Third Party Administrator Services for Orange County Health Services Department

Orange County, Florida is seeking a Third Party Administrator (TPA) to provide claims processing services for its Health Services Department through a competitive Request for Proposals (RFP) numbered Y24-1004. The procurement targets comprehensive medical claims administration for three specific programs: Corrections Health, Medical Clinic, and Ryan White, with an anticipated annual processing volume of approximately 40,500 claims across 200 providers. The selected contractor will be responsible for electronically reviewing, adjudicating, and processing medical claims using Medicare Diagnosis Related Groups (DRG) procedures and rates, with submissions required in standard UB-04 and CMS/HCFA 1500 formats. Evaluation criteria will weight staff qualifications at 25%, firm qualifications at 25%, technical approach at 30%, and fee proposal at 20%. The solicitation requires electronic submission through the OpenGov e-Procurement Platform by 4:00 PM EST on March 12, 2024, with a contract term of one year and potential renewal for four additional one-year periods. Proposers must demonstrate secure claims processing capabilities, maintain detailed records, conduct monthly internal audits, and ensure full compliance with HIPAA privacy standards.

The RFP does not explicitly indicate specific set-aside designations or restrictions for disadvantaged enterprises. The total estimated annual claims payment volume is $20,000,000, with proposers required to complete a fee schedule form detailing per-claim adjudication costs and pass-through funding. Respondents must create a free account on the OpenGov Platform and submit proposals in standard file formats (Microsoft Word, Excel, PowerPoint, PDF) with scanned documents requiring a minimum 150 dpi resolution. Technical support for the procurement platform is available via chat, email (support@procurenow.com), and phone (1-855-680-4747) during weekday business hours. The project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services, indicating potential federal oversight and compliance requirements. While specific incumbent vendor information is not provided, the solicitation suggests a comprehensive, technology-driven approach to medical claims administration with significant potential for a qualified third-party administrator.