MB-3569 - USA (Montana) - Claims Processing and Management Services and Software - Deadline January 30,2020

Product (RFP/RFQ/RFI/Solicitation/Tender/Bid Etc.) ID: MB-3569

Government Authority located in Montana; USA based organization looking for expert vendor for claims processing and management services and software.

[A] Budget: Looking for Proposals

[B] Scope of Service:

(1) Vendor needs to provide claims processing and management services and software to support
the receipt, adjudication and editing, pricing and payment for health care claims.
- Pharmacy Claims Processing and Management Services module is an on-line, real time pharmacy claims adjudication system
• An enterprise system that is flexible to quickly adapt to the dynamic, evolving needs of existing programs and support new regulations, policies and innovations
• An enterprise system founded on business-driven technical solutions
• An enterprise system where business processes are automated wherever possible
• An enterprise system that provides centralized access to data
• An enterprise system that includes data analytics tools to support the use of clinical data to measure treatment outcomes and the changing health status of members.
• An enterprise system that includes standardized and automated electronic communication and data exchange capabilities
• An enterprise system that includes a master client index (MCI)
• An enterprise system that integrates data from disparate systems to enable enterprise wide-program management
- Claims processing and management services module will adjudicate, edit, price, and determine reimbursement amounts for healthcare claims. During claims adjudication this module will also process service authorizations, third party insurance liability, and calculate member liabilities.
(2) All questions must be submitted no later than December 13, 2019.
(3) A pre-proposal conference call and pricing conference call will be held on November 12, 2019 and November 21, 2019 respectively.

[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 : Thursday, 30 January, 2020

Pre-proposal Conference Date : Friday, 13 December, 2019

Question Answer Deadline : Tuesday, 12 November, 2019

Category : Medical Billing and Coding, Software, System and Application

Country : USA

State : Montana

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