seven (7) days a week. The TPA has averaged handling nearly 200,000 provider calls per year on behalf of the Plan. The TPA is responsible for maintaining an automatic call distribution system capable of tracking and reporting phone activity for both participant and provider customer service toll-free numbers. The TPA is required to participate in activities with the Board in responding to participant or provider inquiries or complaints relating to TPA services. The TPA must cooperate with the Board and with all other contractors of the Board with respect to ongoing coordination and delivery of health care services and in any transition of responsibilities. The TPA is responsible for responding to inquiries from employer units concerning administrative procedures and benefits. Participant Mobile App The TPA should have a mobile app that enables participants to obtain important information from a mobile device. Information available through this app must include, but is not limited to, locating a provider, accessing a virtual ID Card, viewing benefit information, viewing claim formation, viewing prescription drug information, viewing articles on various health topics, updating phone number, and updating email address. Electronic Payment to Providers The TPA must provide a system capable of electronic deposit of funds for health care providers. Enrollment and Eligibility The TPA must provide a system for employer to view and maintain enrollment and eligibility information for the health insurance component of the Plan, as well as for the group term life insurance program provided by the Plan (See 3.27 below), for the more than 116,000 participating employees and their covered dependents. The 335+ employer units are primarily responsible for entering and maintaining enrollment changes in the TPA electronic system for their respective employees and dependents. The TPA is responsible for processing any allowed changes for the nearly 25,000 COBRA and retiree participants and any covered dependents. The TPA is responsible for verifying the eligibility for participants for benefits under the Plan based on the information provided by the employer units, participants, and DFA. The TPA will receive (primarily in electronic format) enrollment and eligibility information from the following unique groups: All Employer Units (approximately 335 State agencies, universities, community/junior colleges, libraries, and school districts) DFA-Office of Insurance (some initial retiree applications only) Mississippi Public Employees' Retirement System (PERS) Retirees (primarily paper format) COBRA participants (primarily paper format)
seven (7) days a week. The TPA has averaged handling nearly 200,000 provider calls per year on behalf of the Plan. The TPA is responsible for maintaining an automatic call distribution system capable of tracking and reporting phone activity for both participant and provider customer service toll-free numbers. The TPA is required to participate in activities with the Board in responding to participant or provider inquiries or complaints relating to TPA services. The TPA must cooperate with the Board and with all other contractors of the Board with respect to ongoing coordination and delivery of health care services and in any transition of responsibilities. The TPA is responsible for responding to inquiries from employer units concerning administrative procedures and benefits. Participant Mobile App The TPA should have a mobile app that enables participants to obtain important information from a mobile device. Information available through this app must include, but is not limited to, locating a provider, accessing a virtual ID Card, viewing benefit information, viewing claim formation, viewing prescription drug information, viewing articles on various health topics, updating phone number, and updating email address. Electronic Payment to Providers The TPA must provide a system capable of electronic deposit of funds for health care providers. Enrollment and Eligibility The TPA must provide a system for employer to view and maintain enrollment and eligibility information for the health insurance component of the Plan, as well as for the group term life insurance program provided by the Plan (See 3.27 below), for the more than 116,000 participating employees and their covered dependents. The 335+ employer units are primarily responsible for entering and maintaining enrollment changes in the TPA electronic system for their respective employees and dependents. The TPA is responsible for processing any allowed changes for the nearly 25,000 COBRA and retiree participants and any covered dependents. The TPA is responsible for verifying the eligibility for participants for benefits under the Plan based on the information provided by the employer units, participants, and DFA. The TPA will receive (primarily in electronic format) enrollment and eligibility information from the following unique groups: All Employer Units (approximately 335 State agencies, universities, community/junior colleges, libraries, and school districts) DFA-Office of Insurance (some initial retiree applications only) Mississippi Public Employees' Retirement System (PERS) Retirees (primarily paper format) COBRA participants (primarily paper format)
third-party-administrator-rfp-final.docx