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MB-4551 - USA (Tennessee) - RFI for Medical Claims Audit Services - Deadline October 1,2020

Product (RFP/RFQ/RFI/Solicitation/Tender/Bid Etc.) ID: MB-4551

Government Authority located in Tennessee; USA based organization looking for expert vendor for medical claims audit services.

[A] Budget: Looking for Proposals

[B] Scope of Service:

Vendor needs to provide medical claims audit services to medical and behavioral health claims audits.
- The Department of Finance and Administration, Division of Benefits Administration manages benefits for three self-insured risk pools serving state, higher education, local education and local government employees, retirees and their dependents. For this audit, we are focusing on state
and higher education employees, retirees and their dependents. The Plans have two medicals Third Party Administrators (TPA) and one behavioral health TPA.
- The Department of Finance and Administration’s, Division of Benefits Administration, manages health insurance, dental, pharmacy, life, vision, flexible benefits and Health Savings Accounts for three separate Plans with coordinated benefits and governing bodies charged with the responsibilities of providing benefits to the Plans. The focus of this RFI is the State Plan, which provides benefits to state and higher education employees, retirees and Consolidated Omnibus Budget Reconciliation Act (COBRA) participants and their dependents. The State Plan currently
provides self-funded medical coverage to approximately 146,000 total lives through three health plan benefit options: Premier PPO, Standard PPO, and a Consumer Driven Health Plan (CDHP) paired with a health savings account. For calendar year 2019, there were over 2,107,000 medical claims paid for the State Plan.
- Improper procedure coding, billing errors, and payments inconsistent with the Plan benefits and - policies result in improper payments to providers do occur in the industry. The State seeks services that include a comprehensive and objective review of the claims processed by the TPAs
to determine if claims were adjudicated and paid according to contractual standards between the TPA and the provider, Plan benefits and policies, and industry standards, such as those associated with cost containment and refund procedures.
- For more information describe in document.

[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 : Thursday, 1 October, 2020

Category : Medical Billing and Coding

Country : USA

State : Tennessee

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