TPA Services for PPO

The State of Florida, Department of Management Services' Division of State Group Insurance is issuing an Invitation to Negotiate (ITN) to establish a contract for Third Party Administrative (TPA) Services for its Preferred Provider Organization (PPO) health insurance coverage. The Department is seeking a contractor to provide comprehensive medical and mental health/substance abuse provider networks, as well as handle claims processing, customer service, reporting, and integration with the Department's authorized third-party vendors. The selected contractor will be responsible for managing any disease and clinical programs implemented by the Department. Responses to the ITN must include detailed technical, network, and cost proposals, and will be evaluated based on factors such as prior experience, ability to meet program goals, proposed services, and pricing. The contract term will be for three (3) years, with the option for up to three (3) additional one (1) year renewals. The anticipated implementation date is January 1, 2024. The current PPO program has approximately 79,000 enrollees, with an annual cost of $2.9 billion projected for fiscal year 2021-22.

The ITN does not mention any set-asides or restrictions on the types of organizations that can respond. The current TPA provider is not identified, and the ITN does not provide details on existing infrastructure or technology that requires integration. The ITN also does not specify a budget range or award value, but indicates the Department will select the responsive and responsible vendor(s) whose best and final offers are assessed as providing the best value to the State.