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MB-2892 - USA (Georgia) - Health Benefit Claims Administration, Prescription Drug Claims Administration and Stop Loss Coverage Service - Deadline April 18,2019

Product (RFP/RFQ/RFI/Solicitation/Tender/Bid Etc.) ID: MB-2892

Government Authority located in Georgia; USA based organization looking for expert vendor for health benefit claims administration, prescription drug claims administration and stop loss coverage service.

[A] Budget: Looking for Proposals

[B] Scope of Service:

(1) Vendor needs to provide health benefit claims administration, prescription drug claims administration and stop loss coverage service.
- Claims submitted will be examined and the benefits will be determined under the county’s health care plan. County requires that the administrative service fee be on a per capita basis - a fee per month for each employee (family unit). The payment of administrative fees will be done on a monthly basis. Claims incurred prior to the effective date will be processed by the current TPA.
- The claims administrator, using eligibility information provided by county, will handle verification of eligibility.
- County requires actuarial advice on funding levels and plan design from the claims administrator.
- Benefit checks, if for member reimbursement, and explanation of benefit forms will be mailed to the home address of employees.
- The claims administrator, by electronic transfer, will provide the prescription drug program’s eligibility information to the prescription drug administrator.
- The claims administrator will coordinate any information required by the specific excess insurance company. The excess insurance premium will be paid by the county monthly per single employee unit and employee family unit.
- The county will provide employee eligibility. The county requires an eligibility confirmation report that reflects the data-match of information between the two systems.
- County or its designated representative shall be authorized to visit and audit the administrator’s processing and storage facilities and have access to all data, including but not limited to documents, microfilm, microfiche and magnetically stored data which relate to payments or non-payments made by the administrator and charged to county.
- Monthly, quarterly, and annual reports including suggestions for recommended plan design changes.
- For the purpose of your contract, you shall assume that claims incurred prior to the date that your contract is terminated would be processed by you regardless of the date the claim is submitted for payment. If your TPA services continue under contract for at least three consecutive years, you agree to perform run-out claims processing at no additional fee to the county.
- County requires that the administrative service fee be on a per capita basis - a fee per month for each employee. The payment of administrative fees will be done on a monthly basis.
- Claims shall be monitored under a utilization review program, which includes but is not limited to medical necessity, appropriate level of care, and hospital facility length of stay issues. Concurrent review shall be provided as needed.
- Claims shall be evaluated and large case management and alternative care services are required.
- Benefit eligibility information will be provided by the claims administrator. The utilization management provider, if different, will need to provide program access for the electronic data transfer.
(2) All questions must be submitted no later than March 28, 2019.
(3) An intent to propose will be held on March 8, 2019.
(4) Contract term will be one year.

[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, 18 April, 2019

Question Answer Deadline : Thursday, 28 March, 2019

Category : Medical Billing and Coding

Country : USA

State : Georgia

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