MB-3248 - USA (Texas) - Medical Administration and Ancillary Benefits Services - Deadline August 2,2019

Product (RFP/RFQ/RFI/Solicitation/Tender/Bid Etc.) ID: MB-3248

Government Authority located Texas; USA based organization looking for expert vendor for Medical Administration and Ancillary Benefits Services.

[A] Budget: Looking for Proposals

[B] Scope of Service:

(1) Vendor needs to provide Medical Administration and Ancillary Benefits Services including Flexible Spending Account Administration, COBRA Administration services
• Onshore (U.S.) administration of claims processing, member services, provider services and all aspects of medical administration
• Benefit determination, coordination of benefits and appeals (including external review)
• Managed care network services
• Provider contractual negotiations, including pay for performance
• Custom network development,maintenance and operation
• Online provider search tools that provide robust information on providers, their accreditations, outcomes, and patient satisfaction metrics
• Demonstrated,meaningful M/WBE participation of providers in-network, and through other core and ancillary services
• Full claims fiduciary
• Administer Disabled Dependent Eligibility Verification Process
• Acceptance of electronic eligibility file from district or its third party designate as well as the error reports and other reports that need to be managed by provider as a result of the electronic eligibility file
• Health care medical management services
• Disease management services
• Transplant benefit management services including transplant access program (Transplant Centers of Excellence Network)
• Specialty resource centers – Cancer, Neonatal, Reproductive resource services, Kidney resource, Maternity, and outline others as applicable
• Enhanced clinical review/hi-tech radiology
• Claim recovery services (overpayments and adjustment services due to coordination of benefits, retroactive termination, audits, duplicate bills and contract compliance)
• Escheat services
• Subrogation services
• 24/7 nurseline resource center
• Access to Telehealth options within the medical program
• Claim abuse and fraud management services
• Assistance with general plan administration
• Claim accounting, draft reconciliation and provider 1099 reporting
• Claim systems production and development
• Claims testing during implementation to ensure set up is accurate
• Client testing of systems and access including claims
• Recorded calls
• Account Management Services to include: Dedicated/designed Account Management team, including an Account Executive, Account Manager, Underwriter, Medical Director, Clinical Consultant, Data Analytics Consultant and Executive Sponsor, or  equivalent roles within your organization
• Performance Guarantees as outlined in the Medical Pricing Sheet Tab 3 Labeled
• On-site support – bilingual required, must have experience communicating medical plan benefits and claims adjudication results to members
• Enrollment meeting support
• Administration of account structure (premium and claims accounts for reporting purposes)
• Administration of employer site to review billing, enrollment and claims
• ID card production
• Administration of alternate ID’s
• Single Sign on capabilities
• Billing and eligibility services
• Billing reconciliation services
• Administration, including payout if applicable, of plan performance guarantees
• Administration of allowances including but not limited to Implementation, Communication, Wellness, and Audits
• Plan sponsor reporting, including quarterly “stop light” dashboard as well as annual reporting
• Plan sponsor banking services, HRA administration, care management, stop loss.
(2) All questions must be submitted no later than July 10, 2019.
(3) A pre-proposal conference will be held on July 3, 2019.
(4) A contract period will be for three 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 : Friday, 2 August, 2019

Pre-proposal Conference Date : Wednesday, 3 July, 2019

Question Answer Deadline : Wednesday, 10 July, 2019

Category : Medical Billing and Coding

Country : USA

State : Texas

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