Healthcare Claims Administration Services

This subcontract for Healthcare Claims Administration Services involves the processing and payment of medical claims for prime contractors supporting State of Ohio medical plan projects. The scope of work includes managing claims, issuing Explanations of Benefits, coordinating benefits, performing subrogation, and handling Medicare secondary payer claims. These services must be executed using specialized claims processing software across PPO, HDHP, and Select plan designs while maintaining strict HIPAA compliance and adherence to state-specific plan designs. The selected provider is responsible for delivering processed claims, EOBs, and TPA Monthly Financial Reports to the Administrative Services agency of Ohio. This opportunity is categorized under NAICS code 524292, with a response deadline set for November 13, 2026.