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MB-5810 - USA (Florida) - Health Plan Third Party Administrator Services - Deadline January 5,2022

Product (RFP/RFQ/RFI/Solicitation/Tender/Bid Etc.) ID: MB-5810

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

[A] Budget: Looking for Proposals

[B] Scope of Service:

Vendor needs to provide third-party administrators for services related to managing the School District’s self-insured health services plan for active employees, eligible retirees, and their dependents effective October 1, 2022.
A. Staffing and Access Requirements:
1. Provide one experienced account manager with large client account management experience who is highly accessible to the School Board. This resource is to be supported by a comprehensive customer service component that is accessible, effective, and efficient
2. Provide one dedicated and experienced on-site client service representative to assist employees. This on-site representative must be exclusive to the School Board. The School Board will house the representative at the Administrative Offices on Simpson Rd. and will provide office space, telephone line, and internet access
3. Establish and maintain a toll-free line for members. Provide a dedicated toll-free telephone line with live caller support through a designated member service team (including member service representatives and supervisors) available 24 hours a day, seven days a week, 365 days a year. The incumbent currently has after-hours support with an Aither Representative on call. The toll-free number should include a telephone tree that directs members to the other partners on the account
- Implementation Timeline: TPA must provide a detailed implementation timeline at the time of contract signing. During renewals, the implementation will be furnished 90-days before the beginning of the plan year.
- Claim Reconciliation and Reporting
1. Subject to the exercise of professional judgment, the winning proposer shall accept and settle or deny all reported claims.
2. Meet with the School Board, at a minimum, quarterly, to discuss the status of the plan, performance, audits, reports, and planning. See reporting section for required reports.
3. Verify claimant’s eligibility for benefits based on eligibility requirements furnished by the School Board.
4. Provide secure upload site/FTP site for electronic eligibility file.
- Pay COBRA beneficiary claims
- Medical/Utilization Management (UM): provide precertification, pre-admission review, concurrent, and retrospective review services to eligible persons based on the medical necessity of services and treatment utilizing nationally recognized guidelines. Provide all medical reviews needed (nurse, physician, or medical director).
- Case Management (CM): identify members who may need case management services, transitional care management, and/or targeted interventions. Case management nurses will work with plan members who have a catastrophic or chronic diagnosis that will or could require extensive use of healthcare resources. During this process, case management nurses ensure that all available resources are being used in a timely and cost-effective manner to obtain the most value for both the member and the Plan.
- Chronic Disease Management (DM): Provide creative programs regarding chronic disease management to include but not limited to the following medical conditions: asthma, coronary artery disease, congestive heart failure, ESRD, dialysis, diabetes, high blood pressure, and high cholesterol. Current services include telephonic coaching; however, participation is extremely low.

[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 : Wednesday, 5 January, 2022

Category : Medical Billing and Coding

Country : USA

State : Florida

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