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MB-3918 - USA (California) - Third Party Administrator Service - Deadline April 30,2020

Product (RFP/RFQ/RFI/Solicitation/Tender/Bid Etc.) ID: MB-3918

Government authority located in California, USA; based organization looking for expert vendor for third party administrator service.

[A] Budget: Looking for Proposal

[B] Scope of Service:

(1) Vendor needs to provide third party administrator service to administer health care services for indigent adults.
- third party administrative services for CMSP, a self-funded health benefit coverage program, to be managed in accordance
- participant eligibility verification, management and expansion of the established contracted provider network, claims processing and adjudication (including prospective coordination of benefits and third-party liability recoveries), prior authorization, utilization management, cost containment programs, and accounting services
- Ability to design and administer an effective utilization management program for CMSP benefit
coverage that addresses inpatient and ambulatory prior approval processes, medical case
management, and inpatient concurrent review and discharge planning
- Dedicated account management
- process claims received from providers and determine whether such claims qualify for reimbursement in accordance with the CMSP and Path to Health benefit packages, enrollee eligibility, and sources of other primary payer liability, and determine the payment applicable to them.
- claims processing system capable of accepting claims submitted on standard provider claim forms and through electronic mechanisms
- maintain procedures for prepayment and post-payment claims review, including review of data related to provider, enrollee, and covered services for which payment is claimed.
- Claims with an indicator of an accident-related injury
- Claims with an indicator of employment-related illness or injury.
(2) All questions must be submitted no later than March 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, 30 April, 2020

Question Answer Deadline : Sunday, 15 March, 2020

Category : Medical Billing and Coding

Country : USA

State : California

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