MB-3863 - USA (Virginia) - Medical, Prescription and Stop Loss Insurance Services - Deadline March 10,2020

Product (RFP/RFQ/RFI/Solicitation/Tender/Bid Etc.) ID: MB-3863

Government Authority located in Virginia; USA based organization looking for medical, prescription and stop loss insurance services.

[A] Budget: Looking for Proposals

[B] Scope of Service:

(1) Vendor needs to provide medical, prescription and stop loss insurance services include prescription drug coverage for active employees, COBRA beneficiaries,
- Provide or make available necessary, appropriate and high quality medical and prescription drug benefits and claims administration services to each member,
- Provide networks of providers, which are broad enough to ensure that all members (active and retired) have reasonable access to an adequate number of highly qualified primary care and specialist providers,
- Provide high quality, efficient program administration and services including,
   a. Maintaining central claims and membership files for each covered member that includes identification numbers, SSNs, dates of coverage, tier level of coverage, plan option elected, etc,
   b. Providing identification cards to all covered members prior to the effective date of the program,
   c. Maintaining compliance with health insurance portability and accountability act privacy and security standards, health information technology for economic and clinical health and all other applicable HIPAA requirements,
- Designate a single point of contact (accountable to the City) who is the person with primary responsibility for resolving problems, answering claims and administrative or billing questions, and expediting all issues related to the program,
- Assign a dedicated customer service team to work with the city’s benefits staff with all administrative and service issues related to the program,
- Provide an organizational chart and list of contacts in relevant functional areas (with phone numbers and email addresses). Provide updates to this chart as changes occur,
- Agree to release all pertinent data related to the administration and management of the medical and prescription drug program under the business associate agreement to designated personnel of the city and their consulting team,
- Medical administrator agrees to provide eligibility file to pharmacy benefit manager, PBM agrees to work with the medical administrator to establish like plan structure & potentially same ID numbers,
- Agree to provide bills electronically or in Excel or text format,
- The City desires to include COBRA and retiree monthly billing services. The billing is for direct-billed retiree and COBRA participant contribution requirements as authorized by the city,
- The TPA shall provide bank draft and credit card payment options for COBRA participants and direct-billed retirees,
- The TPA is also responsible for reconciling the accounts receivable each month based on premium payments and additions, terminations, and changes submitted by the city,
- Provide monthly data files to audit firms, outside PBM, outside stop loss vendor and other entities as required. Please outline any fees associated with this reflected as a PEPM fee,
- Provide quarterly data showing the number of members eligible to participate in a disease management or chronic case management program and actual participation in these programs,
- Provide a Mobile App that enables participants to obtain important information from a mobile device. Information available through this app must include, but is not limited to, locating provider(s), accessing a Virtual ID Card, viewing benefit information, viewing plan information, viewing prescription drug information, viewing articles on various health topics, and updating contact information (email address and phone number(s)).
(2) All question must be submitted no later than February 21, 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 : Tuesday, 10 March, 2020

Question Answer Deadline : Friday, 21 February, 2020

Category : Medical Billing and Coding

Country : USA

State : Virginia

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