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MB-4578 - USA (Illinois) - Third Party Administrator Services - Deadline October 16,2020

Product (RFP/RFQ/RFI/Solicitation/Tender/Bid Etc.) ID: MB-4578

Government Authority located in Illinois; USA based organization looking for expert vendor for third party administrator services.

[A] Budget: Looking for Proposals

[B] Scope of Service:

(1) Vendor needs to provide to identify competitive qualified proposers to contract for third party administrator services.
- Provide an automated Claims Management system - with current and historical information. The system will also be made available to agency staff on a view-only basis.
- Monthly Financial Statements and statistics including GAAP, income, and expenses relevant to contract.
- Monthly claim triangles in TPA standard format including restated monthly enrollment.
- Monthly IBNR analyses.
- Monthly bank statement maintenance for the Wells Fargo CMG claim funding account
- Prepare a written corrective action plan with regard to any non-compliant activities performed by TPA that are identified in the course of audits conducted or required in the agency contract.
- Establish bank account for issuing claim disbursements
- Provide monthly reports to agency of checks issued, voided, cancelled, or adjusted
- Maintain check registers for the claims disbursement account and provide copies monthly, to agency.
- Reconcile claims disbursement account each month.
- Update fee schedules in MIS as required or deemed appropriate by agency
- Match claims to their referral or authorization, when required, and deny claims not properly authorized in accordance with standard TPA claim edits, and/or agency referral and prior authorization policies.
- Create fee schedules within the claims system and process claims in accordance with agency - defined fee schedules and payment methods.
- Provide monthly claim extracts to Blue Cross.
- Maintain copies, on paper or in electronic format, of claims and attachments submitted by providers.
(2) All the questions must be submitted no later than October 2, 2020
(3) The contract period will be for three year.

[C] Eligibility:

- Onshore (US Organization Only);

[D] Work Performance:

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

Expiry Date : Friday, 16 October, 2020

Question Answer Deadline : Friday, 2 October, 2020

Category : Medical Billing and Coding

Country : USA

State : Illinois

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