Product (RFP/RFQ/RFI/Solicitation/Tender/Bid Etc.) ID: MB-6568

Government Authority located in Texas; USA based organization looking for expert vendor for medical, stop-loss, dental, PBM, vision, COBRA, flexible spending account administration, medicare, navigator and HRA administration.

[A] Budget: Looking for Proposal

[B] Scope of Service:

(1) Vendor needs to provide medical, stop-loss, dental, PBM, vision, COBRA, flexible spending account administration, medicare, navigator and HRA administration.
- The administrator should prepare a monthly financial report and attend quarterly city and consultant meetings to review special reports and discussions on utilization review, case management, claims, service issues or vendor coordination meetings
- It will be your responsibility to maintain computer eligibility from electronic data provided by the city and updated weekly, and an adequate "direct" claim status system. This responsibility includes training after the original transition date, inputting and tracking all of the necessary data and updating claim status.
- All claims received in your office(s) in proper, complete order will meet or exceed state regulations;
- Responsible for sending all check registers showing all transactions withdrawn from the City's fund.
- The administrator shall not charge against the plan experience any claim payment not authorized under the health policy and summary plan description (except those specifically authorized in writing by the City).
- The city may conduct a random employee satisfaction survey annually.
- All proposals and proposers must sign and agree to the standard contract language regarding indemnification, ownership of records and databases, term of agreement, and no arbitration clause in order to be considered.
- The Administrator must be capable of designing and assisting in booklet preparation, plan documents, customized claim forms, customized ID Cards, and worksheets.
- The claims administrator must provide a quarterly claim dump on diskette, CD or an acceptable electronic format to the city’s consultant. The required data and format will be agreed upon in advance.
- Describe your ability to integrate medical care and disease management, prescription and stand-alone clinical claims data in useable reports for the purpose of identifying cost drivers and metabolic syndrome and for aggregating out-of-pocket costs as required by ACA.
- All fees and charges not covered by your administrative fee:
- Stop Loss coordination and carrier stop loss integration fees
- Ad hoc reporting fees, requested on as needed basis
- (RDS) Retiree Drug Subsidy reporting
- Enrollment data, educational materials, claim forms
- Automated eligibility setup and maintenance
- Reverse eligibility files
- External vendor integration fees
- Duplicate claim identification and reprocessing fees
- Custom or Standard Identification cards (or reprints)
- Plan and benefit booklets or summary plan document and revisions
- Summary benefit of coverage (SBC)
- CMS medicare disclosure notice
- Reporting for retiree drug subsidy
- Summary annual report (SAR)
- Care and disease management reports
- EPO - PPO savings reports
- Provider Relations related reports Monthly, Quarterly and Annual
- Reasonable and customary information
- Coordination for Out-of-Pocket Maximum
(2) The contract period will be for one year.
(3) Pre-proposal conference will be held on June 29, 2022

[C] Eligibility:

- Onshore (USA ONLY);

[D] Work Performance:

Performance of the work will be Offsite.

Expiry Date : Monday, 18 July, 2022

Pre-proposal Conference Date : Wednesday, 29 June, 2022

Category : Medical Billing and Coding

Country : USA

State : Texas

Cost to Download This RFP Document : $ 5

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