MB-6521 - USA (Wyoming) - Dental Benefit Manager Services - Deadline July 7,2022

Product (RFP/RFQ/RFI/Solicitation/Tender/Bid Etc.) ID: MB-6521

Government Authority located in Wyoming; USA based organization looking for expert vendor for dental benefit manager services.

[A] Budget: Looking for Proposals

[B] Scope of Service:

(1) Vendor needs to provide dental benefits manager (DBM) services for dedicated clinical account management on a fee per claim basis.
● Claims processing and adjudication on a fee per claim basis. The contractor’s fee must be disclosed in the amounts in the proposal price sheet.
● Paying dental providers for copay and deductible costs and passing those costs, without markup or fees, to the agency for reimbursement.
● Plan performance review and audit participating dental clinics at a minimum of once per year, or more, as it deems necessary or as reasonably requested by the agency. The contractor shall report to the agency any errors or improper activity detected through such an audit and shall take such corrective action as appropriate to prevent future errors.
● Clinical management services such as service management, monitoring prior authorization requests, duplication of service edits, and retrospective and concurrent utilization review.
● Coordination of benefits with insurance companies.
● Recoupment services, such as assistance with back-billing insurance when coverage was retroactive.
● Collaborate with the agency on an approach for trend (cost) management including strong emphasis on current Medicaid dental providers.
● Work to gain provider agreements for those not designated as Medicaid providers.
● Expertise in data analysis, with specific reporting requirements for communicable disease treatment program (CDTP). Client and patient-level demographics must be collected in a format usable by the agency for annual and monthly reporting. These formats will be provided by the agency.
● Personalized customer service. Contractor must have the ability to customize and freely adapt to the specific needs of a small program.
● Participate with an advisory committee, the agency’s department of administration and information, and federal grant officials if requested by the agency.
● Rectification of invalid claims or overpayments unless the payment of the invalid claim or overpayment is the result of inaccurate or untimely information provided by the agency.
● Respond to inquiries and complaints from participating dental providers with regard to the contractor’s services.
● Staff a help desk to provide information to members and participating dental providers regarding the DBM.
● Assign an account team to assist the agency to answer and resolve questions and issues that arise with respect to administration of the DBM.
● Provide secure, unlimited remote access to a password protected electronic dental claims processing and reporting system accessible to the DBM and the agency. The system should provide electronic communications of claims, product cost, individual claim history, and client demographics.
(2) All questions must be submitted no later than June 23, 2022.

[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 : Thursday, 7 July, 2022

Question Answer Deadline : Thursday, 23 June, 2022

Category : Medical Billing and Coding

Country : USA

State : Wyoming

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