Product (RFP/RFQ/RFI/Solicitation/Tender/Bid Etc.) ID: MB-7216

Government Authority located in Utah; USA based organization looking for expert vendor for oral health program service.

[*] Budget: Looking for Proposals

[*] Scope of Service:

Vendor needs to provide oral health program service to the government authority located in Utah.
- Provide core medical and support services for people living with HIV
- Consequences of poor oral health may interfere with HIV medication treatment and accelerate disease progression
- Implement a dental benefit plan
- Set up eligibility data (member ID, effective dates, etc.).
- Set up a closed network plan design with plan limitations and exclusions.
- Identify services that need to be pre-authorized.
- Pay in-network claims according to dental benefit plan.
- Provide timely ID cards to clients
- Billing
- Bill the Program monthly for administrative fees and claims received on behalf of eligible clients
- Claims
- Process dental claims and bill the Program by the 20th of each month for approved services rendered.
- Procure, maintain, and update procedures and computer software needed to receive and process claims, and dental benefits.
- Provide guidelines, procedures and software which will screen and rectify claims which are duplicate payments, overpayments, underpayments, non-payments, and unnecessary procedures to control costs.  
- Provide method to prevent fraudulent claims.
- Provide each client with an Explanation of Benefits (EOB) after each claim is paid and each claim is denied by mail, e-statement, or both, within two weeks of approval or denial of the claim.
- Provide customer support for clients and dental providers able to assist clients with questions regarding benefits, eligibility, claims, and technical support.
- Provide a toll-free number staffed a minimum of eight hours per day, Monday through Friday. Include information on weekend and after-hours availability.
- Provide customer support staff who are bilingual in English/Spanish.
- Provide procedure of how calls received in other languages are handled.

[*] Eligibility:

- Onshore (US Only)

[*] Work Performance:

- Performance of the work will be Offsite.

Expiry Date : Monday, 10 April, 2023

Category : Medical Billing and Coding

Country : USA

State : Utah

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