MB-3269 - USA (Washington, DC) - Staff Model Health Maintenance Organization and Claim Adjustment Services - Deadline July 30,2019

Product (RFP/RFQ/RFI/Solicitation/Tender/Bid Etc.) ID: MB-3269

Government Authority located in Washington, DC; USA based organization looking for expert vendor for staff model health maintenance organization and claim adjustment services.

[A] Budget: Looking for Proposal

[B] Scope of Service:

(1) Vendor needs to provide staff model health maintenance organization and claim adjustment services
- Adjudication of claims in accordance with plan design, including coordination of benefits,
- A dedicated toll-free telephone number and online customer service for both employees and people and talent personnel.  phone-based service should be available at least Monday thru Friday between 8:00 am to 8:00 pm local time,
- Claim procedures must comply with employee retirement income security act regulations and department of labor claims procedure regulations,
- Contractor must serve as claims fiduciary,
- Determinations with respect to denied or partially denied claims, including a review of potential high abuse areas such as mental health and substance abuse, chiropractic, nursing, and podiatric,
- Provide employees explanation of benefits paid, pending, or denied,
- Assistance with the ongoing administration of the program, including plan design and cost analysis,
- Ongoing assistance with problem identification and problem solving regarding the administration of the plan,
- Contractor must send plan representatives to locations to conduct open enrolment meetings and health fairs, both at initial contract implementation and for annual open enrolment activities,
- Provide and maintain online customer service capabilities,
- Standards include the following transactions: health claims or equivalent encounter information, health claims attachments, enrolment and disenrollment in a health plan, eligibility for a health plan, health care payment and remittance advice, health plan premium payments, health claim status etc.
- Provide targeted and customized evidence-based prevention and care management programs, including but not limited to: disease management and prevention programs, gaps in care, medication adherence, programs to promote healthy pregnancies and babies, tobacco cessation programs, programs to address lifestyle issues such as weight management and stress management etc.
(2) All the Questions must be submitted no later than July 11, 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 : Tuesday, 30 July, 2019

Question Answer Deadline : Thursday, 11 July, 2019

Category : Medical Billing and Coding, Medical Services

Country : USA

State : District of Columbia

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