Dickenson County Public Schools Seeking Proposals from Qualified Providers of Healthcare and Prescription Drug

Background

Dickenson County Public Schools (DCPS), located in Clintwood, Virginia, is seeking proposals for its healthcare and prescription drug programs. The goal is to secure a provider that can effectively manage these services starting July 1, 2026. DCPS currently employs 237 individuals and operates under a partially self-funded plan. The school system aims to enhance its employee benefits offerings through this solicitation.

Work Details

The selected provider will be responsible for the following services: 1. Automated processing and payment of medical and prescription drug claims according to plan documents and contracted network reimbursement schedules. 2. Utilization review, case management, stop loss reporting, third-party recovery, and coordination of medical coverage. 3. Maintenance of a master file of plan documents, summary plan descriptions, and claims administration policies. 4. Verification of eligibility for benefits for plan participants and dependents. 5. Design, print, deliver, and periodically update all forms related to claims processing. 6. Claims processing including inputting historical data from previous TPAs, reviewing claims submitted by providers, determining reasonableness of charges, issuing payments or denials with appropriate correspondence, and maintaining patient information security. 7. Customer service support including timely responses to inquiries regarding eligibility and claims payment. 8. Coordination with a transparent pass-through Pharmacy Benefit Manager (PBM) for prescription drug claims processing. 9. Provision of utilization review services such as pre-admission certification and discharge planning. 10. Management reports detailing program performance as required by DCPS.

Period of Performance

The contract will commence on July 1, 2026.

Place of Performance

Services will be performed in Clintwood, Virginia.

Bidder Requirements

Proposals are accepted from licensed healthcare providers including Third Party Administrators (TPAs), reinsurers, and fully insured carriers. Respondents must demonstrate expertise in employee benefit services relevant to DCPS operations and maintain sufficient staffing resources for timely service delivery.