North Carolina eVP #Doc2142322766

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 vendor to provide Third Party Administrative Services (TPAS) for its health benefit plans, covering over 570,000 members. - Government Buyer: - North Carolina State Health Plan for Teachers and State Employees - Agency: North Carolina Department of State Treasurer, State Health Plan Division - Contracting office located at 3200 Atlantic Avenue, Raleigh, NC - Products/Services Requested: - Third Party Administrative Services (TPAS) for health benefit coverage - Claims adjudication and processing - Network development and management (including PPO and HDHP plans) - Enrollment and eligibility management - Member and provider experience enhancement - Financial services, reporting, and compliance (HIPAA, state and federal laws) - Dedicated call center and member navigation services - Optional population health management (PHM) services (disease management, care coordination, lifestyle coaching, health risk assessments) - Support for Medicare and non-Medicare populations - Tiered copay incentives and preferred provider network - Annual and quarterly reporting, audits, and recovery workflows - Unique or Notable Requirements: - Vendors must provide three customer references and disclose worker locations (including any work performed outside the US) - Certification of financial condition and compliance with security standards - Performance guarantees and fee reductions for unmet service levels - Vendors must be registered in North Carolina's Electronic Vendor Portal (eVP) - Operational readiness (including tested banking/disbursement accounts) required prior to service start - No specific OEMs or vendors are named; opportunity is open to all qualified TPAS providers - Place of Performance: - Services to be performed for the State of North Carolina, with the contracting office in Raleigh, NC

Description

The North Carolina State Health Plan for Teachers and State Employees seeks a Vendor to help execute the Plan’s health benefit coverage strategy. The Vendor must have the technology, resources, and willingness to align financial, health, and experience-based incentives between Members, providers, and the Plan. The Vendor will provide the base platform for improving health and delivering an excellent Member and provider experience while fostering financial sustainability for the Plan.

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