Third Party Administrator and Provider Network Services for Off-Site Healthcare

The Oregon Department of Corrections (ODOC) has issued a Request for Proposals (RFP) for a Third Party Administrator (TPA) and Provider Network Services for Off-Site Healthcare, specifically targeting healthcare services for the state's adult incarcerated population. The selected contractor will be responsible for establishing a discounted provider network, managing medical case management, processing and adjudicating claims, and providing comprehensive information management and reporting. Key deliverables include maintaining network adequacy, processing claims with specific performance requirements such as claims turnaround time, claims accuracy, and auto-adjudication percentage. The RFP requires proposers to demonstrate capabilities in claims administration, provider network management, and implementation of a robust case management program. A pre-proposal conference is scheduled for August 23, 2024, with proposals due on October 9, 2024. The initial contract term is two years, with potential extensions up to a total of ten years, and proposers will be evaluated based on their administrative fee per Average Inmate Count (AIC), provider network capabilities, claims processing expertise, and technological infrastructure.

The ODOC is committed to promoting diversity and equal opportunity, requiring proposers to submit a Certified Disadvantaged Business Outreach Plan and ensuring that certified firms have equal opportunity to participate in state-funded contracts. The RFP includes specific requirements for Certified Disadvantaged Business Enterprise (DBE) participation, with proposers expected to detail their strategies for engaging minority-owned, women-owned, service-disabled veteran-owned, and emerging small businesses. Technology requirements mandate a secure, web-based electronic claims payment system compatible with ODOC's existing infrastructure, capable of tracking claim payments, scheduling medical appointments, and maintaining data integrity. The current monthly cost for services, including inmate healthcare and administrative fees, is approximately $2,500,000, with a maximum not-to-exceed amount of $160 million for the contract period. Proposers must demonstrate financial stability, provide documentation of assets, and undergo a comprehensive responsibility inquiry that reviews their financial resources, personnel expertise, past contract performance, and potential legal or financial challenges.