Product (RFP/RFQ/RFI/Solicitation/Tender/Bid Etc.) ID: MB-7151

Government Authority located in South Dakota; USA based organization looking for expert vendor for all women count program claims administrator services.

[*] Budget: Looking for proposal

[*] Scope of Service:

(1) Vendor needs to provide all women count program claims administrator services.
- Accept Health Care Finance Administration (HCFA) and Uniform Billing (UB) claims by mail and electronically.
- Maintain confidentiality and abide by all applicable rules and regulations as defined in the Health Insurance Portability and Accountability Act (HIPPA).
- Obtain or utilize an existing claim processing system that permits claim adjudication by service line including the ability to code services to be broken down to draw multiple funding sources at time of funding request.
- Provide access to processing system to Department of Health Data Manager to see all outstanding claims that need to be processed and paid.
- Ability to make payments to participating provider sites utilizing various funding sources as determined by Data Manager, reimbursing at Medicare Part B rates and utilizing Current Procedural Terminology (CPT) Codes, for strict time frames,
- Ensure system can support timely updates to fee schedule changes that occur approximately once every 12 months.
- Once charges are paid, vendor will request reimbursement from. A spreadsheet of all claim numbers, name of clients, ID numbers, claim amounts, payment sources, and total spent by each pay (funding) source will need to be provided. An electronic file of individual Explanation of Benefits (EOBs) for each claim processed will also be required to the provider as well as to the
- Ability to enroll members to the vendor system either through a portal or enrolment application.
- Provide a technical support contact to communicate securely with the for enrolment and claim support. This includes timely responses to get new provider sites added, as needed, and direct assistance setting up a process for handling refunds and adjustments.
(2) All question must be submitted no later than March 7, 2023.

[*] Eligibility:

Onshore (USA organization Only)

[*] Work Performance:

Performance of the work will be offsite.

Expiry Date : Friday, 31 March, 2023

Question Answer Deadline : Tuesday, 7 March, 2023

Category : Medical Billing and Coding

Country : USA

State : South Dakota

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