260125_Chapter_1A_-_Medical_Pricebook-RETURN_WITH_BID.xlsx
XLSX spreadsheet 251 KB Posted
- Solicitation number
- 260125
- Issued by
- Pima County, Tucson City, Arizona
About this file
This document is a Medical Third Party Administrator (TPA) Pricing Workbook for the City of Tucson, covering a medical administration and HRA/HSA administration contract opportunity for RFP #260125. The contract is set to commence on 7/1/2026 and spans a five-year term through 7/1/2031, with the City seeking comprehensive medical plan administration services. The scope includes core administrative services, provider network access, care management, utilization review, claims administration, digital services, wellness portals, and interfaces with external pharmacy and stop-loss providers.
The pricing document requires proposers to submit per employee per month (PEPM) fees across multiple administrative categories, with the City strongly encouraging fixed-cost submissions. All fee columns are currently set at $0.00, indicating proposers must complete the detailed pricing matrix. The document outlines performance guarantees and metrics, including implementation readiness, service level standards for claims processing, call center performance, clinical outcomes, and network maintenance. Additional components include potential credits, allowances, and a focus on cost containment services such as third-party liability recovery, coordination of benefits, and provider audits. The City appears to be seeking a comprehensive, transparent pricing model with clear performance expectations for the medical TPA services.
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Cover Sheet
City of Tucson
Plan Effective Date: 7/1/2026
RFP 260125 Medical TPA Administration and HRA/HSA Administration
Statement of Confidentiality
The information contained herein is confidential and proprietary to McGriff, a Marsh & McLennan Agency, LLC Company. It is intended only for use of the intended recipient(s) and may not be disclosed or distributed without prior written consent. Unauthorized distribution, copying or disclosure is strictly prohibited and may be unlawful. Any unauthorized use of disclosure may result in irreparable harm and legal action.
Medical TPA Fees
| Medical TPA Fees and Credits |
| The City strongly encourages all standard administrative cost expressed in fixed PEPM cost. Enter your proposed fee based upon a per employee per month unit. If the specific service is included in the proposal, please enter a $0.00. By entering a $0.00 figure, the City will assume the cost is included. |
The City strongly encourages proposers to provide a fixed fee for other administrative and claim cost containment services. If necessary, provide commentary in a separate document if the fee is based on a variable factor including % of claims, % of savings or similar arrangement. If you are willing to provide internal maximum, caps or other limits on how the variable charges are calculated, please state accordingly.
Proposers which offer good faith efforts to limit variable fees/costs will be viewed positively by the City's Evaluation team.
| All Fees should be expressed as a PEPM | |||||
| Medical TPA Plan Administration (CORE) | 7/1/2026-7/1/20207 | 7/1/2027-7/1/2028 | 7/1/2028-7/1/2029 | 7/1/2029-7/1/3030 | 7/1/2030-7/1/3031 |
| Base Administration | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Provider Network Access | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| ACO or Network Care Management Fee | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Centers of Excellence Network Access (e.g., Transplant) | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Virtual Care Access including Behavioral Health | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Account Management Services | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Comprehensive Claim Administration and Member Service Access and Support | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Standard Communications Services | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Consumer Digital Self-Service Web Portal and Mobile App | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Access to Digital Reporting Portal with ad hoc capabilities | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Standard Embedded Wellness Portal and Services | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Monthly Claim File Extract and Eligibility Fee to Data Warehouse | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| External Pharmacy (PBM) Interface, if applicable | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| External Stop Loss Interface, if applicable | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| ID Card, SPDs and all contract document administration | |||||
| Sub Total | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Utilization Review / Care Management / Disease Management | 7/1/2026-7/1/20207 | 7/1/2027-7/1/2028 | 7/1/2028-7/1/2029 | 7/1/2029-7/1/3030 | 7/1/2030-7/1/3031 |
| Utilization Management - Pre-Certification/Prior Authorization, Concurrent Review, Discharge Planning, Retrospective Review and Comprehensive Care Management | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Large Claim / High Cost Case Management | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Targeted Disease Prevention and Management Services - Diabetes, CAD, CHR, Asthma and COPD | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Specific Point Solutions Programs - MSK, Heart, Cancer, GI, Diabetes (as applicable) | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Comprehensive Maternity Support and Management | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Sub Total | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Out of Network Negotiation | 7/1/2026-7/1/20207 | 7/1/2027-7/1/2028 | 7/1/2028-7/1/2029 | 7/1/2029-7/1/3030 | 7/1/2030-7/1/3031 |
| Out of Network Negotiation (PEPM for all non network negotations preferred) | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| If not quoting a fixed PEPM indicate Percent of Savings | |||||
| If quoting Percent of Savings indicate per claim cap and PEPM Cap | |||||
| Sub Total | |||||
| Other Claim Cost Containment Services | 7/1/2026-7/1/20207 | 7/1/2027-7/1/2028 | 7/1/2028-7/1/2029 | 7/1/2029-7/1/3030 | 7/1/2030-7/1/3031 |
| Third Liability and Subrogation Recovery Services | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Coordination of Benefits Services | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Advance Payment Review | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Post Payment Recovery Services | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Provider Audits | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Additional Programs not Included above (insert rows, as necessary) | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Sub Total | |||||
| Total Administrative Fee (PEPM) |
| Capitation - A fixed monthly fee as pre-payment for care in lieu of a fee-for-service claim. List each service individual. | 7/1/2026-7/1/20207 | 7/1/2027-7/1/2028 | 7/1/2028-7/1/2029 | 7/1/2029-7/1/3030 | 7/1/2030-7/1/3031 |
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Allowances and Credits (Please complete each cell individually). | 7/1/2026-7/1/20207 | 7/1/2027-7/1/2028 | 7/1/2028-7/1/2029 | 7/1/2029-7/1/3030 | 7/1/2030-7/1/3031 |
| Implementation / Transition Allowance | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Annual Communications Allowance | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Implementation Audit Allowance | N/a | N/a | N/a | N/a | |
| Medical Claim Audit Allowance | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Wellness Allowance | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Other Allowances/Credits | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Total Annual Credits | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Total Annual Allowance / Credits | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
&"-,Bold"&14RFP #260125 Chapter 1A - Medical &A
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HRA & HSA Fees
| Aggregate Benefit Maximum | HSA & HRA Fees | Administrator Name: |
| Aggregate Attachment Point | Current Enrollment | |
| HSA Fees | ||
| Commission | HRA Fees |
| HIDE THIS COLUMN | Set Up Fee |
| Annual Renewal Fee | |
| Additional Employer Fees | |
| Additional Member Fees |
| Monthly COST |
| TOTAL COST |
| Rate Guarantee |
| Minimum Monthly Fee |
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Performance and Guarantees Administrative Performance and Claim Target Guarantees
| Minimum Standard | Amount at Risk | |
| IMPLEMENTATION | ||
| Plan Readiness Implementation "Open For Business" on 7/01/2026 | ||
| Plan Implementation Satisfaction Guarantee | ||
| Eligibility File Ready | ||
| ID Card Production and Sent for Delivery | ||
| SERVICE | ||
| First Call Resolution - Client Level | ||
| Call Quality Satisfaction - Client Level | ||
| Claim Process Time Turnaround - Client Level | ||
| Financial Accuracy - Client Level | ||
| Processing Accuracy - Client Level | ||
| Average Speed of Answer Customer Service - Client Level | ||
| Call Abandonment Rate - Client Level | ||
| CLINICAL OUTCOMES | ||
| Please complete below. If necessary, include a separate document clearly outlining your specific target Clinical Outcomes | ||
| Engagement | ||
| Clinical Compliance | ||
| Overall Clinical Programs Savings Return on Investment | ||
| *If your Performance Guarantees vary by year, please indicate as such below. Otherwise, please CONFIRM below. |
I confirm stated PGs are valid for years 1-5 of this contract.
PGs vary by year, as indicated below:
| Minimum Standard | Amount at Risk | |
| CLAIM TARGET GUARANTEES (CTG) | ||
| Please complete below. If necessary, include a separate document clearly outlining your specific targeted Claims Target Guarantee | ||
| Targeted Trend Year 1 | ||
| Risk Free Corridor (if any) | ||
| 1st tier for CTG Payout (if any) | ||
| 2nd tier for CTG payout (if any) | ||
| 3rd tier for CTG payout (if any) |
Are you willing to offer the County Claim Target Guarantees for Year 2? If so, please provide an overview of what you're proposing
Claim Target Guarantees for Year 2 as follows:
| Total Cost of Care Guarantee |
| Will your firm agree to a "Discount Guarantee" for your proposed Network? |
| Will your firm agree to a "Total Cost of Care" Guarantee and "Discount Guarantee" for your Network offering for Medical TPA Administration? |
| What other Cost of Care Guarantees is your firm willing to offer? |
| If any response is Yes, using the cell provided and briefly state your firm's proposal with commentary as needed. |
&"-,Bold"&14RFP #260125 Chapter 1A - Medical &A
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Check Box 1 Check Box 1
Addl Performance Guarantees
| PERFORMANCE GUARANTEES | OFFEROR RESPONSE | ||
| For each of the following categories, provide the financial penalty (maximum dollar amount or % of administrative fees) you will agree to pay if the standard and method of measuring the penalty is not met. | Measurement Frequency | Target | Dollars at Risk |
(% or $)
| 1 | Contractor Call (or e-mail) Return Timeliness | Quarterly | No more than 2 missed responses in the timeframe. |
| 1a | Contractor returns the City of Tucson’s and/or their designated consultant’s calls (or e-mails) within 1 business day (even if the answer is “I am working on it”). | ||
| 2 | Processing Eligibility and Enrollment Updates | Monthly | Receipt of eligibility and enrollment information via a weekly electronic feed, eligibility file loaded in 2 working days of receipt and notification to City of discrepancies and errors within the eligibility file within 2 working days of receipt of each eligibility file. |
| 2a | a. Contractor agrees to receive eligibility and enrollment information via a weekly electronic feed from the City’s online enrollment system, at no additional cost to the City. The City reserves the right to change enrollment system providers at any time. Should a different enrollment system provider be used, there shall be no charge from the Contractor to the City to change providers including any changes to data files or feeds, etc. | ||
| 2b | Contractor agrees to load eligibility file within 2 working days of receipt and notify City of discrepancies and errors within the eligibility file within 2 working days of receipt of each eligibility file. | ||
| 3 | Member Satisfaction Survey | Annual | Contractor will obtain at least a 90% satisfaction rate on the survey. |
| 3a | Contractor will develop and conduct a City specific member satisfaction survey. | ||
| 4 | Implementation (if appropriate) | One Time | Pass or Fail |
| 4a | a. Contractor shall perform comprehensive system testing and quality assurance checks prior to the implementation date of July 1, 2026 Contractor shall report the results to the City no later than May 1, 2026 Meeting these milestones shall be provided at no additional cost to the City. | ||
| 4b | b. Contractor shall have its customer call center and website available forty-five (45) days before open enrollment begins for members transitioning from the current contractor as well as for potential new members with questions about City of Tucson’s program and those who want to view information. Customer service representatives must be fully trained on City of Tucson benefits forty-five (45) days before open enrollment begins. | ||
| 4c | c. Contractor shall have City of Tucson’s specific toll-free telephone number available to all plan members forty-five (45) days before open enrollment begins. | ||
| 5 | Financial Accuracy (dollar value): | Annual | ≥99.3% |
| 5a | At least 99.3% of claims dollars submitted for payment will be accurately processed and paid. Financial accuracy will be based on Contractor’s self-reported numbers using City specific claims and as verified through any claims audit conducted by the City and/or their selected auditor. | ||
| 6 | Claims Turnaround Time: | Annual | ≥95% |
| 6a | 95% of all claims received will be completely processed within fourteen (14) calendar days after they are received. 100% of claims will be processed within 30 calendar days of receipt. Claims turnaround time will be based on Contractor’s self-reported numbers using City specific claims and as verified through any claims audit conducted by the City and/or their selected auditor. | ||
| 7 | Claims Processing Turnaround Time: | Monthly | ≥99% |
| 7a | At least 99% of all fully documented claims will be processed within thirty (30) calendar days of receipt. Claims processing turnaround time will be measured through monthly system-generated reports from the contractor showing time periods for claim processing and payments applicable to the City’s claims and as verified through any claims audit conducted by the City and/or their selected auditor. A claim is defined as a request for a payment of a plan benefit by a plan participant or health care provider; a claim is deemed received when it has been time-stamped by the Contractor. Claims pended for missing information or benefit eligibility will be included as a documented claim. | ||
| 8 | Processing Accuracy: | Monthly | ≥99% |
| 8a | At least 99% of all claims will be processed accurately. Accurate processing includes payment amount, communication to claimant or provider, data entry errors affecting current or future benefit determinations, and management reports. Processing accuracy will be measured through monthly system-generated reports from the contractor showing time periods for claim processing and payments applicable to the City’s claims and as verified through any claims audit conducted by the City and/or their selected auditor. | ||
| 9 | Payment Incident Accuracy: | Monthly | ≥98% |
| 9a | Claim payment accuracy should be at least 98% as measured as the total number of claims with dollars paid correctly divided by the total number of paid claims audited in a statistically valid sample of claims for all members. Payment incident accuracy will be measured through monthly system-generated reports from the contractor showing time periods for claim processing and payments applicable to the City’s claims and as verified through any claims audit conducted by the City and/or their selected auditor. | ||
| 10 | Procedural (non-payment accuracy): | Monthly | ≥95% |
| 10a | 95% of all claims will be processed accurately. Accurate processing includes payment amount, communication to the claimant or provider, data entry errors affecting current or future benefit determinations and management reports. Payment incident accuracy will be measured through monthly system-generated reports from the contractor showing time periods for claim processing and payments applicable to the City’s claims and as verified through any claims audit conducted by the City and/or their selected auditor. | ||
| 11 | Network: | Ongoing | Pass/Fail |
| 11a | Maintain a network of medical providers in your Pima County network at no less than that proposed in this RFP. Contractor shall provide notice to the City of any network provider (any individual entity, person, or other provider of medical service) change or potential change affecting at a minimum five percent (5%) or one hundred (100) enrolled members (whichever is less) in Pima County. | ||
| 11ai | HMO (Network plan) | ||
| 11aii | PPO |
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