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Pharmacy Benefit Management (PBM) Integration Services

Active
State & Local

Contract Overview

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

General Info

Agency

Virginia → Human ResourcesView Agency

NAICS

541511 - Custom Computer Programming ServicesView NAICS

Place of Performance

VA, USA

Set-Aside

NONE

Documents

This scope was carved out of RFP 27-24.

The full solicitation package (26 documents), including the RFP, is on the prime solicitation, not on this scope.

View the prime solicitation

MEDICAL PLAN ADMINISTRATION

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Organization & Contact Information

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AgencyVirginia → Human Resources
ContactsNo contacts available
OfficeN/A
Organization / Agency
Virginia → Human Resources
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Office AddressN/A
ContactsNo contact information available

Full Description

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Coordinates data and clinical integration between medical plans and PBMs for prime contractors on City of Charlottesville medical plan projects. Exchanges eligibility and claim data using EDI 834/837 files and PBM integration APIs to synchronize deductibles and out-of-pocket accumulators per HIPAA standards. Delivers integrated pharmacy/medical reporting and synchronized member accumulators.

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POSTED

1 day ago

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in 4 days
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More opportunities from Virginia → Human Resources

Same awarding agency

NAICS: 524292
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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.
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NAICS: 524292
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