MB-5821 - USA (Arizona) - Dental and Vision Plan Services - Deadline December 15,2021

Product (RFP/RFQ/RFI/Solicitation/Tender/Bid Etc.) ID: MB-5821

Government Authority located in Arizona; USA based organization looking for expert vendor for dental and vision plan services.

[A] Budget: Looking for Proposals

[B] Scope of Service:

(1) Vendor needs to provide dental and vision plan services
- to offer a Fully Insured PPO Dental plan and a Fully Insured Voluntary Vision plan with current or a similar plan designs for the July 1, 2022 through June 30, 2023 plan year.
- Provide a designated Account Manager and Account Management Team
- Customer Service:
- Provide a designated call and claim unit with toll free telephone access.
- Provide customer service to answer inquiries on claims, eligibility, services, coverage, or other inquiries from participants Monday through Friday from 8:00 AM to 6:00 PM
- Provide prompt response to all telephone inquiries from plan participants and providers of service
- Communication/Education Support:
- Provide bilingual communication/educational materials
- Claims Administration:
- Provide claims forms (as applicable)
- Determine benefits payable under the Plan, pursuant to the terms and conditions of the District’s Benefit Plan booklets
- Receive claims and process payments of benefits in accordance with the plan designs for all claims incurred
- Correspond with participants if additional information is necessary to complete the processing of claims
- Coordinate benefits payable under the Plan and with other benefit plans, if applicable
- Provide notice to the Participants regarding the reason(s) for denial of benefits (which are denied) and provide for the review of such denied claims
- Provide an explanation of benefits resulting from claims transactions to plan participants
- Reporting Requirements:
- Provide timely management reports or internet access to monitor financial and service level performance. Such reports must include the following information, as applicable based on type of coverage being provided:
- PPO Dental:
- Monthly:
- Enrollment (subscriber/member) by coverage tier and status (active/COBRA)
- Premiums paid
- Claims paid by status (active/COBRA) and in-network vs out-of-network.
- Annually:
- Utilization Report
- Lag Report,
- Voluntary Vision:
- Monthly:
- Enrollment (subscriber/member) by coverage tier and status (active/COBRA)
- Premiums paid
- Claims paid by status (active/COBRA) and in-network vs out-of-network.
- Annually:
- Utilization Report
- Lag Report.
(2) All the questions must be submitted no later than November 16, 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 : Wednesday, 15 December, 2021

Question Answer Deadline : Tuesday, 16 November, 2021

Category : Medical Billing and Coding

Country : USA

State : Arizona

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