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MB-5213 - USA (Alabama) - Self-Funded Group Health Insurance and Prescription Benefit Program Services - Deadline May 20,2021

Product (RFP/RFQ/RFI/Solicitation/Tender/Bid Etc.) ID: MB-5213

Government Authority located in Alabama; USA based organization looking for expert vendor for self-funded group health insurance and prescription benefit program services.

[A] Budget: Looking for Proposals

[B] Scope of Service:

(1) Vendor needs to provide self-funded group health insurance and prescription benefit program services for more complicated cases or disputes with providers, medical case management must be provided by a licensed and board-certified physician consultant.
- This employee will coordinate administrative issues, customer service, claims management, computer data entry, enrollment of new employees, COBRA administration and retiree issues or concerns
- Assignment of a dedicated account manager as the district’s account representative in each of the respective areas medical claims, medical eligibility, reporting and data services
- Ensure patients receive the most appropriate and cost-effective care
- Derive maximum advantage from available plan benefits
- Coordinate the provision of care and management of benefits for catastrophic illness or injury
- Administer the plan on a detailed billing remittance basis by division, separated by active employees, retirees, and COBRA beneficiaries
- Provide claims fiduciary services
- Establish claim denial and grievance procedures that are clearly communicated to members
- Provide the district’s designee direct access to claims data and reporting capabilities
- Coordinate with the district’s prescription benefit manager on the prescription claim data to be inclusive in each member’s medical and prescription out-of-pocket maximum
- COBRA and their dependents
(2) All question must be submitted no later than May 6, 2021.

[C] Eligibility:

Onshore (USA organization Only)

[D] Work Performance:

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

Expiry Date : Thursday, 20 May, 2021

Question Answer Deadline : Thursday, 6 May, 2021

Category : Medical Billing and Coding

Country : USA

State : Alabama

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