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MB-3001 - USA (California) - Pharmacy Benefits Management Services - Deadline May 10,2019

Product (RFP/RFQ/RFI/Solicitation/Tender/Bid Etc.) ID: MB-3001

Government Authority located in California; USA based organization looking for expert vendor for pharmacy benefits management services.

[A] Budget: Looking for Proposal

[B] Scope of Service:

(1) Vendor needs to provide pharmacy benefits management services for all legacy health plans.
- Prescription benefits management services with proposer(s) who can offer comprehensive services including, but not limited to, a proven record in administering 340B pricing, implementation of formulary management programs with minimal member disruption, contractual compliance,
account management services, and customer service.
- Claims Processing (Electronic and Paper) and Related Services to include receive claims and process payments of benefits in accordance with the plan designs for all claims incurred, correspond with participants and providers if additional information is necessary to complete the processing of claims, determine, based on the county’s medical necessity guidelines, benefits payable under the plan, pursuant to the terms and conditions of the county’s benefit plan booklet, all levels of claim appeals, receive and review claims and claims-related documents, including run-in claims, direct member reimbursement, pharmaceutical company relations, rebate contracting, rebate contract management, rebate invoicing, reconciliation and payment.
- Customer service to answer inquiries on claims, eligibility, provider network, services, coverages, or other inquiries from participants Monday through Friday from 8:00 AM to 5:00 PM, 1-800 pharmacy locator service, 1-800 pharmacy help desk and on-line drug utilization review services and On-Line Formulary Usage Monitoring.
(2) A pre-proposal conference will be held on April 17, 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 : Friday, 10 May, 2019

Pre-proposal Conference Date : Wednesday, 17 April, 2019

Category : Medical Billing and Coding, Pharmaceutical, Pharmacy & Related Services

Country : USA

State : California

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