MB-3951 - USA (Delaware) - Medical and Prescription Insurance Audit Servics - Deadline March 27,2020

Product (RFP/RFQ/RFI/Solicitation/Tender/Bid Etc.) ID: MB-3951

Government Authority located in Delaware; USA based organization looking for medical and prescription insurance audit services.

[A] Budget: Looking for Proposals

[B] Scope of Service:

(1) Vendor needs to provide medical and prescription insurance audit services.
- Provider submissions included necessary documentation to support the claim,
- Claims were paid in strict accordance with Plan provisions,
- Established administrative procedures were followed and within industry guidelines,
- Claims were paid only for eligible individuals,
- Claims that required reviews, including pre-certification and utilization review for example, received appropriate evaluation,
- Third party recovery procedures, including coordination of benefits with Medicare and other group plans, were followed in accordance with plan provisions and standard insurance industry protocols,
- Amounts paid were within contracted or non-contracted allowances,
- Benefits were paid under the proper benefit classification, diagnostic, and procedure codes,
- Benefit limitations, deductibles, copays, coinsurance, and out-of-pocket maximums were properly applied,
- Arithmetic calculations were correct and payments were made to the proper party,
- Duplicate claims have been properly denied,
- Number of claims examined and total paid amount of the claim.
(2) Mandatory pre-bid conference will be held on March 10,2020.
(3) All question must be submitted no later than March 13, 2020.
(4) A contract term will be for one year.

[C] Eligibility:

Onshore (USA Only)

[D] Work Performance:

Performance of the work will be Offsite. Vendor needs to carry work in their office location.

[E] Proposal Submission:

Response should be submitted physically (courier or post).

Expiry Date : Friday, 27 March, 2020

Pre-proposal Conference Date : Tuesday, 10 March, 2020

Question Answer Deadline : Friday, 13 March, 2020

Category : Medical Billing and Coding, Insurance Services, Medical Services

Country : USA

State : Delaware

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