MB-5245 - USA (New Hampshire) - Pharmacy Benefit Management Services - Deadline May 28,2021

Product (RFP/RFQ/RFI/Solicitation/Tender/Bid Etc.) ID: MB-5245

Government Authority located in New Hampshire; USA based organization looking for expert vendor for pharmacy benefit management services.

[A] Budget: Looking for proposal

[B] Scope of Service:

(1) Vendor needs to provide pharmacy benefit management services for its employee and retiree health benefit plan, including the services and programs.
- Mandatory Mail order for maintenance drugs after three retail purchases per prescription, with employee opt-out.
- Claims adjudication.
- Exclusive specialty pharmacy program.
- Clinical and cost management programs.
- Administration of run-out claims for 12 months following termination of the contract. The cost of run-out administration must be included in Bidder proposed administration fees.
- Acceptance of payment of claims and administrative expense invoices via electronic funds transfer.
- Report on a minimum of 23 group breakouts and a lesser number of COBRA breakouts, which may be adjusted during the term of the contract.
- Interface with the state's eligibility systems.
- Ability to give credit for charges applied to out-of-pocket maximums that accumulated with a prior carrier.
- Provide quarterly reports detailing plan performance and address account and member service issues, federal and state pharmacy benefit management and pharmacy legislation and legislative trends and development in the market.
- At the state's discretion, attendance at a mid-year and annual plan performance review for each plan year in person.
- The account executive and clinical account executive shall remain constant, within the contractor's control, for at least the first 18 months of the contact period.
- Attendance at annual open enrollment meetings as needed.
- Provide a designated customer service toll-free phone number to be answered by a live person in the United States with 24/7 customer service hours.
- Ability to have an independent audit performed of the claims operation at no cost to the state.
- The State is currently contracted with SkySail Rx to perform ongoing, real-time electronic review and validation of pharmacy benefit management claim invoices as the foundation for reconciling pharmacy bills.
- This includes performing ongoing and ad hoc verification, analysis and reporting of all financial terms at a claims detail level.
- Claims invoice review and monitoring are not audits but a proactive review and re-adjudication of all claims to ensure the contract is being appropriately upheld and executed by the bidder.
(2) All questions must be submitted no later than May 10, 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 location.

Expiry Date : Friday, 28 May, 2021

Question Answer Deadline : Monday, 10 May, 2021

Category : Medical Billing and Coding

Country : USA

State : New Hampshire

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