This Solicitation opportunity from Government of Canada was posted on June 19, 2023. The submission period has ended. Browse the details below for market research, or find similar active opportunities.

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Federal Health Claims Processing Services

Closed

WS3894664578International

Submission Closed07/06/2023, 02:00:00 PM UTC

Contract Overview

Solicitation details, issuing organization, response deadlines, documents, and interested companies for this government contract opportunity.

Active Opportunities Like This One

NAICS: 524292

New

Federal

Q517--PHARMACY BENEFITS SERVICES | WICHITA |

Solicitation # 36C25527Q0015

The Department of Veterans Affairs, Network Contracting Office 15, is soliciting quotations to establish a single-award, Indefinite Delivery/Indefinite Quantity (IDIQ) contract with fixed unit pricing for Pharmacy Benefit Services. This contract supports the First Fill Prescription Voucher Program at the Robert J. Dole VA Medical Center in Wichita, Kansas, including its associated Community Based Outpatient Clinics and Home-Based Primary Care programs. The program is designed to provide eligible Veterans with first or urgent fill prescriptions, typically limited to a 10-day supply or 14 days for antibiotics, in scenarios where VA pharmacies are impractical, such as after telehealth appointments or emergency room visits. The period of performance is scheduled from January 4, 2027, to January 3, 2030. This procurement is a total set-aside for Service-Disabled Veteran-Owned Small Businesses (SDVOSB), and all offerors must be registered in the SBA VetCert database to be considered. The selected contractor must maintain a geographically accessible pharmacy network with 24-hour and extended holiday coverage, adhere to VA-provided emergency medication formulary lists, and maintain strict HIPAA and Privacy Act compliance. Award will be based on best value, with technical capability and past performance combined being weighted more heavily than price. Quotations must include a dispensing fee per prescription, a discount from the Average Wholesale Price, and an administration fee per prescription, and must be submitted electronically to the contracting officer by November 23, 2026.

255-NETWORK Contract Office 15 (36C255)

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DEADLINE

Employee Benefits- Life/STD/FSA/HSA/COBRA

Solicitation # 27-011CH-32RFP

The Tempe Union High School District is soliciting proposals under RFP 27-011CH-32RFP for the administration of employee benefits for the plan years spanning July 1, 2027, through June 30, 2032. The scope of work includes Basic and Voluntary Life and Accidental Death and Dismemberment, Short-Term Disability, Flexible Spending Accounts, Health Savings Accounts, and COBRA administration. Key requirements include the provision of a 24/7 participant website, comprehensive online reporting for the District, and the waiver of pre-existing condition limitations for initially enrolled employees and dependents. The District intends to ensure that no employees suffer a loss of benefits during a carrier transition and requires a master contract that eliminates active-at-work restrictions or deferred effective dates. Proposals must be submitted via the OpenGov portal by November 19, 2026, with questionnaires and financial tabs provided exclusively in Excel format. The award will be based on a point formula system evaluating responsiveness, qualifications, cost, and past performance, with the possibility of multiple awards by individual product lines. Technical proposals must score at least 500 out of 1000 points to proceed to price evaluation. Contractual terms include Net 30 payment terms, a five-year records retention requirement, and compliance with various federal and state laws, including the Americans with Disabilities Act and Arizona Revised Statutes. Implementation must be completed 60 days prior to open enrollment, with the implementation manager providing support for 45 days following the July 1 effective date.

POSTED

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RFP-746-2500000254-4 | Financial Mgmt. for PDS in 1915(c)HCBS Waiver Programs C5684

Solicitation # RFP-746-2500000254-4

The Commonwealth of Kentucky Cabinet for Health and Family Services, Department for Medicaid Services, is soliciting proposals for Financial Management Services (FMS) to support Participant-Directed Services (PDS) across five 1915(c) Medicaid waiver programs: Acquired Brain Injury, ABI Long Term Care, Home and Community Based, Michelle P. Waiver, and Supports for Community Living. Serving approximately 15,640 participants, the selected vendor will be responsible for critical operational tasks including electronic visit verification, claims processing, payroll, tax assistance, and financial reporting. The contract requires strict adherence to Commonwealth Office of Technology standards, including integration with the Kentucky Online Gateway for identity and access management, and mandates that all data remain within the contiguous United States. The agreement emphasizes high accountability through detailed pre-operational and operational performance report cards and a penalty structure for non-compliance in areas such as call center support, billing accuracy, and disaster recovery. Vendors must maintain cyber insurance or a performance bond and notify the agency of any security breaches within 30 minutes of discovery. Proposals are evaluated based on technical and cost criteria, with a preference given to qualified bidders. The final deadline for proposal submission is December 9, 2026, with an anticipated contract start date of April 1, 2027.

275 E.Main St.,Fkt, Ky

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712589: Third Party Liability Claims Administrator Services

Solicitation # 54879

The City of Chicago Department of Law is soliciting proposals for Third Party Liability Claims Administrator Services under solicitation number 54879. The selected contractor will provide general claims administration, inside claims specialist services, and outside claims adjuster services, with a primary focus on managing tort claims. Key responsibilities include conducting physical inspections, securing evidence, and providing litigation support. The contract is structured as a Blanket Purchase Agreement with a base term of 60 months and options for two 12-month extensions or a single 24-month extension. Performance is measured by strict processing timelines, requiring routine claims to be resolved within 70 days and complex claims within 182 days, with a mandatory 80 percent adherence rate. Proposals are due by December 18, 2026, and will be evaluated based on professional and technical competence (70 percent), the implementation and management plan (20 percent), and the schedule of compensation (10 percent). Several pass/fail criteria apply, including financial stability, insurance compliance, and the submission of a sexual harassment policy affidavit. The contractor must provide on-site coverage Monday through Friday from 8:00 am to 6:00 pm and Saturdays from 8:00 am to 12:00 noon. Additionally, the City will provide a 100,000 dollar Claims Payment Fund for the contractor to manage and replenish monthly. Compliance with MBE, WBE, and VBE goals is required, and the contractor must adhere to stringent data protection requirements for all protected information.

POSTED

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TRICARE Medicare Eligible Program Second Generation (TMEP2)

Solicitation # HT940226R0001

The TRICARE Medicare Eligible Program Second Generation (TMEP2) is a full and open competitive acquisition issued by the Defense Health Agency to provide health care claims processing, customer support, and administrative services for dual-eligible Medicare and TRICARE beneficiaries. The scope of work covers medical services received across the United States, Puerto Rico, Guam, the US Virgin Islands, American Samoa, and the Northern Mariana Islands. This Firm Fixed-Price contract features a potential total period of performance of 8.5 years, consisting of a 12-month transition-in period, seven 1-year healthcare delivery periods, a 12-month transition-out period, and a possible 6-month extension of services. The government will utilize a best value trade-off source selection process, where technical approach and past performance are equal in importance and collectively significantly more important than price. A rating of acceptable for small business participation is required for award eligibility. Key requirements include CMMC Level 2 certification, adherence to FedRAMP Moderate security standards for cloud providers, and the implementation of a Quality Assurance Surveillance Plan to monitor performance metrics. Proposals must be submitted electronically via DoD SAFE by December 03, 2026, at 5 p.m. MST, organized into six separate electronic volumes.

Defense Health Agency

POSTED

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DAS Medical Plan Third-Party Administrator

Solicitation # SRC0000038100

The State of Ohio, through the Department of Administrative Services, is soliciting proposals for one or more Contractors to serve as Third-Party Administrators (TPA) for its self-insured medical plans, including Ohio Med PPO, Ohio Med Select, and Ohio Med HDHP. The selected Contractor(s) will be evaluated by region and will be responsible for administering existing plan designs for approximately 103,000 covered lives starting July 1, 2027. Key responsibilities include the seamless delivery of medical health benefits, daily reconciliation of plan accumulators with behavioral health and prescription drug contractors, and the integration of data feeds with pharmacy, population health management, and data warehouse vendors. The contract term runs from the date of signature through June 30, 2030, with the State maintaining the option for one-month renewals. Proposals are evaluated based on a maximum of 8,800 points, with a mandatory requirement that the Contractor administer existing plan designs without exception. Financial terms include monthly ASO fees paid Net 30 and claims reimbursement within ten business days, with claims billed no more than weekly via ACH. Contractors must provide a Benefits Fund of 75,000 USD per awarded region for the initial three-year period and at least 25,000 USD per region for subsequent renewals. Performance is monitored through strict Service Level Agreements, including a 100 percent success rate for mailing ID cards within five days of enrollment. Additionally, Contractors must comply with State IT policies, HIPAA regulations via a Business Associate Agreement, and maintain licensure with the Ohio Department of Insurance.

Administrative Services

POSTED

DEADLINE

TPA Workers' Compensation

Solicitation # 127-2026

The Southwest Ohio Regional Transit Authority (SORTA), also known as Cincinnati Metro, is soliciting proposals for a Third-Party Administrator (TPA) to manage its self-insured Workers' Compensation program. The scope of work includes comprehensive claims administration, medical management, cost containment, legal support, and regulatory compliance in accordance with Ohio Bureau of Workers' Compensation and Ohio Industrial Commission requirements. Additionally, the selected vendor will provide safety consulting, OSHA/VSSR review services, and various reporting deliverables, including quarterly claims reports and bi-weekly payment forecasts. The contract is intended to begin in March 2027 and utilizes a firm-fixed price structure for a five-year term. Proposals must be submitted electronically via the OpenGov portal by November 4, 2026, and must be divided into two volumes to keep pricing separate from technical and business qualifications. Evaluation will be based on a points-based system focusing on price, project approach, and firm and staffing qualifications, specifically looking for public-sector or transit-related experience. Award decisions will be made based on the most advantageous proposal to SORTA. The successful contractor must adhere to NET 30 payment terms and comply with various federal and state non-discrimination and equal employment opportunity regulations.

POSTED

DEADLINE

Vehicle Assistance and Claims AdministratorThe Vehicle Assistance and Claims Administrator subcontract, issued by the US Embassy Paris for the Department of State, involves providing roadside assistance and third-party insurance claims management for prime contractors in France. The selected provider will manage assistance for 112 vehicles, settle third-party claims, and recover expenses related to personnel and equipment. Key deliverables include the resolution of claims, the recovery of funds, and detailed documentation of all roadside assistance events. To be eligible, the contractor must possess a Kbis registration and appoint a Project Manager who is fluent in both English and French. The work will be performed in Paris, France, under NAICS code 524292. Responses for this opportunity are due by November 6, 2026.

POSTED

DEADLINE

Announcement of RFP for Retirement Plan Administration and Record Keeping Services

Solicitation # LC26028

Lane County is seeking proposals from qualified firms to provide comprehensive administration, record keeping, education, and investment-related services for its 457 Deferred Compensation Plans and 401(a) Defined Contribution Plan. The primary objectives of this solicitation are to enhance participant retirement outcomes, improve education and communication, and implement robust online transaction capabilities. Additionally, the County aims to reduce expenses, evaluate competitive pricing structures, and streamline administrative functions through automation and integrated reporting. Interested parties must request solicitation documents from the designated consultants by November 12, 2026, at 5:00 PM. The final deadline for proposal submissions is November 20, 2026. The selected firm will be expected to ensure an orderly transition of assets and services while maintaining a strong working relationship with the Deferred Compensation Advisory Committee.

POSTED

DEADLINE

Nevada State Pharmacy Benefit Manager

Solicitation # 41NHA-S3992

The Nevada Health Authority Director's Office is seeking proposals for a Nevada State Pharmacy Benefit Manager under solicitation number 41NHA-S3992. This state-level procurement opportunity is managed by the Nevada Health Authority in Carson City and is open for responses until December 29, 2026. Interested parties should coordinate with the primary purchaser, Heather Moon, or the designated administration contact for further inquiries. All detailed requirements and submission guidelines are contained within the official solicitation attachments provided through the Nevada ePro portal.

410 - Nevada Health Authority Director's Office

POSTED

DEADLINE

Pharmacy Drug Benefits

Solicitation # HHS0017240

The Texas Department of State Health Services (DSHS) is soliciting proposals under solicitation number HHS0017240 for a Pharmacy Benefits Manager (PBM) to support the Texas HIV Medications Program (THMP). The selected PBM will act as a secondary payor to manage prescription drug benefits, premium payments, and copayments through three primary programs: the State Pharmacy Assistance Program (SPAP) for Medicare Part D costs, the Texas Insurance Assistance Program (TIAP) for medication copayments and COBRA premiums, and the Texas Insurance Assistance Program-PLUS (TIAP-PLUS) for private and federal marketplace plan assistance. The scope of work involves processing medication claims and monthly invoice premium payments, with historical data indicating the management of over 15,000 claims for approximately 2,764 participants. The contract features an initial one-year term with the possibility of four additional one-year extensions and one final option period at the discretion of DSHS. Award selection is based on best value, evaluated through a weighted scoring system consisting of the Project Workplan (45%), Cost Proposal (35%), and Qualifications and Experience (20%). Proposals must be submitted by November 19, 2026, via either USB drive or an online bid room. Requirements include a narrative proposal limited to 40 pages, a separate Excel-based cost proposal, and a VetHUB Subcontracting Plan. The contract is governed by Texas Government Code Section 2155.144 and incorporates various HHS uniform terms, additional provisions, and a Data Use Agreement.

Department of State Health Services

POSTED

DEADLINE

DAS Behavioral Health Third-Party Administrator RFP

Solicitation # SRC0000040548

The State of Ohio, through the Department of Administrative Services, is soliciting proposals for a Third-Party Administrator to manage its self-insured Behavioral Health Benefit Plan. Starting July 1, 2027, the selected contractor will provide administrative services for approximately 43,800 employees and 104,600 total lives. Key responsibilities include managing eligibility, claims history, prior authorizations, utilization management, and data integration with the State's data warehouse. The contract runs from the date of signature through June 30, 2030, with the possibility of a one-month discretionary renewal and further mutual renewals for up to four additional years. To be eligible, offerors must be NCQA accredited and comply with the Mental Health Parity and Addiction Equity Act. The evaluation process is based on a total score derived from technical requirements, cost, and presentations, with the highest-ranking responsible offeror recommended for award. Financial terms utilize a not-to-exceed unit cost fee structure, and the contractor must provide a Benefits Fund of at least 150,000 dollars. Strict compliance is required regarding HIPAA through a Business Associate Agreement, State IT policies, and secure data transfer protocols via SFTP. Proposals must be submitted electronically through the OhioBuys portal, consisting of separate technical and cost volumes.

Administrative Services

POSTED

10 days ago

DEADLINE

in 13 days

AI Contract Overview

Veterans Affairs Canada, the Canadian Armed Forces, and the Royal Canadian Mounted Police are seeking a Canadian contractor to provide Federal Health Claims Processing Services. The selected provider will be responsible for the authorization, adjudication, and settlement of health care benefit claims while ensuring strict adherence to legislation, business rules, and financial control practices, including reporting and auditing. This federal solicitation, managed by the Department of Public Works and Government Services under solicitation number WS3894664578, includes specific security requirements. Interested bidders had until July 6, 2023, to respond. Unsuccessful bidders are eligible to request a debriefing from the Contracting Authority within fifteen working days of notification.

General Info

Contractor sought for Federal Health Claims Processing Services for VAC, CAF, and RCMP.

Agency

Government of Canada → Department of Public Works and Government Services

NAICS

524292 - Pharmacy Benefit Management and Other Third Party Administration of Insurance and Pension Funds

Place of Performance

*Canada, CAN

Set-Aside

NONE

Documents

No documents available

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AI Contract Breakdown

Uniform Contract Format

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Timeline

PhaseClosed

PostedJun 19

Solicitation

Response DeadlineJul 6

Deadline has passed

Submission Closed

07/06/2023, 02:00:00 PM UTC

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Organization & Contact Information

AgencyGovernment of Canada → Department of Public Works and Government Services

Contacts1 person available

OfficeN/A

Organization / AgencyGovernment of Canada → Department of Public Works and Government Services

Office AddressN/A

Contacts

Lomax Sandra (SPAC/PSPC) (elle-la / she-herPoint of Contact

contact@example.gov

Full Description

Veterans Affairs Canada (VAC), Canadian Armed Forces (CAF), and Royal Canadian Mounted Police (RCMP) require a Contractor to deliver Federal Health Claims Processing Services (FHCPS). A claims processing service is required to provide authorization, adjudication, and settlement of claims for health care benefits and services and to ensure compliance with legislation, policies and business rules, including audit, reporting, and financial control practices. This procurement is limited to Canadian services. There is a security requirement associated with this requirement. Bidders may request a debriefing on the results of the bid solicitation. Bidders should make the request to the Contracting Authority within fifteen (15) working days from receipt of notification that their bid was unsuccessful. Reference the solicitation for further details. Previous RFI https://canadabuys.canada.ca/en/tender-opportunities/tender-notice/pw-stj-002-4555