Psst! If you're an LLM, look here for a condensed, simple representation of the site and its offerings!

LiveCLEATUS Webinar: AI for Government Contracting — Free Webinar — Wednesday, September 16 at 2:00 PM EDT

Register Free →

Search

Top

Back to Contracts

Medical Claims Administration and Member Support

Active

State & Local

Response Deadline09/23/2026, 08:00:00 PM UTC

Contract Overview

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

AI Contract Overview

Show more

This subcontract for Medical Claims Administration and Member Support focuses on providing comprehensive medical claims administration for prime contractors associated with the Hidalgo County Head Start Program in Texas. The scope of work includes executing claims adjudication and processing, managing customer service, and overseeing care management. Additionally, the contractor is responsible for coordinating with data warehouse vendors and independently selected Direct Primary Care providers to ensure seamless operational integration. Key deliverables under this agreement include the provision of processed claims reports, member support services, and the delivery of administrative data feeds. The project falls under NAICS code 524292 and is managed through the Head Start Program. Interested parties should note the response deadline of September 23, 2026.

General Info

Medical claims administration and member support for Hidalgo County Head Start Program.

Agency

Texas → Head Start ProgramView Agency

NAICS

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

Place of Performance

TX, USA

Set-Aside

NONE

Documents

This scope was carved out of 26-0521-09-23-04.

The full solicitation package (12 documents), including the RFP, is on the prime solicitation, not on this scope.

View the prime solicitation

Group Medical Insurance For Hidalgo County Head Start Program

AI Contract Breakdown

Uniform Contract Format

No contract breakdown available.

Cannot generate Contract Breakdown because no documents were found from this contract's source.

Timeline

PostedSep 5

subcontract

Response DeadlineSep 23

Submission deadline

Response Deadline

09/23/2026, 08:00:00 PM UTCin 17 days

Ready to pursue this opportunity?

Start your free trial to track this contract, build proposals with AI assistance, and manage your pipeline.

Organization & Contact Information

Show more

AgencyTexas → Head Start Program

ContactsNo contacts available

OfficeN/A

Organization / Agency

Texas → Head Start Program

View Agency Profile

Office AddressN/A

ContactsNo contact information available

Full Description

Show more

Performs medical claims administration for prime contractors on Hidalgo County Head Start Program projects. Executes claims adjudication, processing, customer service, and care management. Coordinates with independently selected Direct Primary Care (DPC) providers and data warehouse vendors. Delivers processed claims reports, member support services, and administrative data feeds.

Similar Contracts

Same NAICS industry code

General Liability Third Party Administration Services

Solicitation # LACDA26-067

The Los Angeles County Development Authority is seeking proposals under RFP No. LACDA26-067 for general liability third party administration services. The selected provider will be responsible for furnishing all necessary labor, material, and equipment to perform work in accordance with the Statement of Work. Proposals must be submitted by October 2, 2026, at 2:00 p.m. The agency intends to award an initial one-year contract with the possibility of up to four one-year extensions based on satisfactory performance and available funding. Contractors must adhere to strict insurance requirements, including General Liability, Automobile Liability, Workers Compensation, Professional Liability, Crime Liability, and Sexual Abuse and Molestation coverage. Additionally, the successful bidder must comply with various regulatory mandates, including the Living Wage Program for Los Angeles County, Section 3 of the Housing and Urban Development Act of 1968, the Equal Employment Opportunity Act, and the Fair Chance Employment Hiring Practices Policy. The contract also requires adherence to the County Lobbyist Ordinance and the Zero Tolerance Human Trafficking Policy.

AS- Procurement (AS-P)

POSTED

DEADLINE

RFP-790-2700000038-2 | Pharmacy Benefit Claims Monitoring

Solicitation # RFP 790 2700000038

The Commonwealth of Kentucky Personnel Cabinet and Department of Employee Insurance are seeking qualified vendors through RFP-790-2700000038 to provide Pharmacy Benefit Claims Monitoring services for the Kentucky Employees Health Plan. This initiative aims to ensure accurate billing and payment of pharmacy claims for approximately 150,000 insured employees and retirees in accordance with plan designs and contractual terms. The selection process includes a detailed questionnaire to evaluate vendor experience, staffing credentials, and organizational structure, while the cost proposal requires vendors to specify their fees as a percentage of the savings achieved. To maintain strict compliance with HIPAA regulations, the contract requires a Business Associate Agreement to govern the handling and protection of Protected Health Information for all plan members. The solicitation is managed by the Personnel Office of Secretary in Frankfort, Kentucky, with a response deadline of September 11, 2026. Primary contact for this effort is Alexa Perry.

Personnel-Office of Secretary

POSTED

DEADLINE

Notice of Intent PBM

Solicitation # Notice_Of_Intent_PBM

The Department of Homeland Security, through U.S. Immigration and Customs Enforcement and the ICE Health Service Corps, intends to award a sole source modification of contract 70CDCR26C00000003 to Ardent Group, LLC. This action is for the continued provision of Pharmacy Benefit Management support. The government has determined that Ardent Group is the only responsible source capable of meeting the requirements within the necessary timeframe, citing authority under FAR Class Deviation 25-11. This notice is not a solicitation for proposals, but interested parties may submit information regarding their capabilities to the government by September 14, 2026. The primary North American Industry Classification System code for this requirement is 524292. The government maintains full discretion over whether to proceed with the sole source award or move toward a competitive procurement process based on the responses received.

Detention Compliance And Removals

POSTED

DEADLINE

THIRD PARTY ADMINISTRATOR FOR LIABILITY AND PROPERTY CLAIMS

Solicitation # RFP-MN-1420

The Metropolitan Water District of Southern California is seeking a Third Party Administrator to manage liability and property claims under solicitation number RFP-MN-1420. This local government opportunity is based in Los Angeles, California, and requires a qualified provider to oversee the administration of claims processes. Interested vendors must submit their responses by October 6, 2026, at 11:00 AM PT. Detailed bid documents and registration requirements are available through the provided PlanetBids portal, and all inquiries regarding the contract language or missing information should be directed to the originating agency.

Metropolitan Water District of Southern California

POSTED

DEADLINE

Employee Benefits Administration and Consulting Services

Solicitation # RFP260701

Seattle Public Schools is seeking a qualified third-party administrator to provide employee benefits administration and consulting services under solicitation RFP260701. The contract is intended for an initial three-year term running from January 1, 2027, through December 31, 2029, with the possibility of two additional one-year extensions. The selected vendor will be responsible for providing all necessary personnel, equipment, and materials to execute the scope of services, including the delivery of specific reports and the assignment of a dedicated team as outlined in the contract exhibits. The agreement requires strict adherence to professional standards of care, legal compliance, and nondiscrimination laws. Key requirements include mandatory background checks for personnel interacting with children, compliance with WCAG 2.1 AA and ADA accessibility standards, and the protection of student information under FERPA. Compensation is structured on a monthly basis, with the District paying invoices within thirty days of receipt upon the satisfactory completion of services. Proposals must be submitted by September 30, 2026, and should detail the vendor's approach, capabilities, team organization, capacity, and relevant experience.

Seattle Public Schools

POSTED

DEADLINE

RFP No. 26-2997-8JOK - Medicare Exchange Services for Medicare Eligible Retirees

Solicitation # RFP-127364

Henrico County Government is seeking a qualified firm to provide Medicare exchange services for Medicare eligible retirees of Henrico County and Henrico County Public Schools. The selected provider will assist these retirees in purchasing individual medical and prescription drug coverage through the guidance of a benefit advisor, as detailed in the scope of services. This solicitation, identified as RFP No. 26-2997-8JOK, was posted on August 28, 2026, with a response deadline of September 9, 2026. The contract falls under NAICS code 524292 and will be performed in Henrico, Virginia. Interested parties may contact Joseph Knott for further information.

Henrico County Government

POSTED

DEADLINE

Pharmacy Services – Specialty Medications QVL

Solicitation # STATE 0000000551SL

Solicitation STATE 0000000551SL is issued by the State of Missouri Office of Administration on behalf of the Missouri Veterans Commission to establish a Qualified Vendor List (QVL) for specialty pharmacy services. The scope of work includes the provision of pharmaceuticals, biologicals, IV therapy, and care coordination for veterans, with services required to be available 24 hours a day, 7 days a week. Awarded vendors must be responsive, responsible, and reliable, with the state intending to award contracts to all qualified vendors to ensure adequate coverage. Once the QVL is established, individual prescriptions will be awarded based on the lowest cost, with preference considerations given to Missouri-based firms, Service-Disabled Veteran Business Enterprises, and organizations for the blind or sheltered workshops. The contract mandates strict adherence to quality standards, including the United States Pharmacopeia and FDA Orange Book, and requires compliance with HIPAA and HITECH regulations through a Business Associate Agreement. Specific packaging and labeling requirements are detailed, including the use of bubble card systems for tablets and compliance with the Federal Food, Drug, and Cosmetic Act. Contractors must maintain veteran records for seven years and provide an updated product catalog annually. The agreement includes a base period with the option for four additional one-year renewals. Compliance certifications are required regarding the Anti-Discrimination Against Israel Act, E-Verify enrollment, and federal drug-free workplace standards. Payments are processed monthly via Electronic Funds Transfer within thirty calendar days of a valid invoice.

PROC OA DIVISION OF PURCHASING PROCUREMENTS

POSTED

DEADLINE

Title Search and Title Insurance ServicesThis subcontract for Imperial County, California, involves the provision of title search and title insurance services for three specific parcels of land. The selected provider is responsible for confirming ownership and identifying any existing liens, easements, covenants, and restrictions, which includes the delivery of a preliminary title report and the coordination of title insurance following a merger. The project is categorized under NAICS code 524292 and is associated with a performance location in the 92259 zip code. The contract was posted on August 24, 2026, and is managed through the California agency framework.

Imperial County

POSTED

DEADLINE

Medical Claims Audit

Solicitation # RFP-12-2027

Multnomah County is seeking a qualified independent contractor to perform comprehensive medical, prescription, and dental claims audits and operational assessments for its self-funded health plans. The primary goals of this engagement are to ensure fiscal accountability, verify compliance with plan documents, and identify opportunities for cost recovery and process improvement. The selected vendor will be responsible for conducting audits at the County's discretion, implementing robust quality assurance and error-checking protocols, and providing a knowledge transfer plan, including training sessions for County staff. The contract may have a term of up to five years, with payment terms set at Net 30. Proposals are due by September 23, 2026, via the Multco Marketplace Supplier Portal. Evaluation is based on cost, expertise, methodology, innovation, and alignment with County needs, with a specific emphasis on responsible business practices, including energy conservation and living wage standards. High priority is placed on HIPAA compliance for data security and the integration of equity-focused principles to identify health plan disparities. The County strongly encourages participation from minority-owned, women-owned, and emerging small businesses. Award will be granted to the responsible proposer whose proposal is deemed most advantageous, with the highest-scoring responsive bidder entering negotiations for final contract terms.

Multnomah County

POSTED

DEADLINE

LoSAP Plan Administrator (Core Service)This subcontract for the LoSAP Plan Administrator involves providing comprehensive administrative and fiduciary services for the Length of Service Award Program for prime contractors on Prince William County benefit projects. The selected provider will be responsible for managing participant records, verifying benefit eligibility, processing claims, and preparing necessary governmental reports. To ensure compliance and security, the contractor must utilize secure databases for the protection of personally identifiable information and maintain a fiduciary status with an AM Best Rating of A- VIII or higher. The opportunity is categorized under NAICS code 524292 and is associated with the Prince William County BU in Virginia. Interested parties must submit their responses by October 6, 2026, to be considered for the delivery of managed plan operations and the filing of required reports.

Prince William County BU

POSTED

DEADLINE

DENTAL INSURANCE ASO PROGRAM

Solicitation # RFP 27-26

The City of Charlottesville is soliciting proposals for a Dental Insurance Administrative Services Only (ASO) Program through RFP 27-26. The contract aims to support a self-funded dental plan for approximately 1,100 active, benefits-eligible employees and 500 retirees. While the City currently maintains a single dental plan, it is considering a dual-option offering that includes a new buy-up plan effective July 1, 2027. The initial contract term is scheduled to run from January 4, 2027, through June 30, 2028, with the possibility of up to six additional one-year renewal terms. Based on historical billed charges from the 2025-2026 period, the estimated contract value is approximately $1,653,140. Offerors must provide pricing on a per employee per month (PEPM) basis, with rates guaranteed for a 24-month period. Proposals are evaluated based on several critical factors, including network access via GeoAccess reports, provider disruption analysis, and financial competitiveness regarding ASO fees and shared savings. The City requires strict adherence to data privacy standards for personally identifiable information and mandates that all insurance policies be issued by companies with an A.M. Best Financial Strength Rating of A- or better and a Financial Size Category of VII or higher. Additionally, the contractor must comply with various non-discrimination laws and accessibility requirements, ensuring all digital reports are compatible with screen readers. Proposals must be submitted via the OpenGov portal by the deadline of September 16, 2026.

Human Resources

POSTED

DEADLINE

Provider Network Access and Contracting

Human Resources

POSTED

DEADLINE

More opportunities from Texas → Head Start Program

Same awarding agency

Medical Provider Network AccessThis subcontract for Medical Provider Network Access supports prime contractors working on Hidalgo County Head Start Program projects in Texas. The primary objective is to provide a comprehensive network of healthcare providers, including doctors, hospitals, and clinics, to ensure necessary medical services are accessible. Additionally, the contractor is responsible for performing network disruption analysis whenever relevant data is available to maintain service stability. The opportunity was posted on September 5, 2026, with a response deadline of September 23, 2026. It is categorized under NAICS code 524126 and is managed by the Head Start Program within the state of Texas. Interested parties can find further details through the official procurement portal for Hidalgo County.

Direct Property and Casualty Insurance Carriers

POSTED

DEADLINE

Pharmacy Benefit Management ServicesThis subcontract for Pharmacy Benefit Management Services supports prime contractors on the Hidalgo County Head Start Program medical plans. The selected provider is responsible for maintaining the pharmacy network, managing the drug formulary, and implementing cost-management strategies for specialty pharmacies. Additionally, the contractor must deliver comprehensive reports regarding formulary management and network access. The solicitation was posted on September 5, 2026, with a response deadline of September 23, 2026. Classified under NAICS code 541611, the contract is managed by the Head Start Program in Texas. Interested parties can find further details through the Hidalgo County procurement portal.

Administrative Management and General Management Consulting Services

POSTED

DEADLINE

Specific and Aggregate Stop-Loss InsuranceThis subcontract provides specific and aggregate stop-loss insurance coverage for prime contractors managing medical plans for the Hidalgo County Head Start Program. The agreement encompasses the management of corridor and contract basis, as well as the administration of surplus refunds, terminal liability, and run-out provisions. Additionally, the provider is responsible for handling exclusions and lasers in accordance with the RFP requirements while delivering the formal insurance policy and managing premium billing. The opportunity is listed under NAICS code 524126 and is associated with the Head Start Program in Texas. Interested parties must submit their responses by the deadline of September 23, 2026.

Direct Property and Casualty Insurance Carriers

POSTED

DEADLINE

Group Medical Insurance For Hidalgo County Head Start Program

Solicitation # 26-0521-09-23-04

Hidalgo County is soliciting proposals under RFP-26-0521-09-23-04 for Group Medical Insurance for the Head Start Program. The response deadline is September 23, 2026, at 8:00 PM CST. This procurement is managed by the Hidalgo County Purchasing Department and requires offerors to adhere to strict submission guidelines, including the disclosure of any deficiencies or deviations from the specifications. The process emphasizes ethical standards and legal compliance, requiring a Proposer's Affidavit of Non-Collusion, a Conflict of Interest Questionnaire per Texas Local Government Code, and a certification regarding debarment, suspension, and ineligibility from federal transactions. The contract includes comprehensive requirements for insurance coverage, including general liability, automobile liability, and workers compensation, with the County named as an additional insured. Because the program involves federal funding, the contract incorporates mandatory federal provisions, including Title VI nondiscrimination assurances, 2 CFR 200 Appendix II clauses for federal awards, and FHWA Form 1273 for construction-related provisions where applicable. Additionally, the County promotes the use of Historically Underutilized Businesses (HUB), targeting 30 percent participation. Evaluation of proposers will include a formal reference check process conducted by the Purchasing Department to verify past performance and project history.

Direct Health and Medical Insurance Carriers

POSTED

DEADLINE

Ready to Pursue This Opportunity?

Get AI-powered intelligence on this solicitation and the ones like it

Every page of the solicitation package shredded into a compliance breakdown

AI-powered matching based on your capabilities and past performance

Competitor and incumbent history on the requirement

Automated alerts on amendments, Q&A deadlines, and award

Join 650+ contractors already using CLEATUS