County of Dona Ana Workday #26-0050

Doña Ana County Seeks TPA Services for Health Care Assistance Program

Doña Ana County Health and Human Services Department is seeking information from qualified organizations for Third-Party Administrator (TPA) services to support its Health Care Assistance Program (HCAP) for indigent cancer patients. - Government Buyer: - County of Doña Ana Health and Human Services Department (Procurement Office) - Products/Services Requested: - Third-Party Administrator (TPA) services for HCAP - Claims administration for cancer diagnostic services - Eligibility determination and enrollment - Cost-sharing assistance (co-pays, co-insurance for New Mexico Medical Insurance Pool and Medicaid participants) - Premium assistance administration - Provider contracting - HIPAA-compliant data management - Bilingual (English/Spanish) client-facing service delivery - Reporting on utilization and expenditures - Unique or Notable Requirements: - All client-facing services must be available in both English and Spanish - Strict HIPAA compliance and secure data management are mandatory - Experience with health program eligibility, claims processing, and premium assistance is required - Focus on serving indigent residents diagnosed with cancer under 250% of the Federal Poverty Level - No specific OEMs or commercial vendors are named in the opportunity - The County may use this information to develop a formal RFP and may select multiple partners

Description

The County of Doña Ana is seeking information from qualified organizations to provide Third-Party Administrator (TPA) services for its Health Care Assistance Program (HCAP). The services include health program eligibility determination, claims processing and payment, provider contracting, premium assistance administration, HIPAA-compliant data management, and bilingual (English/Spanish) service delivery. The County intends to create a short list of offerors determined to be the best value and may proceed with a Request for Proposal (RFP) process. The scope includes claims administration for cancer diagnostic services, eligibility determination and enrollment, cost-sharing assistance, and premium assistance.

View original listing