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MB-6540 - USA (California) - Automated Claim System - Deadline July 22,2022

Product (RFP/RFQ/RFI/Solicitation/Tender/Bid Etc.) ID: MB-6540

Government Authority located in California; USA based organization looking for expert vendor for automated claim system.

[A] Budget: Looking for Proposals

[B] Scope of Service:

(1) Vendor needs to provide automated claim system.
- The department of risk management oversees a financially secure self-insurance program and seeks to minimize the frequency and severity of financial loss to the County through a coordinated Integrated Risk Management Program. As part of the Integrated Risk Management Program, DRM partners with a Vendor to provide Automated Claims System services.
- CLAIM VOLUME
To assist proper system sizing and capacity planning, the following is offered for review and consideration. The table below shows the approximate number of claims for each insurance line of coverage that are in the current database system as of June 30, 2021.
- CLAIM STATISTICS
Statistics have been provided for calendar year 2021 to establish minimum potential baseline usage and to assist in proper consideration towards system capacity, planning and growth.
- VENDOR RESPONSIBILITIES
The Vendor shall furnish and deliver a network-based Windows Automated Claims System that will provide state-of-the-art technology in administering and managing claims, loss control programs and cost allocation in the most cost-effective and expeditious manner. The project involves installation and programming required for data mapping to ensure data fields are properly converted from the existing system to the proposed system for accuracy and validity, testing, training, on-going support services and necessary monthly maintenance. The system must integrate (leverage) existing County and Risk
Management resources where feasible.
1. Administrative Control
Selected Vendor must adhere to a schedule, budget and cost information analysis appropriate to implement the successful management of a contract, program status and planned activities. This information includes an on-going analysis of cost and scheduled variances.
2. Implementation Schedule
Selected Vendor and the County shall perform their duties and responsibilities in accordance with the schedule contracted to between the County and Selected Vendor, which must include go-live date of July 1st, 2023. Selected Vendor and County acknowledge that prompt performance of all services is required
3. Training
A specific training plan and training for Risk Management staff and/or designee on the day-to-day operations along with backend system administration is required. The Vendor shall provide several
instructor led training sessions at the County Risk Management Department facilities, which should span on multiple dates to ensure that all staff could attend training while maintaining coverage for existing workload.
4. Liquidated Damages
The County will suffer certain damages in the event the Vendor should fail to complete the project within the time stipulated
5. Reviews, Reports, Meetings
During the term of the project, selected Vendor will conduct a project status review with the County once every week, or as otherwise agreed
- FUNCTIONAL GENERAL REQUIREMENTS
1. Application must be able to run off a Wide Area Network (WAN) Environment.
2. Application must be certified to run on Windows 10 or latest.
3. Application must be certified to run on SQL 2019 (if data repository is MS SQL).
4. Application must be cluster aware.
5. Application must be running in Windows environment as a Service.
6. Application must be able to use Windows Authentication (Single Sign On compatible).
7. Application component function must be able to run on separate server (i.e. the database can run on a database server, the application can run on a separate application server).
- SYSTEM TESTING, AUDIT TRAIL AND SECURITY
1. A minimum of two System Administrators must be able to manage system user accounts and user access levels and reset passwords in real-time.
2. The system must be able to track each successful and unsuccessful User Login and Logout.
3. System must be able to track each user and claims they’ve accessed or each claim and employees who accessed it on a given date range.
4. System should provide security within a claim as well (A claim marked as “confidential” should not be able to be accessed by anyone other than assigned adjuster/supervisor).
- DIGITAL MEDIA AND CORRESPONDENCE
The County requires the contracted provider to submit any or all correspondence, reporting and media to be transmitted electronically to the Director of Risk Management and other designated contacts.
(2) All question must be submitted no later than June 24, 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 : Friday, 22 July, 2022

Question Answer Deadline : Friday, 24 June, 2022

Category : Medical Billing and Coding

Country : USA

State : California

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