MB-4139 - USA (Washington, DC) - Supplemental Dental Benefits Administer Services - Deadline June 1,2020

Product (RFP/RFQ/RFI/Solicitation/Tender/Bid Etc.) ID: MB-4139

Government Authority located in Washington, DC; USA based organization looking for expert vendor for supplemental dental benefits administer services.

[A] Budget: Looking for Proposal

[B] Scope of Service:

Vendor needs to provide administer and insure its supplemental dental insurance plan.   
1. Administrative and Enrollment Services
- Administer a dental plan that provides the benefits of work on a fully-insured, non-participating basis.
- Design, produce and distribute, subject to the approval of agency, enrollment forms, claim forms, employee booklets, summary plan descriptions (SPDs), and all other forms required to administer the plan.
- Provide electronic files of the plan materials (booklets, SPDs, etc.) and fillable forms in a .pdf format to be uploaded to the Intranet.
- Provide monthly enrollment reports, included with the monthly invoice.
- Provide an electronic portal where covered employees and eligible individuals may enroll, change coverage, submit documentation, access claim related information and access a list of providers.
2. Claims Processing Requirements
- Processing all claims on a direct claims verification and payment basis.
- Establishing and maintaining a clean turnaround time. (i.e., 90% of claims received are processed in 10 work days or less, and 98% are processed in 15 work days or less.)
- Verifying claim charges are for covered employees and dependents.
- Determining eligibility for benefits.
- Providing explanation of benefits (EOB) statements.
- Maintaining current, complete and confidential records for each covered person.
- Providing effective coordination of claims payment and reporting formats.
- Providing service personnel who are accessible and knowledgeable in all aspects of the Plan.
- Maintaining an automated calendar system to ensure follow-up to correspondence and claims review and establishing a mechanism to resolve errors expeditiously.
3. Management Information System and Reporting and Monitoring Service Requirements
- Provide an annual utilization report including, but not limited to, a breakdown of claims experience by types of service (i.e., total amounts paid and number of claims for each type of service).
4. Phase-Out and Transition of Operations and Cooperation with Successor
- The contractor shall perform phase-out activities to transition work to a successor contractor.
Specifically, the contractor shall cooperate with any successor contractor, and perform all actions necessary to transfer operations to ensure full continuity of services.

[C] Eligibility:

- Onshore (USA Organization Only);

[D] Work Performance:

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

Expiry Date : Monday, 1 June, 2020

Category : Medical Billing and Coding

Country : USA

State : District of Columbia

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