MB-3610 - USA (New Jersey) - Medicare Eligibility Audit Services - Deadline January 29,2020

Product (RFP/RFQ/RFI/Solicitation/Tender/Bid Etc.) ID: MB-3610

Government Authority located in New Jersey; USA based organization looking for expert vendor for medicare eligibility audit services.

[A] Budget: Looking for Proposal

[B] Scope of Service:

Vendor needs to provide medicare eligibility audit services.
- Coordinate with the state health benefits program and the school employees’ health benefits program (SHBP/SEHBP) claims administrators to identify and initiate recovery of medical claims which were paid as primary immediately upon member identification of medicare eligibility; and monitor recovery efforts by the SHBP/SEHBP claims administrators.
- Provide initial educational communications to members identified in the claims analysis. member assistance, at a minimum, should include filing of initial claim, appeal support which includes attendance at hearings; and preparation of supporting documentation including medical evidence.
- Identify Members where the SHBP/SEHBP is incorrectly indicated as the primary but who are Medicare primary covered in the Division of Pensions and Benefits (DPB) census file and the files of the SHBP/SEHBP medical and pharmacy benefit manager administrators (currently Aetna, Horizon Blue Cross and Blue Shield of NJ, and OptumRx).

[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 : Wednesday, 29 January, 2020

Category : Medical Billing and Coding, Auditing, Finance and Accounting

Country : USA

State : New Jersey

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