MB-2909 - USA (Illinois) - Third Party Administrator Services for Group Health - Deadline April 18,2019

Product (RFP/RFQ/RFI/Solicitation/Tender/Bid Etc.) ID: MB-2909

Government Authority located in Illinois; USA based organization looking for expert vendor for third party administrator services for group health.

[A] Budget: Looking for Proposal

[B] Scope of Service:

(1) Vendor needs to provide third party administrator services for health plan administration services.
- Claims Administration and Customer Service including accurate and timely claims administration of our plans, explanation of benefits to participants and providers, payments are to be issued on county drafts, investigate coordination of benefits and pursue recoveries of monies when necessary, integrate PPO fee schedules and coordinate timely repricing when necessary, negotiate out-of-network discounts and use most current reasonable and customary allowances, investigate third party liability and pursue subrogation reimbursement where legally possible, coordinate claims and provide necessary information to excess insurance carrier, prepare and issue 1099 forms to providers, provide prompt telephone response with accurate benefits information to participants and providers, provide written documentation when the HIPAA compliance officer has questions relating to a specific claim, attend committee, board and employee meetings, open enrollment, and the health fair as necessary and legislative updates on an ongoing basis.
- Flexible Spending administration including adjudicate and pay flex claims, including preparation of explanation of benefits and checks, provide flex debit cards, assist in the preparation of employee benefit booklets and amendments to the plan, assist in establishing a claims fund account at bank of employer’s choice, assist in flexible spending annual enrollment, make available quarterly activity reports to the employer and the employee.
- Managed Care administration including hospital pre-certification with continued stay review via a toll-free number, preadmission, admission screening for outpatient procedures and procedures requiring a presurgical review as required by the plan, early identification with intervention of high cost, catastrophic claims via the preadmission and continued stay review program, consult with the patient regarding utilizing network providers if applicable, coordinate patient care to promote cost effectiveness without compromising the quality of care and prevent duplication of services, review clinical records to determine if a patient can be treated as effectively in a less intensive setting at less cost within the geographic area, second surgical opinion when medically indicated, physician-to-physician communication on all questioned cases, written notification to patient, physician and hospital of all review determinations and obtain county prior approval for services that require additional fees including: large case management, hospital bill audits, medical (dental and chiropractic) consultant reviews and maternity management programs.
(2) A mandatory pre-bid meeting will be held on March 20, 2019.
(3) All question must be submitted no later than March 25, 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, 18 April, 2019

Pre-proposal Conference Date : Wednesday, 20 March, 2019

Question Answer Deadline : Monday, 25 March, 2019

Category : Medical Billing and Coding

Country : USA

State : Illinois

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