Texas County Seeks TPA Proposals

San Patricio County is seeking proposals for TPA services to be effective January 2021. San Patricio County was the first political subdivision in Texas to adopt Reference Based Pricing more than ten years ago.

The current program employs several cost saving strategies including cash-pay point-of-service, direct provider contracts, Reference Based Pricing, and medical bill review audits. The RFP incorporates an additional strategy – Primary Care centric benefit program.

Scope of Services:

☐ Health Plan Administrative Services

☐ Dental Plan Administrative Services

☐ Pharmacy Benefit Management

☐ Reference Based Pricing Administrative Services

☐ Claim Repricing

☐ Patient Advocacy

☐ Legal Defense & Indemnification

NOTEThe county is not seeking stop loss insurance quotes
The County is seeking a highly qualified and experienced TPA that will provide backroom support to meet the County’s six major objectives:

1) Flexible and accurate claims processing,

2) Ability to access and own data/timely and actionable reporting in real time,

3) Provide direct provider contracting,

4) Coordinate unbundled administrative functions among vendors of the County’s choosing,

5) Administer and/or coordinate Reference Based Pricing plan strategies, and

6) Provide the tools, technology and management necessary towards establishing a Primary Care centric health plan option in 2021.

For additional information and the RFP package contact the County Auditor’s office 361.364.9317 or write to Alonzo.arce@co.san-patricio.tx.us or RiskManager@RiskManagers.us