Product (RFP/RFQ/RFI/Solicitation/Tender/Bid Etc.) ID: MB-7172

Government Authority located in Missouri; USA based organization looking for expert vendor for pharmacy claim audit services.

[*] Budget: Looking for Proposal

[*] Scope of Service:

Vendor needs to provide pharmacy claim audit services.
• Agency has two separate prescription drug plans – one for the non-Medicare population (i.e., commercial population) and the second is the Employer Group Waiver Plan (EGWP) Medicare prescription drug plan.
• Agency has three plan designs. In general, PPO plan members pay fixed copayments for prescriptions obtained from a network pharmacy. Health Savings Account (HSA) Plan members pay a percentage of the allowed amount after meeting the deductible. EGWP plan members have a plan design that is modeled after the commercial PPO Plan.
- Claims Pricing (Discount) Accuracy Review, which requires analyzing 100 percent of the claims for each of the two pharmacy plans incurred in the time period of the audit to confirm pricing accuracy.
- Benefit Design Accuracy Review, which requires analyzing claims for each time period to validate application of plan benefits designed for each of the two pharmacy plans.

[*] Eligibility:

- Onshore (USA Organization Only);

[*] Work Performance:

Performance of the work will be Offsite. Vendor needs to carry work in their office location.

Expiry Date : Friday, 3 March, 2023

Category : Medical Billing and Coding

Country : USA

State : Missouri

RFP Expired

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