X
X

MB-2965 - USA (Texas) - Medical Administration and Ancillary Benefits Services - Deadline May 8,2019

Product (RFP/RFQ/RFI/Solicitation/Tender/Bid Etc.) ID: MB-2965

Government Authority Located in Texas; USA based organization looking for medical administration and ancillary benefits services.

[A] Budget: Looking for Proposal

[B] Scope of Service:

(1) Vendor needs to provide medical administration and ancillary benefits services, Flexible Spending Account Administration and COBRA Administration Services.
- administration of claims processing, member services, provider services and all aspects of medical
Administration,
- Benefit determination, coordination of benefits and appeals (including external review),
- Full claims fiduciary, administer disabled dependent eligibility verification process,
- Disease management services, transplant benefit management services including transplant access program, access to telehealth options within the medical program,
- Claim abuse and fraud management services, assistance with general plan administration,
- Claim systems production and development, claims testing during implementation to ensure set up is accurate, client testing of systems and access including claims,
- Administration of account structure (premium and claims accounts for reporting purposes),
- Administration of a fee schedule based on Medicare allowable for out-of-network claims,
- Development of customized explanation of benefits (EOBs), as needed,
- Access to stop loss management services, including reporting to a third-party vendor, if selected,
- Billing and eligibility services, Billing reconciliation services,
- Administration of allowances including but not limited to implementation, communication, wellness and audits,
- Medicare secondary payer reporting, integration of pharmacy third party claims data to support benefit accumulators as well as predictive modeling,
- Administration of fund allocation, employer plan sponsor reporting including available funds, transactions etc., Administration of plan audits, and cooperation with third party audits,
- Custom Care Management utilizes evidence based best practices in counseling and support,
- Case management is the process of assessment, planning, facilitation, care coordination, evaluation, and advocacy for options and services to meet an individual’s health needs, promoting cost-effective treatments and quality outcomes,
- Administration of individual excess risk benefit level (specific stop loss/ISl) which includes all services as outlined in the summary plan description,
- Reimbursement of stop loss triggers above the ISL level,
- Tracking and payment of individual/specific stop loss claims,
- Administration of annual aggregate attachment point and tracking,
- Clinical evaluation of large claimants, include advance funding for both individual and aggregate stop loss.
(2) A pre-proposal conference will be held on April 2, 2019.
(3) All questions must be submitted no later than April 9, 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 : Wednesday, 8 May, 2019

Pre-proposal Conference Date : Tuesday, 2 April, 2019

Question Answer Deadline : Tuesday, 9 April, 2019

Category : Medical Billing and Coding, Auditing, Finance and Accounting, Billing Services, Case Management Services

Country : USA

State : Texas

RFP Expired

You can either pay for Single RFP/Bid document or Subscribe with Monthly Subscription for whole Medical Billing and Coding, Auditing, Finance and Accounting, Billing Services, Case Management Services Category/Categories.

If you will obtain monthly subscription for Medical Billing and Coding, Auditing, Finance and Accounting, Billing Services, Case Management Servicescategory/categories, you will be able to access all the RFPs from that Category. Here are the Monthly Subscription offers. So, subscribe for Monthly offers and get rid of Individual RFP payment.

*No commitment =
(1) There is no minimum commitment.
(2) You can subscribe for as less as 1 month and cancel it any time. If you subscribe for annual offer, you can cancel it any time within year.
(3) There is no partial refund policy after Monthly or Annual subscription. You will be required to use services for a Month (Or Year since you have availed discounted pricing).
(4) You can cancel your subscription any-time directly from your PayPal account to stop further recurring charges before next due date.
(5) You will be able to download all RFPs for subscribed Category or Location without any extra cost.

Similar RFPs