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MB-3074 - USA (Illinois) - Stop Loss Administration Services - Deadline June 13,2019

Product (RFP/RFQ/RFI/Solicitation/Tender/Bid Etc.) ID: MB-3074

Government Authority Located in Illinois; USA based organization looking for expert vendor for stop loss administration services.

[A] Budget: Looking for Proposal

[B] Scope of Service:

(1) Vendor needs to provide stop loss administration services for medical and pharmacy claims,
- Specific stop loss coverage applies to all medical and drug expenses, including all mental health and substance abuse claims, covered under the self-insured plan,
- All benefits paid under the benefit plan must accumulate to specific stop loss limits without any limitations or exclusions,
- The specific stop loss lifetime maximum must be consistent with the underlying medical plan,
- Specific stop loss coverage applies to all eligible members,
- For claims exceeding the specific stop loss level, describe the following:
- Timeframe from start to finish,
- Timing parameters for all parties that may be involved, including the client,
- Interaction with the claim administrator, medical and/or pharmacy,
- Interaction with Utilization Review,
- Interaction with Case Management,
- Auditing stop loss claims,
- Reimbursement process,
- Provide your organizations process for credits issued by the medical and pharmacy claims administrators.
(2) All questions must be submitted no later than May 15, 2019.
(3) A contract term will be for one year.

[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, 13 June, 2019

Question Answer Deadline : Wednesday, 15 May, 2019

Category : Medical Billing and Coding

Country : USA

State : Illinois

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