Third-Party Administrator for Ryan White Part B Program

Background
The Mississippi State Department of Health (MSDH) is soliciting bids for a Third-Party Administrator (TPA) for the Ryan White Part B Program. The program aims to provide medical and support services to individuals living with HIV/AIDS. The TPA will help manage the complexities of insurance benefits, pharmacy claims, rebate administration, and eligibility management, thereby optimizing program efficiency and improving health outcomes.

Work Details
The successful TPA will be responsible for:

1) Insurance Benefit Management including premium payments and claims processing;

2) Pharmacy Benefit Management ensuring accurate adjudication and coordination of benefits;

3) Rebate Administration handling invoicing and collections;

4) 340B Administration managing eligibility and compliance;

5) Reporting and Analytics generating monthly utilization reports;

6) Clinical Programs overseeing prior authorization and adherence support;

7) Eligibility Management coordinating with MSDH to verify client eligibility.

The contractor must also ensure secure online access for real-time tracking, manage provider enrollment, and implement client adherence programs.

Period of Performance
The contract will commence upon award and is expected to last for a period of 12 months, with potential renewals based on performance.

Place of Performance
All work will be performed at the contractor's office. The State will not provide workspace or reimburse travel costs.

Bidder Requirements
Bidders must be registered to do business in Mississippi, possess necessary licenses and certifications, demonstrate financial stability through audited financial statements, and have at least five years of relevant experience. Additionally, bidders must comply with all applicable laws, maintain professional liability insurance, and ensure their personnel adhere to state policies while on state property.