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MB-3188 - USA (Florida) - Third Party Administrator Services for Self-Insured Health Plan - Deadline June 25,2019

Product (RFP/RFQ/RFI/Solicitation/Tender/Bid Etc.) ID: MB-3188

Government Authority located Florida; USA based organization looking for expert vendor for third party administrator services for self insured health plan

[A] Budget: Looking for Proposals

[B] Scope of Service:

(1) Vendor needs to provide third party administrator services for self insured health plan for their comprehensive medical and prescription drug plan from qualified companies with access to a network of providers
A. A senior account executive from your sales/marketing department.
B. A senior claim consultant or claim section manager to participate in the installation of the plan.
C. Properly review, process, and pay claims. This includes verifying coverage, liability, and deductible satisfactions.
D. Make direct payments to network providers upon assignment by covered employees/dependents or reimburse employees for out-of-network covered expenses as the case may be.
E. Provide up-to-date Provider listing, including Medical Provider Network and Pharmacy Network, to the Risk Management Department and posted on a portal accessible to employees 24-hrs a day.
F. Apply Reasonable and Customary limits to out-of-network claims.
G. Provide report(s) to comply with COBRA requirements and conform to accepted accounting procedures.
H. Provide conversion privilege to individual policy(s) as alternative to COBRA.
- Promptly send Explanation of Benefits (EOB’s) on each claim to employee’s home or email address, stating the claim description, the employee, the amount paid, to whom paid, status of deductible and out-of-pocket requirements, including 800# for information and web portal access to EOB information.
- CUSTOMER SERVICE
A. Prepare, maintain, and mail plan documents to each employee’s home and provide additional supply
(2) All questions must be submitted no later than June 20, 2019.
(3) A contract period will be for five (5) years.

[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 : Tuesday, 25 June, 2019

Question Answer Deadline : Thursday, 20 June, 2019

Category : Medical Billing and Coding

Country : USA

State : Florida

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