RFP 26-020 Third Party Administration and Stop Loss

R P
EQUEST FOR ROPOSAL
Third Party Administration
& Stop Loss
Medical Benefit Coverage
RFP# 26-020
Russellville Arkansas
Advisors:
Tom Kane, Executive Vice President, - Tom.Kane@stephens.com
Tyler Runnells, Senior Vice President - Tyler.runnells@stephens.com
Stephens Insurance, LLC
111 Center Street
Little Rock, AR 72201
May 8, 2026

Table of Contents
SECTION PAGE
I. Overview 3
II. General Information Questionnaire 7
III. Claims Processing/Eligibility & Enrollment/Customer 8
Service Questionnaire
IV. Utilization Management Questionnaire 18
V. Disease Management Questionnaire 21
VI. Miscellaneous Questions 26
EXHIBITS
A. Preferred Contractual Provisions 28
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I. OVERVIEW
Arkansas Tech University is a state university established in 1909 with programs at the technical
certification, associate, baccalaureate and graduate levels. The University has campuses in Russellville,
Arkansas, and Ozark, Arkansas. The institution also operates Arkansas Tech Career Center (ATCC), a
career and technical training initiative headquartered in Russellville with satellite locations at Clarksville,
Danville, Ozark and Paris.
ATU Russellville-Offers 120 undergraduate degree programs and more than 25graduate degree options.
ATCC-Serves over 1,000 students from 19 school districts across 9 program areas.
ATU Ozark-Serves over 2,100 students in 29 technical and associate programs.
ATU has approximately 780 full-time employees located on three campuses -Russellville, Ozark and the
Arkansas Tech Career Center (ATCC). ATU also provides benefits to pre-65 Retirees and post-65 Retirees.
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ATU currently offers the following benefit programs:
* Fully Insured Medical
* Dental
* Vision
* Basic and Voluntary Group Term Life
* Voluntary Short Term and Long Term Disability
* Critical Care with Cancer
* Accident
* Section 125 (HSA and FSA)
B. REQUEST FOR PROPOSAL
ATU is respectfully requesting proposals for TPA Services to include the following effective January 1,
2027:
* Self-funded medical plan claims processing
* Utilization management
* Large case management
* Disease management
* Re-Insurance (Stop Loss)
* Reference Based Pricing
* Prescription Drug Management - Integrated and carved out
C. CONSULTANT
Stephens Insurance, LLC was retained to provide consulting services for ATU. There should be no
commissions or any other compensation paid to brokers, agents, or consultants included in your proposed
fees for any products quoted.
D. QUESTIONS
Please address all questions regarding this request for proposal to:
Tyler Runnells Adam Ritchie
Phone: 501-377-2093 OR Phone: 501-377-8415
E-mail: tyler.runnells@stephens.com E-mail: adam.ritchie@stephens.com
Direct all questions regarding the proposal to the above persons in writing, no later than May 15, 2026.
E. TIMETABLE OF SELECTION PROCESS
Activity Completion Date
Release of RFP May 8, 2026
Questions due from TPAs May 15, 2026
Response to TPA questions due May 20, 2026
Proposals due June 8, 2026
Finalist presentations TBA
Effective date January 1, 2027
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F. PROPOSAL DEADLINE
ATU must receive an electronic copy no later than June 8, 2026, at 12:00 p.m.
Stephens Insurance must receive an electronic copy and one hard of your proposal no later than June 8,
2026 at 12:00 p.m. This includes the completion of the following questionnaires and exhibits:
* General Information Questionnaire
* Medical Claims Processing Questionnaire
* Utilization Management Questionnaire
* Disease Management Questionnaire
Mailing address for hard copy of proposal: Electronic Copies sent to:
Stephens Insurance, LLC ATU Procurement Services
Attention: Adam Ritchie RFP# 26-020
RFP# 26-020 Jennifer Warren
111 Center Street, Suite 100 Jwarren2@atu.edu
Little Rock, AR 72201
Stephens Insurance
RFP# 26-020
Adam Ritchie
Adam.ritchie@stephens.com
G. REVIEW OF PROPOSALS
ATU reserves the right to:
* Reject any or all components of proposals.
* Cancel the entire RFP process.
* Remedy technical errors in the RFP.
* Negotiate with any, all or none of the respondents to the RFP.
* Solicit the best and final offers from all or some of the prospective vendors.
* Accept any or all components of the proposal as an "offer" without negotiation and issue
Notice to Proceed.
H. PROVISIONS DEEMED INCLUDED IN THE PROPOSAL
A Firm may wish to propose an alternative to these specifications by expressly and specifically so stating
in its proposal. Included are specific requirements in an attempt to evaluate all proposals on a uniform
basis. If your firm feels that any of the provisions are unreasonable, contact Tyler Runnells and Stephens
Insurance, LLC. Stephens Insurance, LLC will determine if the provision should be amended.
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I. MANDATORY PROVISIONS
Each proposal received by ATU shall automatically be deemed to include the Firm's agreement to the
following provisions:
1. The proposal constitutes an offer by the Firm, which shall remain open and irrevocable,
for 275 days from the deadline for submitting proposals as stated in Section F.
2. The firm consents to ATU or Stephens Insurance, LLC contacting and obtaining any
information relevant to this RFP from the references and others identified by the Firm in
its proposal.
J. PROPOSED TPA AND REINSURANCE COVERAGE OF EMPLOYEE MEDICAL PLAN
Proposals should include the information relevant to the Firm's proposed third-party claims
administration and stop-loss coverage of the employee medical plan.
Proposals should include Reference Based Pricing (RBP) as an option with 2 to 3 options both on a PEPM
pricing model and a percentage of savings model in terms of the RBP vendor fees.
Proposals should include Pharmacy Services including rebate transparency. In the event pharmacy
services are carved out, please provide your willingness to work with a PBM selected by a separate RFP
process and costs associated with the PBM carve out including data transfer and all other fees associated
with pharmacy services. Please provide names of PBM's you will work with. If there is an additional
admin fee charged to work with "non-preferred" PBM's, please explain.
Each firm shall describe how it will meet the required specifications outlined in Exhibit A.
Any specifications which are not met should be identified in the proposal and an alternate described.
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II. GENERAL INFORMATION QUESTIONNAIRE
1. Provide the full name of your company, address, and telephone numbers. Also, provide a detailed
summary of your company's structure, background, and experience in the healthcare industry.
Describe the organization's resources and capabilities, including size, number of offices, locations,
and number of employees.
2. Who will be the primary administrative and service contact from your company involved in this
program if awarded the contract? Provide a brief resume of each individual.
3. Describe any organizational structure/operational changes, which may occur within the next
eighteen months.
4. Provide a list of five (5) client references for which you provide the requested services, including
clients that closely mirror the size and geographic location of ATU, with the name and telephone
number of a contact person as well as the number of employees and services in place at
employer.
5. Provide a list of two (2) former clients that have recently terminated their services with you, not
to include any terminated due to an acquisition. Include the name and telephone number of a
contact person as well as the number of employees and services terminated.
6. Please provide an implementation plan and detail the timing of when the following will be
available assuming your firm is awarded the ATU account effective January 1, 2027.
* Contracts and administrative agreements
* Claims system loaded with the ATU benefit plans
* Receipt and testing of eligibility files
* Receipt and testing of history load from the current claims administrator
* Testing of interfaces with other vendors
* Banking arrangements
* Reporting requirements
* Open enrollment planning
* Employee communication
* Benefit Administration implementation
* Employee access to benefits, claims, education, support information, and ID cards
7. Please describe the transition team that will work with ATU on implementation and transition
issues.
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III. CLAIMS PROCESSING / ELIGIBILITY & ENROLLMENT/CUSTOMER SERVICE QUESTIONNAIRE
GENERAL INFORMATION
1. Please provide the following information about the specific location from where claims,
administration services, enrollment and eligibility are housed. (for the last three years):
* Location - Please provide address, telephone and fax numbers name and title of the
individual responsible for the daily operations of this location
* the number of clients served from this location
* the number of members served from this location
* the number of claims processors located in this location
* the number of lives (employee and dependent) for which medical claims are processed in this
location
2. Describe your disaster recovery program concerning computer files, eligibility/enrollment
information, claim system, and loss of the facility.
3. Indicate the hours/days of operation (please be time zone specific) for the office that will service
this account.
CLAIM OFFICE PERFORMANCE-QUALITY AND ACCURACY
4. Provide your definition of a claim.
5. Describe the auditing program currently in place in the claims location you are recommending for
ATU Include information on the following:
* Auditing procedures (both internal and external)
* Definition of auditing categories
* Frequency/percentage of production audited
* Description of staff performing the audits
* Communication of audit results (to processors and client)
* The latest copy of your firm's Statement of Standards for Attestation Engagement No. 16
(SSAE NO. 16) Report
* A copy of your firm's Reporting on Controls at a Service Organization (SOC1.Type 2)
Report
6. Describe your claims processing workflow from the time a claim is received in your office until the
claim is resolved and/or payment is made.
7. What are your standards for claims processing?
* Payment accuracy (%)
* Procedural accuracy (%)
* Financial accuracy (%)
* Turnaround time
* Volume per day
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8. What are your 2024 and 2025 results for claims processing for the office proposed to process
claims for ATU?
* Payment accuracy (%)
* Procedural accuracy (%)
* Financial accuracy (%)
* Turnaround time
* Volume per day
9. Provide your definition of claims turnaround.
10. Indicate the average number of business days in which 90% of medical claims are paid. Indicate
the average number of business days for 95%. (Should reflect statistics for calendar years 2024
and 2025).
11. Describe the procedures employed by the claims processors to review medical claims for
compliance with benefits, to measure the reasonableness of charges and to determine the
appropriateness of services. Are there separate groups of reviewers for network claims, appeals,
etc.?
12. Describe your procedures/approach to monitor and prevent creative billing, upcoding, DRG creep,
etc. What criteria are utilized to identify the appropriateness of charges? Describe any clinical
edit /review procedures performed by the claims system, specifically the ability to identify and
correct code "bundling." What controls are in place to prevent duplicate payments? Describe
procedures employed to prevent fraudulent claims.
13. How does your system track alternate recipient information?
STAFFING
14. Provide the total number of staff, as well as a breakdown by functional area, in the claims office
that will service ATU.
15. What is your average ratio of examiners to covered employee lives?
16. If awarded this account, will you need to hire additional staff? What formula and/or ratios are
utilized to determine when additional staff is necessary for claims processing?
17. ATU may require a dedicated representative, other than the salesperson, to be responsible for
their account. Will dedicated processors and customer service representatives be assigned to
this account? If so, how many? If not, how will claims be assigned?
18. Provide the average length of service of your processors and their experience level. Additionally,
provide the average length of service for those processors, if applicable, that will be assigned
specifically to the ATU account.
19. What are the minimum per-day production standards, if any, expected of your claims processors?
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20. If claim processors are compensated on an incentive base, please detail the specifics of the
program.
21. How will backlogs in processing be handled for this account?
CLAIMS PROCESSING SYSTEM
1. What claims administration system does your firm use? (Provide specifics on both hardware and
software.)
2. How long has this system been operational in the specific office that will administer this account?
Provide dates and descriptions of recent upgrades as well as any upgrades anticipated in the
next 24 months.
3. Describe the back-up procedures you have in place in the event of a claim system shut down.
4. Where is your claim data stored?
5. How are "rejected transactions" handled?
6. What criteria are used to determine reasonable and customary (R&C) fee allowances for out-of-
network claims? What level of R&C do you typically apply? How do you ensure that reasonable
and customary allowances are applied correctly to claims?
7. Describe your procedures for handling pended claims.
8. Describe the tracking mechanisms you follow for all communications requiring additional
information.
9. Can your system capture primary and secondary diagnoses utilizing ICD-10 codes?
10. Describe your process for obtaining codes if the primary and secondary diagnoses are not entered.
11. Are all inpatient and outpatient procedures recorded utilizing the current CPT codes?
12. Describe what actions the Claims Administrator will take on behalf of the Plan to negotiate the
provision of stop loss coverage for claims in excess of the specific limit.
13. Provide a list of reinsurance carriers from whom you requested quotes. Do these carriers
provide funding for data analytics and/or wellness initiatives?
14. In addition to marketing the reinsurance through the TPA, Stephens Insurance reserves the right to
shop/place reinsurance with additional markets outside of the TPA's preferred vendors including
PBM's. Please confirm your willingness to comply.
15. Are additional fees charged when working with "non-preferred" reinsurance carriers? If so,
please explain.
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