Product (RFP/RFQ/RFI/Solicitation/Tender/Bid Etc.) ID: MB-7184

Government Authority located in Minnesota; USA based organization looking for expert vendor for dental plan administrator services.

[*] Budget: Looking for Proposals

[*] Scope of Service:

(1) Vendor needs to provide dental plan administrator services
- The TPA must assign a dedicated (but not necessarily exclusive) account manager, located in the Twin Cities Metro area,
- When provides the TPA with written notification of a significant issue, the TPA will respond in writing with the resolution of the issue or an explanation of when the issue can be resolved, within an average of two (2) business days (measured on an annual basis).
- The TPA is responsible for the electronic exchange of claims, provider, and eligibility file and related information to and from the vendors
- The TPA is responsible for maintaining a system for timely and accurate processing, adjudicating, and recording of claims for benefits in accordance with the 2024 Summary Plan Document. The TPA is responsible for reviewing submitted claims information or completeness and requesting any additional information necessary for proper adjudication of the claim in a timely manner. The claims payment system must be capable of accepting both electronic and paper submitted claims
- The Claim Administrator must have the capabilities to detect and report potential fraud and abuse cases; compare total charges against total payments; identify duplicate charges; verify services are provided within the employee's eligibility date and maintain breaks in active service; recognize historical benefit maximums; identify excess "usual, customary and reasonable" charges for all procedures; verify provider license to the type of procedure billed; compute benefit year deductibles; integrate in-network deductible accumulations with out-of-network deductibles requirements; identify and maintain information on potential coordination of benefits, subrogation, and other party liability situations; verify out-of-pocket amounts; review age limits for eligibility or coverage limits; determine coinsurance levels; and identify ineligible services
- The TPA must maintain the following information for all claims: employee name, employee identification number, patient name or other specific identifier, claim number, provider number, provider name, service date, type of service, amount of charges, co-payment amount, amount allowed to the claimant, and reason codes that specify the reason for claim payment/non-payment.
(2) All the questions must be submitted no later than March 17, 2023.

[*] 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 : Wednesday, 5 April, 2023

Question Answer Deadline : Friday, 17 March, 2023

Category : Medical Billing and Coding

Country : USA

State : Minnesota

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