Monday, April 17, 2023

UnitedHealthcare Notifies State Health Plan It Will Not Appeal Denial of Protest Over Third-Party Administrative Services Contract Award

Blue Cross North Carolina only Losing Bidder to Proceed with Litigation Against State Health Plan
Raleigh, NC
Apr 17, 2023

State Treasurer Dale R. Folwell, CPA, and the State Health Plan (Plan), part of the North Carolina Department of State Treasurer, announced today that they have been notified by UnitedHealthcare Services, Inc. (UMR, Inc.) that the health care giant will not be pursuing an appeal of the denial of a protest of the awarding of the Plan’s 2025 Third-Party Administrative (TPA) Services Contract.  

In December of last year, the State Health Plan Board of Trustees voted unanimously to award the TPA contract to Aetna for a three-year initial service period beginning Jan. 1, 2025, through Dec. 31, 2027, with the option to renew for two, one-year terms. Aetna was one of three companies bidding for the contract. Blue Cross NC and UMR, Inc. also submitted proposals but were not awarded the contract. Blue Cross NC will continue to be the Plan’s TPA claims processor for the next two years under terms of its current contract. 

The award was the result of a competitive bid process in which the Plan solicited and selected from industry-leading partners providing exceptional customer service, technological resources and professional support. The services in the contract include processing claims and offering a comprehensive network of health care providers. The contract is also intended to reflect a partnership that focuses on transparency and controlling costs.   

The new three-year TPA claims processing contract was awarded after a transparent and competitive bid process in which submissions were evaluated by a team of in-house subject matter experts and outside professionals, with scores assigned to various sections.

In February, the Plan rejected the protests for the TPA contract from losing bidders Blue Cross NC and UMR, Inc. Letters were sent to the losing bidders explaining why their appeals had been denied. 

“We appreciate UnitedHealthcare’s efforts to win the TPA award for the Plan in 2025. We have a great relationship with them and hope that they will try to earn the business at some point in the future,” Treasurer Folwell said.  

In February, the Plan received notice that Blue Cross NC had filed a petition for a contested-case hearing in the North Carolina Office of Administrative Hearings and a petition for judicial review in Durham County Superior Court. The administrative law judge recently ordered the case to mediation. 

“To sue until you are blue causes chaos and uncertainty; it is not what’s best for those that teach, protect and serve,” Treasurer Folwell added. 

Aetna currently has more than 600 employees assigned to work on the transition for the next two years. They will be working diligently, in close collaboration with Plan staff and multiple vendors, to develop comprehensive plans and processes, systems and platforms to ensure members will enjoy a smooth transition when its services roll out.  

Plan benefits including copays and deductibles are not determined by Aetna or the current TPA, Blue Cross NC. The State Health Plan Board of Trustees has sole authority to decide benefits, premiums and copays. When the new contract begins, the Plan will use Aetna’s network of providers.  

The State Health Plan, a division of the Department of State Treasurer, provides health care coverage to nearly 740,000 teachers, state employees, retirees, current and former lawmakers, state university and community college personnel, and their dependents.