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Third Party Administrator (TPA) for LTSS Services

Read below for information about the TPA for LTSS services

On July 1, 2016, MassHealth issued a Request for Responses (RFR) to obtain the services of a Third Party Administrator (TPA) to support EOHHS’s capacity to effectively administer Fee-for-Service services including Long Term Services and Supports (LTSS) to eligible MassHealth Members. The primary focus of the LTSS TPA is to augment the administrative capacity of EOHHS in its performance of LTSS provider-facing activities. EOHHS will continue to lead and direct the administration of these functions. The TPA will provide clinical, administrative/operations, and systems support to MassHealth in accordance with MassHealth Regulations to:

  • Strengthen program integrity analyses and audits
  • Conduct analyses on utilization and quality patterns
  • Perform prior authorization, as directed by MassHealth
  • Credential providers and maintains a provider directory

For more information, please consult BID Number BD-16-1039-EHS01-EHS01-00000008526 on COMMBUYS at www.commbuys.com/bso/external/bidDetail.sdo?docId=BD-16-1039-EHS01-EHS01-00000008526&external=true&parentUrl=bid.

 

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