North Carolina eVP #270-20260421TPAS

North Carolina State Health Plan Seeks Third Party Administrative Services for Health Benefits

The North Carolina State Health Plan for Teachers and State Employees is seeking a qualified partner to provide third party administrative (TPA) services for its health benefit plans covering over 570,000 members. - Government Buyer: - North Carolina Department of State Treasurer, State Health Plan Division - Office: Senior Manager of Contracting, 3200 Atlantic Avenue, Raleigh, NC 27604 - Scope of Services: - Comprehensive TPA services including claims adjudication, network development, enrollment, member experience, financial services, and reporting - Administration of PPO and HDHP plans, Medicare coordination, and support for both Medicare and non-Medicare populations - Population Health Management (PHM) services (optional): disease management, care coordination, lifestyle coaching, and health risk assessments for non-Medicare members - Member Navigation Services: multimodal support for healthcare decisions, provider selection, and utilization management - Dedicated call center and robust member/provider experience enhancements - Compliance with HIPAA, state, and federal regulations - Detailed performance guarantees, fee reductions, and extensive reporting, auditing, and recovery workflows - Notable Requirements: - Vendors must be registered and in good standing with the North Carolina eProcurement portal (eVP) - Disclosure of all worker locations, including any work performed outside the United States - Customer references, financial condition certification, and operational readiness prior to contract start - Annual and quarterly reporting, audits, and reconciliations required - No specific OEMs or vendors are named; opportunity is open to all qualified third party administrators - Place of Performance: - Services to be performed for the State Health Plan, with the main office at 3200 Atlantic Avenue, Raleigh, NC 27604

Description

The North Carolina State Health Plan for Teachers and State Employees is seeking a vendor to provide third party administrative services. The vendor will support the Plan's health benefit coverage strategy by providing technology and resources to align financial, health, and experience-based incentives among members, providers, and the Plan. The contract aims to improve health outcomes, enhance member and provider experiences, and ensure financial sustainability for the Plan. Responses must be submitted via sealed mail and require registration on the North Carolina eProcurement portal.

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