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MB-4587 - USA (Hawaii) - Benefit Consulting Services and Pharmacy Benefit Consulting and Audit Services - Deadline November 5,2020

Product (RFP/RFQ/RFI/Solicitation/Tender/Bid Etc.) ID: MB-4587

Government Authority located in Hawaii; USA based organization looking for expert vendor for benefit consulting services and pharmacy benefit consulting and audit services.

[A] Budget: Looking for Proposal

[B] Scope of Service:

(1) Vendor needs to provide benefit consulting services and pharmacy benefit consulting and audit services
- to provide benefit consulting services for all of its health benefit plans, and pharmacy benefit consulting and audit services for its standalone self-insured prescription drug plans only,
-  Benefits and plan design,
-  Premiums and rates, including plan administration fees and costs, 5-year projected premiums and rates, and Medicare Part B premium reimbursements,
- Enrollment,
- Claim utilization, including breakout of claims paid by bargaining unit,
- Contract terms with insurance carriers and self-funded plan administrators,
- Performance of insurance carriers and self-funded plan administrators, including annual member satisfaction survey results,
- Services and programs provided by insurance carriers and self-funded plan administrators 8. Sufficiency of funding and reserves,
- Plan compliance with applicable federal and state laws, including HIPAA, COBRA, FMLA, ACA, USERRA, Medicare, and tax and insurance laws,
- Comparison of EUTF plan benefits and rates to large employer and public sector plans in and outside the State,
- Identification of cost drivers for the medical plan and determination of whether the insurance carriers and self-funded administrators have programs in place that address these conditions and whether they have been successful (e.g. HEDIS),
- Other matters relating to the performance and operations of the EUTF plans for the purpose of recommending improvements, modifications or revisions to be considered by the Board,
- Pharmacy Benefit Plan Audit Services:
- Whether claims have been paid properly,
- The dollar amount of any improperly paid claims,
- The options available to recover overpayments resulting from improperly paid claims,
- The PBM’s compliance with performance guarantees,
- Recommendations for improvement in the delivery of services and plan design.
(2) A Pre-Proposal conference will be held on October 8, 2020.
(3) All questions must be submitted no later than October 16, 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 : Thursday, 5 November, 2020

Pre-proposal Conference Date : Thursday, 8 October, 2020

Question Answer Deadline : Friday, 16 October, 2020

Category : Medical Billing and Coding, Auditing, Finance and Accounting, Pharmaceutical, Pharmacy & Related Services, Professional, Consulting, Administrative or Management Support Services

Country : USA

State : Hawaii

Cost to Download This RFP Document : $ 5

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