MB-4278 - USA (New York) - Medical Claims Administration Services - Deadline July 17,2020

Product (RFP/RFQ/RFI/Solicitation/Tender/Bid Etc.) ID: MB-4278

Government Authority located in New York; USA based organization looking for expert vendor for medical claims administration services.

[A] Budget: Looking for proposal

[B] Scope of Service:

(1) Vendor needs to provide medical claims administration services with strategic plan management capabilities for self-insured medical programs.
- Administration, claim processing and service;
- Managed care capabilities, including scope and quality of existing provider networks;
- Utilization management programs and services;
- Administrative charges and retention;
- Availability of reporting capabilities;
- Compliance with specifications as presented;
- Ability to provide data file feeds/ downloads to subcontracted vendors on a weekly basis;
- On-line capabilities, including web tools, employer portal with reporting and an online benefit eligibility management and employee portal;
- Ability to accept a direct feed from enrollment vendor;
- Performance Guarantees.
- The Town’s goal is in developing a long-term strategy that incorporates strategic plan management opportunities with access to the most appropriate and cost-effective national provider networks.
- COBRA/HIPAA Administration;
- Stop loss reporting;
- Claim Adjudication: -
- A dedicated claims supervisor (team leader) that will be assigned to the Town’s account;
- Appropriate EOB, paid or denied. If a network discount is applied, the EOB must reference the patient is not responsible for the amount of the negotiated contract discount;
- Review, adjudication, processing and payment of all claims including folding, stuffing, addressing (including postage) of all drafts, EOBs, and forms;
- Claim investigation and analysis prior to payment. Outline your process and suspense procedure with regard to questionable claims, incomplete claims, or in an instance where a fee or charge is in excess of your reasonable and customary profile;
- Primary requirements to meet this goal:
• Provide a strategy incorporating network reimbursement/managed care capabilities into new or existing programs.
• Deliver accurate, responsive and timely claims payment.
• Provide effective and accurate member services.
• Provide timely, standard reporting and data file feeds to Premier and/or subcontracted vendors to assist the client in managing its plan.
- Select an administrator with a well-developed provider network to ensure employee access to high quality care through network physicians, hospitals and providers.
- Maintain effective pre-admission certification, concurrent review and case management programs for all employees regardless of in or out-of-network access.
- Maintain freedom of choice for the employees to those providers best able to offer both the quality care and utilization controls necessary to meet benefits cost objectives.
- Maintain effective utilization management in all areas
- For more information describe in documents.
(2) All question must be submitted no later than June 24, 2020.

[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 : Friday, 17 July, 2020

Category : Medical Billing and Coding

Country : USA

State : New York

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