MB-3639 - USA (New York) - Medical Benefits Administration Services - Deadline December 30,2019

Product (RFP/RFQ/RFI/Solicitation/Tender/Bid Etc.) ID: MB-3639

Government Authority located in New York; USA based organization looking for expert vendor for medical benefits administration services.

[A] Budget: Looking for Proposal

[B] Scope of Service:

(1) Vendor needs to provide medical benefits administration services to developing a long-term strategy that incorporates plan management opportunities with access to the most appropriate and cost-effective provider networks.
- General account management services, will include On-line enrollment capability (with an independent vendor), Direct claim verification of eligibility, Direct claims submission, Claim adjudication, HCRA Filing, Customer Services (employer, provider or participant inquiries), Medical Management services and reports, Annual financial accounting reports, Banking transfer, reporting and reconciliation services, Implementation, Communication services, Underwriting and actuarial services, Renewal services, Regulatory compliance services, Managed Network Services (to include adjudication of non-network claims), Utilization Review Services/Large Case Management, Disease Management/Wellness Plans and reporting, Fiduciary responsibility for second level appeals, Network access; primary and wraparound, Subrogation, Vision, Summary Plan Description (SPD) and Summary Benefit Comparisons (SBC) production, printing, distribution and updates, COBRA/HIPAA Administration, Stop loss reporting, Ad-hoc reporting, Download of data files to external vendors, Additional services as requested by the City.
- Claims Administrator agrees to provide an accurate claims data feed to a third-party claims and eligibility warehouse.
- Claim investigation and analysis prior to payment. Outline your process and suspense procedure with regard to questionable claims, incomplete claims, or in an instance where a fee or charge is in excess of your reasonable and customary profile.
- Timely and accurate claim service and responsiveness to employee inquiries is important.
customer service capacities and guarantees will play an important role in the city’s offeror selection decision.
- Toll-free access to claims and customer service personnel as follow 8:00 AM – 8:00 PM (Eastern Standard Time) Monday through Friday, and 24-hour provider access through voice response or member service.
- Legal services, including preparing and filing all legal documents necessary to implement and maintain the plan, including policies, amendments, contracts and required state filings including HCRA filings, provide necessary legal defense in the event of litigation, involving a managed care network and its providers and/or utilization review services, monitoring federal and state legislation affecting the plans.
(2) All question must be submitted no later than December 02, 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 : Monday, 30 December, 2019

Question Answer Deadline : Monday, 2 December, 2019

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

Country : USA

State : New York

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