Request for Proposal for Pharmacy Benefit Management and Claims Administration Program
ID: 017-202407-KA
• State: California
Opportunity Assistant
Loading
Description
Background
The County of Orange is seeking proposals for a Pharmacy Benefit Management and Claims Administration Program to assist its Human Resources/Employee Benefits department. This RFP aims to select a contractor who can effectively meet the County's needs over a three-year contract, with two optional one-year renewal terms.
The County currently utilizes OptumRx as its Pharmacy Benefits Manager for its self-funded PPO health plans administered through Blue Shield of California, providing services to employees, retirees, and their dependents.
Work Details
The selected contractor will be responsible for providing comprehensive pharmacy claims administration services, including customer service, claims processing, and reporting. Key responsibilities include:
- Managing pharmacy benefits for the Sharewell and Wellwise health plans.
- Ensuring compliance with federal regulations such as the Affordable Care Act (ACA) and HIPAA.
- Collaborating with Alight Solutions LLC for eligibility verification and customer service.
- Providing high-quality customer service and industry-standard technologies.
- Implementing clinical guidance and best practices in claims administration.
- Handling eligibility inquiries and maintaining accurate records in coordination with Blue Shield of California.
Period of Performance
The contract will commence upon award and will last for three years, with the possibility of two additional one-year renewals.
Place of Performance
Services will be performed primarily within the County of Orange, California.
The County of Orange is seeking proposals for a Pharmacy Benefit Management and Claims Administration Program to assist its Human Resources/Employee Benefits department. This RFP aims to select a contractor who can effectively meet the County's needs over a three-year contract, with two optional one-year renewal terms.
The County currently utilizes OptumRx as its Pharmacy Benefits Manager for its self-funded PPO health plans administered through Blue Shield of California, providing services to employees, retirees, and their dependents.
Work Details
The selected contractor will be responsible for providing comprehensive pharmacy claims administration services, including customer service, claims processing, and reporting. Key responsibilities include:
- Managing pharmacy benefits for the Sharewell and Wellwise health plans.
- Ensuring compliance with federal regulations such as the Affordable Care Act (ACA) and HIPAA.
- Collaborating with Alight Solutions LLC for eligibility verification and customer service.
- Providing high-quality customer service and industry-standard technologies.
- Implementing clinical guidance and best practices in claims administration.
- Handling eligibility inquiries and maintaining accurate records in coordination with Blue Shield of California.
Period of Performance
The contract will commence upon award and will last for three years, with the possibility of two additional one-year renewals.
Place of Performance
Services will be performed primarily within the County of Orange, California.
Overview
Opportunity ID
017-202407-KA
Response Deadline
Feb. 13, 2025
Past Due
Date Posted
Jan. 7, 2025
Source
Est. Value Range
Experimental
$5,000,000 - $15,000,000
(AI estimate)
Agency Distribution
Moderate
On 1/7/25 County Executive Office - Human Resources in California issued Pharmacy Benefit Management and Claims Administration Program with ID 017-202407-KA due 2/13/25.
Contacts
Documents
Posted documents for Request for Proposal for Pharmacy Benefit Management and Claims Administration Program
Opportunity Assistant
AI Analysis
AI Generate