MB-2868 - USA (Alaska) - Professional Medical and Pharmacy Billing Auditing Service - Deadline March 21,2019

Product (RFP/RFQ/RFI/Solicitation/Tender/Bid Etc.) ID: MB-2868

Government Authority located in Alaska; USA based organization looking for expert vendor for professional medical and pharmacy billing auditing service.

[A] Budget: Looking for Proposals

[B] Scope of Service:

(1) Vendor needs to provide computerized medical bill auditing and pharmacy benefit management program to the self-administered workers compensation claim program.
1. Computerized medical bill auditing services must include:
- The ability to review individual WC medical bills and identify charges in excess of the current state medical fee schedule or any other fee schedule that the State of Alaska may subsequently choose to adopt.
- The ability to review each line item charged and identify those items improperly coded.
- The ability to review individual WC medical bills and identify medical procedures not covered by workers compensation.
- The ability to identify services billed for that are not related to injury or illness claimed.
- The ability to review and reject WC bills as duplicate submissions.
- The ability to resolve any fee reduction disputes directly with the applicable medical provider.
- The contractor shall arrange for pick up or transfer of medical bills and related documentation in a manner and on a schedule acceptable.
- The contractor shall review each medical bill within a maximum of seven (7) calendar days from the date the bill is made available to the contractor assuming that all necessary supporting documentation is also available at that time. The contractor shall electronically transmit bills and medical records and payment recommendations in a manner compatible with the computerized claim system, claim pilot, employed.
- The contractor shall provide itemized explanations of reductions for each bill reduced.
- The contractor shall at all times provide a quality assurance representative that will assist in the handling of problems, disputes, and workflow challenges, this representative shall be available during normal state business hours Monday through Friday.
- The contractor shall submit an electronically comprehensive monthly savings report in an agreed-on format.
2. Pharmacy benefit management program must include:
- The ability to receive electronic requests for pharmacy benefits through the municipality's computerized claim system, claim pilot.
- Describe the process by which you will provide each claimant with a retail drug card. The card must list an effective date. Retail drug cards must be provided for new claimants and replacement cards must be provided to existing claimants on an ongoing basis. Please describe any capabilities you might have to supply such information in a digital format, e.g., to a claimant's cell phone via an app.
The pharmacy ID cards will provide eligible claimants with access to prescription medications at a large national network of preferred providers.
- Claimants enrolled in the pharmacy benefit program will be entitled to receive eligible medications via home delivery order.
- Generic medications should be substituted in compliance with state statutes. Contractor shall employ medication plans and formularies specific to body part and nature of injury.
- The contractor shall review prescriptions to identify those not related to the claimant's medical treatment.
- Medications that are temporarily blocked at point of sale should be immediately routed to the municipality's claims adjusters for review.
- The contractor shall have a staff of clinical pharmacists available to provide customized support for medication-related decisions.
- The contractor shall provide invoices for services on a daily basis as the services are incurred via electronic means compatible with the claim system employed, claim pilot.
(2) All questions must be submitted no later than March 8, 2019.
(3) A non-mandatory meeting will be held on March 6, 2019.

[C] Eligibility:

- Onshore (USA Only);

[D] Work Performance:

Performance of the work will be Offsite. Vendor needs to carry work in their office location.

Expiry Date : Thursday, 21 March, 2019

Pre-proposal Conference Date : Wednesday, 6 March, 2019

Question Answer Deadline : Friday, 8 March, 2019

Category : Medical Billing and Coding

Country : USA

State : Alaska

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