MB-3319 - USA (Arkansas) - Fully Insured Medical and Rx Plan Services - Deadline August 6,2019

Product (RFP/RFQ/RFI/Solicitation/Tender/Bid Etc.) ID: MB-3319

Government Authority Located in Arkansas; USA based organization looking for expert vendor for fully insured medical and Rx plan services.

[A] Budget: Looking for Proposal

[B] Scope of Service:

(1) Vendor needs to provide fully insured medical and Rx plan services for medical, dental, vision, basic and voluntary group life, voluntary short term and long-term disability, critical care with cancer, accident and hospital care,
- Fully insured medical plan and prescription drug coverage including utilization management, large case management and disease management,
- Claims system loaded with the benefit plans, receipt and testing of eligibility files with benefit administration, testing of interfaces, employee access to benefits, claims, education, support information, and ID cards,
- Describe your disaster recovery program concerning computer files, claim system, and loss of the Facility,
- Describe the back-up procedures you have in place in the event of a claim system shutdown,
- Describe process for establishing and verifying dependent eligibility,
- Describe the procedures for identifying and reviewing special medical cases such as medical necessity, experimental procedures, complex cases, etc.:
- Pre-certification review, concurrent review, retrospective review, outpatient review, second surgical opinion, catastrophic/large case management, short term case management, discharge planning, high-risk pregnancy, pre-payment claims review, chiropractic/podiatric review and rehabilitation services,
- Claims status inquiry, ability to e-mail customer service, ability to review previous claims history and ability to access third party medical and disease management information,
- Hospital pre-certification review, concurrent stay review, procedure specific second opinion (inpatient and outpatient), large case management for inpatient and outpatient claims, mental health and substance abuse case management, hospital bill audit program, tracking on-going treatments by specialists and large claim negotiations for out of network services, etc.
(2) All questions must be submitted no later than July 24, 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, 6 August, 2019

Question Answer Deadline : Wednesday, 24 July, 2019

Category : Medical Billing and Coding, Medical Services

Country : USA

State : Arkansas

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