Medical third-party administrator (TPA)

The Ohio Department of Administrative Services (DAS) Competitive Selection IDV (CSP900020-1) provides comprehensive medical third-party administrator (TPA) services across the state. The contract enables procurement of health insurance and medical claims review and management services, specifically covering administrative services for Preferred Provider Organization (PPO) and Consumer-Driven Health Plan (CDHP) models. Designed to support state employees and various Ohio regions including Columbus, Toledo, Youngstown, Cleveland-Akron, Cincinnati, Dayton-Springfield, and out-of-state employee populations, this IDV offers flexible healthcare administrative solutions.

The IDV is awarded to two prime contractors: Community Insurance Company (Anthem Blue Cross and Blue Shield) and Medical Mutual of Ohio, with a contract period from July 1, 2019, through June 30, 2026. The competitive selection contract covers the entire state of Ohio and includes administrative service fees ranging from $26.50 to $33.76 per employee per month. Contractors are geographically assigned based on regional coverage, with the contract featuring detailed provisions for administrative fees, discount guarantees, and performance metrics. The most recent amendment (Amendment No. 5) was effective September 1, 2023, and maintains the existing contract's core terms while updating specific contractual provisions.