RFP for Claims Management Solutions Services

1. ABOUT L.A. CARE

L.A. Care’s mission is to provide access to quality health care for Los Angeles County's vulnerable and low-income communities and residents, and to support the safety net required to achieve that purpose. 

As the nation's largest publicly operated health plan, L.A. Care is dedicated to helping Los Angeles County residents obtain health care for their families from doctors and other health care providers who understand and respect them. L.A. Care Health Plan is governed by 13 board members representing medical and health care professionals, as well as Medi-Cal consumers. L.A. Care is accountable to community stakeholders, not stockholders. 

L.A. Care advances individual and community health through a variety of targeted activities including a Community Health Investment Fund that has awarded more than $180 million throughout the years to support the safety net and expand health coverage. The patient-centered health plan has a robust system of consumer advisory groups, including the Regional Community Advisory Committees and the Executive Community Advisory Committee, health promoters, fourteen Community Resource Centers that offer free health education and exercise classes to the community, and has made significant investments in Health Information Technology for the benefit of the more than 10,000 doctors and other health care professionals who serve L.A. Care members. 

L.A. Care has approximately 2,000 employees, and projects $9.0 Billion in Revenues for the 2023-24 Fiscal year. 

Programs 

Medi-Cal – L.A. Care Health Plan has been serving Medi-Cal beneficiaries in Los Angeles since 1997. Medi-Cal beneficiaries who join L.A. Care can choose to get their Medi-Cal coverage from L.A. Care or from one of our two subcontracted health plans that L.A. Care partners with to provide Medi-Cal coverage in Los Angeles County. Our two Plan Partners are Anthem Blue Cross and Blue Shield of California Promise Health Plan. Since 2015, L.A. Care’s Medi-Cal membership has grown by 46% with more than774,000 additional members, and as of November 2024, L.A. Care has over 2.3 million Medi-Cal members who represent a close to 90% of all L.A. Care membership. 

L.A. Care Covered (LACC) – LACC started in January 2014, L.A. Care Health Plan is one of many health plans designated to offer health insurance on the California State Exchange known as Covered California. L.A. Care Covered offers all metal coverage levels (Platinum, Gold, Silver, and Bronze) and a Catastrophic Plan for enrollees within Los Angeles County in Regions 15 and 16 on the Exchange. 

L.A. Care Medicare Plus (HMO D-SNP) Plan – L.A. Care has been serving Medicare and Medi-Cal dual eligible beneficiaries in Los Angeles County since 2008. L.A. Care Medicare Plus (HMO D-SNP) is a Dual Eligible Special Needs Medicare Advantage plan. It was launched in 2023 after California State Department of Health Care Services (DHCS) sunset the Cal MediConnect (CMC) Program at the end of December 2022. The Medicare Plus plan is an exclusively aligned enrollment D-SNP plan. It coordinates members’ Medicare and Medi-Cal benefits and care under one plan. 

PASC-SEIU Homecare Workers Health Care Plan – The PASC-SEIU Plan was created by the Personal Assistance Services Council (PASC) and the Service Employees International Union (SEIU) to provide healthcare coverage for In-Home Supportive Services (IHSS) workers who live or work in Los Angeles County and meet all of the employer’s eligibility requirements. PASC administers the plan and contracts with L.A. Care to provide health plan services, claims processing, and COBRA/Cal-COBRA continuation coverage. 

2. PURPOSE 

2.1 L.A. Care is issuing this Request for Proposals (“RFP”) to solicit proposals for claims management solutions services, including complete mailroom services, paper-to-electronic (“P2E”) data capture services of claims and attached Explanation of Benefits (“EOB”) data, and generation of electronic claims files for L.A. Care’s Commercial, Medicare, and Medicaid lines of business. 

2.2 Interested participants, “Bidders,” may submit a proposal (“Proposal”) containing the information requested in this RFP. L.A. Care will select one Bidder to be contracted at L.A. Care's discretion to perform the required services. The Bidder will provide services pursuant to a contract to be entered into with L.A. Care. L.A. Care is under no obligation to order any work pursuant to this RFP. 

2.3 At L.A. Care, our procurement practices encourage diversity while maintaining competition. All qualified Bidders are encouraged to participate and respond to this RFP.

PROPOSAL TIMELINE 

The timetable for this RFP is as follows: 

If interested in participating in this RFP, please contact RFP@lacare.org for the full RFP package.