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
- 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

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