level data that differentiates claims paid between the various insurance benefit levels and programs within the THMP insurance assistance program. d. Enact internal controls that ensure that the THMP does not pay for a medication(s) that is not approved by the THMP and is not in the formulary for the specific insurance plan in which a participant is enrolled. e. Develop and maintain a network of pharmacies that allows for coordination of benefits with third party payers. The network of pharmacies must be geographically dispersed throughout the State of Texas, have at least one mail order pharmacy option, and not exclude independent, hospital, public health department, and not for profit clinic pharmacies.
