MB-3367 - USA (California) - RFI for Third Party Administration Integrated Health Care Network Provider Services - Deadline September 6,2019

Product (RFP/RFQ/RFI/Solicitation/Tender/Bid Etc.) ID: MB-3367

Government Authority Located in California; USA based organization looking for expert vendor for provide third party administration integrated health care network provider services.

[A] Budget: Looking for Proposal

[B] Scope of Service:

(1) Vendor needs to provide third party administration integrated health care network provider services including,
- To increase access to and the timely provision of health care services by contracting with a network of outside medical providers, including the incorporation of current contracted outside medical providers and expanding on the number of available specialty services,
- To provide an electronic and standardized guide in assessing clinical appropriateness for patient referrals to outside medical services using InterQual criteria while retaining the ability for clinicians to override,
- Validates and adjudicates medical invoicing,
- Mitigates and controls inaccurate and duplicative billing,
- Ensures that the invoicing matches the terms of the contract and,
- Creates an electronic payment file that will be transmitted for payment to providers,
- TPA will determine which amounts of a Provider’s paid claim will be a “reportable” payment for 1099 reporting will track and maintain reportable payment information on a calendar year basis,
- The hospitals access outside medical service providers when the needs of a patient go beyond the scope of the internal medical staff or hospital services that can be provided on-site,
- To secure outside medical services, each hospital identifies providers, negotiates and executes contracts, oversees those contracts, processes invoices and schedules payments,
- Staff is also responsible for maintaining positive relationships with providers, resolving service quality issues and overseeing the services provided to patients.
(2) All questions must be submitted no later than August 16, 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 : Friday, 6 September, 2019

Question Answer Deadline : Friday, 16 August, 2019

Category : Medical Billing and Coding

Country : USA

State : California

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