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MB-4521 - Canada (Quebec) - Health Care Claims Processing and Other Related Services - Deadline November 2,2020

Product (RFP/RFQ/RFI/Solicitation/Tender/Bid Etc.) ID: MB-4521

Government Authority located in Quebec; Canada based organization looking for expert vendor for health care claims processing and other related services.

[A] Budget: Looking for Proposal

[B] Scope of Service:

Vendor needs to provide health care claims processing and other related services.
a) Contract Start-Up: - The Contract includes a Start-Up Phase during which time the Contractor must develop, test, finalize and implement its solution for delivering the PSHCP ASO work requirements; migrate PSHCP Member information and claims data from Canada and the incumbent ASO contractor to its own claims processing system; and obtain the required TBS Project
Authority approvals in order to commence processing claims for the PSHCP.
b) Privacy and Security
All services and deliverables provided under the Contract must comply with the Privacy and
Security requirements set-out in the Contract.
c) Member and Provider Facing Core Services
The services to be provided under the Contract encompass Member and Provider facing
services which are further described herein and summarized as follows:
i. Claims Processing and Claims Payment Services provides PSHCP Members with timely and accurate claims processing, claims adjudication and claims payment services for eligible claims under the PSHCP;
ii. Positive Enrolment and Membership Management Services provides the systems and processes necessary to maintain accurate PSHCP enrollment information for all Members and Eligible Dependents and affirm Consent from Members for the use of personal information;
iii. Provider Registration and Management Services provides the systems and processes necessary to qualify and track Providers that are eligible to provide services to be considered for payment under the PSHCP as well as establishes formal Agreements with eligible Providers so that the Contractor can accept Digital claims submissions for these Providers;
iv. Member Communications and Information Services - provides a solution which facilitates the provision of information related to the PSHCP and claims to Members through multiple channels including Contact Centers, Member Digital Services, and written communication products;
v. Provider Communications and Information Services - provides a solution which facilitates the provision of information related to the PSHCP and its claim procedures to Providers through multiple channels including Provider Contact Centres, Provider Digital Services, and written communication products; and
vi. Veterans Affairs Canada (VAC) Remittance Administration Services – provides collection services for VAC monthly Member contributions on behalf of the PSHCP.
d) Supporting Services: - The supporting services required under the Contract facilitate high quality service to Participants and program accountability for sound fiduciary and resource management. The required programs and services included are further described herein and are summarized as
follows:
i. Financial Management Services and Controls ensure that all aspects of business
transactions conducted by the Contractor for the PSHCP are accurate, efficient, secure
and free from errors or abuse;
ii. An Audit and Claim Verification Program to reduce the risk and financial implications of
PSHCP claims being processed and reimbursed incorrectly and/or inconsistently with the
PSHCP Directive;
iii. A Quality Assurance Program provides ongoing assessment and continuous
improvement activities, to foster quality service to all stakeholders, by defining ways to
eliminate causes of unsatisfactory performance and incorporate recommendations into
operations; and identify best practices and apply them consistently across PSHCP
services;
iv. Reporting Services provide an extensive and in-depth solution to facilitate the
management of the PSHCP and support management of the Contractor’s performance.
The Reporting Services solution must include Standard, Ad-hoc and Plan Annual reports
as well as management dashboard capabilities, which are accessible to the Project
Authority via a Secure Reporting and Documentation Website dedicated to the PSHCP;
v. Continuity Management ensures that the necessary processes and procedures are in
place to enable the restoration and recovery of critical functions and services in the event
of short-term interruption or a major interruption that requires access to alternative
resources such as power, systems, buildings and staff;
vi. Retention of Records safeguards all Digital and paper Records and Documentation (e.g.
completed PSHCP Claim Forms and associated records and documents, communication
materials, manuals, financial records, registration documentation, recorded calls and call
logs and Provider Audit records), in a format which can be easily retrieved by the Project
Authority when required; and
vii. Strategic Review and Advice Services provides the Project Authority with insight t

[C] Eligibility:

- Onshore (Canada Organization Only);

[D] Work Performance:

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

Expiry Date : Monday, 2 November, 2020

Category : Medical Billing and Coding

Country : Canada

State : Quebec

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