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MB-3732 - USA (Alaska) - Professional Pharmacy Billing Auditing Services - Deadline January 23,2020

Product (RFP/RFQ/RFI/Solicitation/Tender/Bid Etc.) ID: MB-3732

Government Authority located in Alaska; USA based organization looking for expert vendor for professional pharmacy billing auditing services.

[A] Budget: Looking for Proposal

[B] Scope of Service:

(1) Vendor needs to provide professional pharmacy billing auditing services.
- Computerized pharmacy benefit management program to the municipality self-administered workers compensation claim program.
- Pharmacy benefit management program must include ability to receive electronic requests for pharmacy benefits through the municipality’s computerized claim system, claim pilot, describe the process by which you will provide each claimant with a retail drug card. the card must list an effective date. retail drug cards must be provided for new claimants and replacement cards must be provided to existing claimants on an ongoing basis. please describe any capabilities you might have to supply such information in a digital format, e.g., to a claimant’s cell phone via an app, the pharmacy ID cards will provide eligible claimants with access to prescription medications at a large national network of preferred providers, claimants enrolled in the pharmacy benefit program will be entitled to receive eligible medications via home delivery order, generic medications should be substituted in compliance with statutes, contractor shall employ medication plans and formularies specific to body part and nature of injury, the contractor shall review prescriptions to identify those not related to the claimant’s medical treatment, medications that are temporarily blocked at point of sale should be immediately routed to the municipality’s claims adjusters for review, contractor is required to follow municipality’s escalation of approvals process – 24 hours after initial fill request is received by contractor, if initial authorized approver has not responded, contractor will contact next senior municipality adjuster for approval, and so forth, the contractor shall review prescriptions to identify duplications, early refills, and possible abuse, MOA must be alerted to any such findings, the contractor shall track opioid prescription usage for potential abuse and notify the prescribing physician of potential problems in writing, the contractor shall maintain a clinical staff capable of performing medication utilization review accompanied by recommendations for therapy, considering available medical records and prescription history, the contractor shall have a staff of clinical pharmacists available to provide customized support for medication-related decisions.
(2) All question must be submitted no later than January 15, 2020.

[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, 23 January, 2020

Question Answer Deadline : Wednesday, 15 January, 2020

Category : Medical Billing and Coding, Auditing, Finance and Accounting, Billing Services, Professional, Consulting, Administrative or Management Support Services

Country : USA

State : Alaska

Cost to Download This RFP Document : $ 5

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