MB-5933 - USA (Maryland) - Camp Lejeune Family Member Program Pharmacy Benefits Manager Services - Deadline January 6,2022

Product (RFP/RFQ/RFI/Solicitation/Tender/Bid Etc.) ID: MB-5933

Government Authority located in Maryland; USA based organization looking for expert vendor for Camp Lejeune family member program pharmacy benefits manager services.

[A] Budget: Looking for Proposals

[B] Scope of Service:

(1) Vendor needs to provide Camp Lejeune family member program pharmacy benefits manager services
- To provide PBM services to coordinate with pharmacies
- The Contractor shall provide claims processing via a network of pharmacies in the most cost-efficient method to the government by achieving cost savings, in accordance with the highest standards of retail pharmacy practice
- The Contractor shall provide a comprehensive pharmacy network to all the CLFMP beneficiaries
- The Contractor shall provide a conduit for on-line coordination of benefits from other primary payers, such as Medicare Part D
- The Contractor shall provide with compliant batch files containing electronically received claims that were submitted for processing on a regularly scheduled basis
- The Contractor shall provide detailed reports of pharmacy claims history
- The contractor shall create and maintain a pharmacy network sufficient to meet the following minimum beneficiary access standards on an overall basis:
- Urban: a pharmacy within two-ten miles estimated driving distance of 90% of the beneficiaries;
- Suburban: a pharmacy within eleven- twenty miles estimated driving distance of 90% of the beneficiaries;
- Rural: a pharmacy within twenty-one to fifty miles estimated driving distance of 90% of the beneficiaries,
- The Contractor shall ensure that network pharmacies submit any claims for processing within two years of the date of service. Claims submitted after the two-year filing deadline will be denied
- The Contractor shall accept and process all electronic claims received from network pharmacies for pharmaceuticals and supplies furnished
- Ninety-eight percent (98%) of electronic claims will be processed to completion within five (5) seconds of electronic submittal of receipt of files from the pharmacy, measured on a monthly basis
- Parties to this contract will ensure only authorized access to this data to guarantee that the electronic data interchange (EDI) messages are authentic, properly authorized and traceable.  The messages will also be protected from loss, modification, or unauthorized disclosure both during transmission and storage,
- The Contractor shall establish and maintain a pharmacy network throughout the fifty United States, the District of Columbia, Puerto Rico, Guam, Northern Mariana Islands, U.S. Virgin Islands, American Samoa, and the Minor Outlying Islands.
(2) This bid is set aside for Service-Disabled Veteran-Owned Small Business (SDVOSB) Set-Aside (FAR 19.14).

[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, 6 January, 2022

Category : Medical Billing and Coding, Pharmaceutical, Pharmacy & Related Services

Country : USA

State : American Samoa , District of Columbia , Guam , Maryland , Northern Marianas Islands , Puerto Rico , Virgin Islands

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