Medical third-party administrator (TPA)

The Ohio Competitive Selection IDV (CSP900020-2) provides comprehensive medical third-party administrator (TPA) services for state agencies, covering medical claims review, management, and health insurance administrative services. The contract enables state entities to access administrative service organization (ASO) solutions through two primary contractors: Medical Mutual of Ohio and Community Insurance Co. (Anthem Blue Cross and Blue Shield). The IDV's scope encompasses multiple service categories, including preferred provider organization (PPO) and consumer-driven health plan (CDHP) administrative services across various Ohio regions such as Columbus, Toledo, Cleveland-Akron, Cincinnati, Dayton-Springfield, and Southern regions.

The IDV is managed by the Ohio Department of Administrative Services (DAS) and was awarded on September 1, 2023, with a performance period extending through June 30, 2026. The contract is a competitive selection type with statewide coverage, featuring per employee per month (PEPM) rates that vary by fiscal year and contractor. Medical Mutual of Ohio offers PEPM rates ranging from $26.50 to $27.96, while Anthem Blue Cross Blue Shield provides rates between $32.78 and $33.76. The contract allows for ongoing refinement of discount guarantees and service terms, providing Ohio state agencies with flexible and comprehensive health insurance administrative solutions.