Product (RFP/RFQ/RFI/Solicitation/Tender/Bid Etc.) ID: MB-7830

Government Authority located in Virginia; USA based organization looking for expert vendor for claims administrative services.

[*] Budget: Looking for Proposals

[*] Scope of Service:

Vendor needs to provide claims administrative services for the medical plan would include, but not be limited to, the automated processing and payment of medical and prescription drug claims (in accordance with plan documents and the contracted network reimbursement fee schedule), utilization review, case management, stop loss reporting, third party recovery and coordinating medical review.
 - Input historical data from previous TPA, including, but not limited to, deductibles and lifetime maximums. Maintain accurate claims records, which contain all pertinent claims, bills, correspondence, deductibles, benefits accumulators, coordination of benefits information, etc. Provide adequate security of patient information.
- Review and examine claims (bills, invoices, and statements) submitted by plan participants or received from physicians, hospitals, pharmacies, labs and any other eligible providers who have rendered care to eligible employees and their dependents. Procure any missing information immediately, by personal contact, telephone, or correspondence.
- Prepare/issue checks or electronic payments and itemized Explanation of Benefits forms to plan participants and providers.
- Furnish a toll-free telephone number for incoming customer service calls.

[*] Eligibility:

Onshore (USA Organization Only)

[*] Work Performance:

Performance of the work will be Onsite/offsite

Expiry Date : Friday, 10 November, 2023

Category : Medical Billing and Coding

Country : USA

State : Virginia

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