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MB-3697 - USA (Massachusetts) - Healthcare Medical and Prescription Drug Claims Services - Deadline January 29,2020

Product (RFP/RFQ/RFI/Solicitation/Tender/Bid Etc.) ID: MB-3697

Government Authority located in Massachusetts, USA based organization looking for expert vendor for healthcare medical and prescription drug claims services.

[A] Budget: Looking for Proposal

[B] Scope of Service:

Vendor needs to provide healthcare medical and prescription drug claims services for all claims incurred during the 2019 fiscal year to evaluate the claims from the city health insurance companies against industry and contract standards for accuracy, timeliness and quality of operation and service, to recommend improvements and to identify performance issues for future contracts.
- The operational review will focus on operational issues, which pose potential risks to the city healthcare trust fund through claim adjudication
- A statistical claim audit will involve on-site testing of a statistically valid sample of claims at a level of accuracy consistent with industry standards
- Payment accuracy defined as the number of claims with correct payments divided by the total number of claims, processing accuracy defined as the number of claims with no payments or procedural errors divided by the total number of claims and financial accuracy defined as the total benefits paid correctly divided by the total of all benefits paid
- Procedures for coordination of benefits, unusual or excessive claims
- How telephone inquiries were handled
- How pending claims were handled
- Controls against duplicate payments
- Available management reports
- Procedures for handling employee questions and claim disputes practices
- Employee submitted claims communication materials and resolution procedures

[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

Country : USA

State : Massachusetts

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