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MB-2894 - USA (South Carolina) - Third-Party Claims Administrator Services - Deadline April 16,2019

Product (RFP/RFQ/RFI/Solicitation/Tender/Bid Etc.) ID: MB-2894

Government Authority located in South Carolina; USA based organization looking for third-party claims administrator services.

[A] Budget: Looking for proposal

[B] Scope of Service:

(1) Vendor needs to provide third-party claims administrator services for the self-funded state dental plan, and accompanying insurance for the state’s voluntary supplemental dental product, dental plus to the government authority located in Decatur, GA.
- Health, dental, dental plus, and state vision plan benefits are available to retirees, survivors and former spouses, administers COBRA for most participants; certain participating entities administer COBRA themselves.
- Process all dental claims incurred on and after January 1, 2020 and up to and including December 31, 2025, in accordance with this Request for Proposal, statutory provisions and the Group Dental Insurance Benefit Plan Document provisions.
- Provide access to legal advisors, expert dental, and medical advisors including general dentists; orthodontists, periodontists, endodontists, oral surgeons, medical doctors and dental, medical texts, literature, dental medical care standards and other materials as needed for consideration and determination of claims and for review of disputed claims.
- Receive, date, and control claims within twenty-four hours of receipt;
- Confirm the claimant’s eligibility against the eligibility files supplied electronically before authorizing benefits or processing claims;
- Determine whether a claim is payable as a medically necessary and covered service under the Plan;
- Apply any applicable plan exclusion;
- Check claims history and prevent duplicate payments or payments that exceed contract limits;
- Identify any claim that is unusual in amount or service rendered and review the claim;
- Administer the plan such that the terms and conditions of the plan are interpreted in a consistent manner within accepted dental standards;
- Apply deductible and coinsurance and determine the amount payable under the plan.
- Provide standardized reports, or an on-line reporting system capable of generating such reports, in a format that shall include, at a minimum: enrollment and tier statistics, claims, claims, reports, incurred but not reported claims, by procedure code, by procedure code classification, claims by subscriber status active vs. retiree, employer group, age and gender, relationship to the insured, etc., pended claims, design effectiveness, provider summaries, claims inventory.
(2) All questions must be submitted no later than March 14, 2019.
(3) A pre-proposal conference will be held on March 18, 2019.
(4) A contract term will be for four years.

[C] Eligibility:

Onshore (USA Only)

[D] Work Performance:

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

Expiry Date : Tuesday, 16 April, 2019

Pre-proposal Conference Date : Monday, 18 March, 2019

Question Answer Deadline : Thursday, 14 March, 2019

Category : Medical Billing and Coding

Country : USA

State : South Carolina

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