Product (RFP/RFQ/RFI/Solicitation/Tender/Bid Etc.) ID: MB-6523

Government Authority located in New York; USA based organization looking for expert vendor for medical benefits administration services.

[A] Budget: Looking for Proposals

[B] Scope of Service:

(1) Vendor needs to provide medical benefits administration services to the government authority located in New York.
- The Client’s goal is in developing a long-term strategy that incorporates plan management opportunities with access to the most appropriate and cost-effective provider networks.
- The County is looking to select and implement a claims administrator with plan management capabilities for the self-insured medical programs. It is not the Client’s intent to implement more restrictive plan design features within their Medical plans but to enhance the management of these programs through access to strong, quality-based networks.
- Select an administrator with comprehensive provider networks, both in and out of New York state, to ensure employee access to high quality care through network physicians, hospitals and providers.
- Maintain effective pre-admission certification, concurrent review and case management programs for all employees regardless of in or out-of-network access.
- All claims and related data acquired as a result of any relationship with the Client will be deemed the property of the Client. You must agree to provide an electronic transfer of the Client data within 14 calendar days of any request by the Client.
- Completeness: -
- Administration, claim processing and service;
- Managed care capabilities, including scope and quality of existing provider networks;
- Utilization management programs and services;
- Administrative charges and retention;
- Availability of reporting capabilities;
- Compliance with specifications as presented.
- Criteria used for claims denial;
- Appeal process; the selected vendor should be able to provide fiduciary responsibility for level two claims appeals;
- Services for outsourced claims appeals;
- Provide a sample Explanation of Benefits (EOB), as well as sample messaging, such as participant advice, vendor directed inquiries, etc.;
- Dedicated service representative should be assigned to the Client for employer and member customer service and claims adjudication;
(2) All question must be submitted no later than June 17, 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 : Wednesday, 29 June, 2022

Question Answer Deadline : Friday, 17 June, 2022

Category : Medical Billing and Coding

Country : USA

State : New York

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