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
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.
