MB-3961 - USA (Kansas) - Medical Plan Administration Services - Deadline March 30,2020

Product (RFP/RFQ/RFI/Solicitation/Tender/Bid Etc.) ID: MB-3961

Government Authority located in Kansas; USA based organization looking for expert vendor for medical plan administration services.

[A] Budget: Looking for proposal

[B] Scope of Service:

(1) Vendor needs to provide medical plan administration services to over 500,000 residents through more than 40 offices, agencies, and departments.
• Administration:
- Provide coordination of benefits administration. Vendor must confirm they can pend or deny claims affected by a failure of the employee to not annually declare the existence or absence of other group health coverage.
- Provide at no cost and in a timely manner all data and written or recorded material pertaining to this contract, including provider quality of care data, provider payment information and premium construct by medical service code and category as well as administrative expenses of bidder, e.g. such as report progress of the benefits plan on a quarterly basis, coordinating with benefit providers to obtain relevant performance data, provide analysis of benefit plan performance, premiums vs. claims, clinical data analysis, and wellness programs.
- Provide complete plan administration, accounting, data processing, and cost control, quality assurance, utilization review, marketing, claims processing, customer service, fiscal services, and other services related to the medical and prescription (if applicable) plan. Furnish a monthly accounting of all payments of claims and utilization data for the medical and prescription (if applicable) plan in a mutually agreed upon secure electronic format.
- Provide complete banking arrangements for claims payments, including the printing and issuing of checks and preparation and filing of 1099 forms with the IRS.
• Claims Processing:
- Provide coverage without restriction by residence, 24 hours per day, on a worldwide basis.
- Begin processing and paying claims at 12:01 a.m., January 1, 2021.
- Provide processing of all claims run-out incurred during term of contract for six months (or mutually agreed upon date if less than 6 months) following termination date of the contract, if requested by the Client.
- Provide for all levels of unbiased review of claims, claim denials and appeals made by employee and dependents. Determination of payment or denial of claims or appeals of claims shall be made by the vendor following appropriate analysis and review. Employer retains the right to uphold, overturn or modify any denial of a claim by vendor.
• Education and promotional:
- Provide a Vendor web site that is accessible to all employee members and their dependents for access to medical/Rx information with the plan provider directories, provider facilities, plan coverage, plan eligibility, plan claims and appeals, and registration to a personal medical/Rx account to view employee and dependent claim payment activity and details.
• Limited Consulting Services:
- Advise and assist in a consultative capacity with regard to the benefits under the medical plan and related benefit programs and any revisions of the medical plan design as deemed appropriate from time to time, including advice and assistance with respect to provisions relating to eligibility, effective dates, coverage and cessation of coverage under the plan or related programs.
(2) All the questions must be submitted no later than March 13, 2020
(3) The contract period 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 premises.

[E] Proposal Submission:

Response can be submitted digitally via Email or Online.

Expiry Date : Monday, 30 March, 2020

Question Answer Deadline : Friday, 13 March, 2020

Category : Medical Billing and Coding

Country : USA

State : Kansas

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