Third Party Administrator Services for the State's Public Sector Health Plans
Open State & local contract opportunity Posted
- Solicitation number
- RFP 31786-00190
- State
- Tennessee
- Responses due
Opportunity facts
- Jurisdiction
Updated .
About this opportunity
The State of Tennessee Department of Finance and Administration is soliciting proposals for Third Party Administrator services supporting three self-funded public sector health plans covering approximately 306,000 employees, retirees, and dependents, with responses due December 18, 2026 at 2:00 p.m. Central Time under RFP #31786-00190. The State anticipates awarding up to two contracts.
Mandatory qualifications include current Tennessee TPA licensing; audited financial statements from fiscal years ended within the past 36 months; at least two years of experience administering medical claims for groups of 10,000 or more members with annual claims volume exceeding $100 million; and NCQA Health Plan Accreditation at 4 or 5 stars by December 31, 2028. No minimum participation requirements will be guaranteed.
The scope encompasses network administration, utilization management, claims adjudication, call center services, and benefits communication materials for three financially independent self-funded PPO plans (Copay PPO, Standard PPO, and Consumer Driven High Deductible Plans) across all 95 Tennessee counties and nationally. The TPA must support two distinct provider networks—Efficient and Broad—and meet specified provider access standards by geography (urban, suburban, rural) using Quest Analytics Network Access Analysis. The contractor must also implement subrogation recovery processes, handle 834 enrollment file processing with Tennessee-specific requirements, submit standardized claims data in fixed-format ASCII files monthly, and support integrated reporting through Quest Analytics and Merative systems.
Estimated 2025 claims volume is approximately $1.358 billion medical, $1.231 billion pharmacy, and $52 million behavioral health. The contract term extends through full contract period including any renewals or extensions specified in the pro forma contract.
Evaluation uses a 100-point scale: general qualifications and experience (5 points), technical qualifications and approach (30 points), network analysis including provider network and disruption analysis (30 points), and cost proposal including claims costs, administrative fees, and trend guarantee (35 points). The State's contracted actuarial firm Aon will evaluate claims costs using provider network discounts, normalized utilization, and trend assumptions of 6 percent medical, 6 percent outpatient facility, 5 percent professional services, and 3 percent laboratory/radiology.
Key dates include a pre-response conference on September 21, 2026, written questions deadline October 5, 2026 with a second round deadline November 13, 2026, network and claims information deadline December 3, 2026, and Notice of Intent to Award February 25, 2027. Technical responses and cost proposals must be submitted separately in digital format to a designated Box file sharing link. Responses must include provider data files, network access analysis reports, HIPAA Business Associate Assessment completion, and cost tables addressing claims costs, ASO and utilization management fees, out-of-network repricing shared savings fees, and medical/pharmacy trend guarantee for January 1, 2029 through December 31, 2032.
Opportunity text
3 versions
Update #3 · Latest ·
Request for Proposal for Third Party Administrator (TPA) services to support three self-funded public sector health plans covering approximately 306,000 employees, retirees, and dependents across State/Higher Education, Local Education, and Local Government populations. Services include network administration, utilization management, claims adjudication, call center services, benefits communication materials, medical claims processing, pharmacy claims administration, behavioral health claims management, provider network management with two distinct provider networks (Efficient and Broad), subrogation recovery services, and comprehensive reporting through Quest Analytics platform. TPAs must provide access to efficient and broad existing commercial PPO networks serving all 95 Tennessee counties statewide and nationally.
Update #2 ·
The State of Tennessee seeks up to two contracts with Third Party Administrator(s) (TPAs) to provide network administration, utilization management, claims adjudication, call center services, and benefits communication materials for three financially independent self-funded public sector health plans (Copay PPO, Standard PPO, and Consumer Driven High Deductible Plans) covering approximately 306,000 employees, retirees, and dependents across all 95 Tennessee counties. TPAs must provide access to efficient and broad existing commercial PPO networks serving all 95 Tennessee counties statewide and nationally. Services include medical claims processing, pharmacy claims administration, behavioral health claims management, provider network management, subrogation recovery services, and comprehensive reporting through Quest Analytics platform.
Update #1 ·
The State of Tennessee seeks up to two contracts with Third Party Administrator(s) (TPAs) to provide network administration, utilization management, claims adjudication, call center services, and benefits communication materials for three financially independent self-funded public sector health plans covering approximately 306,000 employees, retirees, and dependents. TPAs must provide access to efficient and broad existing commercial PPO networks serving all 95 Tennessee counties statewide and nationally. Services include medical claims processing, pharmacy claims administration, behavioral health claims management, provider network management, subrogation recovery services, and comprehensive reporting through Quest Analytics platform.
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