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MB-5824 - USA (Virginia) - Medical and Prescription Drug Program Administration Services - Deadline December 9,2021

Product (RFP/RFQ/RFI/Solicitation/Tender/Bid Etc.) ID: MB-5824

Government authority located in Virginia; USA based organization looking for expert vendor for medical and prescription drug program administration services.

[A] Budget: Looking for Proposal

[B] Scope of Service:

(1) Vendor needs to provide medical and prescription drug program administration services.
- To provide employees with a quality, affordable health insurance program responsive to the diverse needs of employees.
- To ensure costs are managed effectively by taking advantage of cost and utilization management opportunities available in the marketplace while increasing quality.
- To responsibly utilize governmental dollars.
- Provide all resources as may be required to administer its group medical and prescription drug program to owner employees, their dependents and retirees.
- Provide and/or make available necessary, appropriate and high-quality medical care to the county’s eligible employees, retirees, and their dependents.
- Provide necessary and appropriate program administration and services, including but not limited to, maintaining central claims and membership files (including social security numbers, dates of coverage, type of coverage, etc.) for each covered member, by account/division number (i.e. county, schools, other agencies); maintaining payment record; capable of the wire transferring of funds; capable of making payment of providers directly; capable of providing state-of-the-art data tracking and claims paying services; furnish monthly accounting statements by benefit plan and employer showing enrollment, premiums/revenues received, amount of claims paid, capitation expenses charged, detailed list of expenses charged, network discounts earned, claims exceeding the specific stop-loss limit and an estimate of incurred but not reported claims.
- Furnish to each employee enrolled in the plan a benefit booklet outlining and defining all covered services, limitations and exclusions, procedures for receiving services, schedule of benefits, COBRA and other plan information requirements.
- Provide the owner with quarterly utilization and savings reports specific to the benefits paid and services rendered to covered members.
- Maintain a local or toll-free customer service number for employees and dependents.
- Provide a systematic procedure for appeal of claims.
- Provide cost containment services. Cost containment services may include but need not be limited to: pre-certification of hospital admissions, utilization review services, large case management for hospital inpatient services, and review of high-cost outpatient services.
(2) All questions must be submitted no later than November 17, 2021.

[C] Eligibility:

- Onshore (US Organization Only);

[D] Work Performance:

Performance of the work will be Offsite.

Expiry Date : Thursday, 9 December, 2021

Question Answer Deadline : Wednesday, 17 November, 2021

Category : Medical Billing and Coding

Country : USA

State : Virginia

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