Product (RFP/RFQ/RFI/Solicitation/Tender/Bid Etc.) ID: MB-7833

Government Authority located in Tennessee; USA based organization looking for expert vendor for self-funded third-party administrator service.

[*] Budget: Looking for Proposals

[*] Scope of Service:

(1) Vendor needs to provide self-funded third-party administrator service.                          
- For administration of its self-insured medical, tele-health, Rx, dental, vision, COBRA, and agency.
- The third-party administrator is to provide a proposal for agency (traditional & specialty), and agency Network.
a. Timely processing of claims;
b. Advising the plan concerning the payment of claims;
c. Data management reporting and analysis;
d. Updating the plan document (in coordination with the City);
e. Preparation and printing of employee identification cards and summary plan descriptions;
f. Investigation of unusual or excessive claims.
g. All-inclusive administrative fee.
h. Create complete transparency, which includes full disclosure of agency Vendors' revenue and revenue sources related to the plan and clearly defined and auditable pharmacy pricing terms.
i. Minimize the cost and rate of future increases for both the City and its employees.
j. Establish performance targets to assess and monitor agency performance.
k. Maintain network access to a geographically diverse population.
l. Financial performance guarantees;
m. Service level performance guarantees;
n. Formulary and manufacturer rebates handling and level of reimbursement;
o. Willingness to guarantee that agency pricing will be used for all generics and multi-source brand dispensed for both mail and retail claims.
p. Proposed pricing arrangement utilizes "lower of' formula contract price or "usual and customary" for both brands & generics.
q. Other areas offered by the vendor including but not limited to Wellness Programs, Smoking Cessation Programs, Use of Technology, Direct Contracting, etc. These can be submitted and will viewed during the evaluation process.
(2) All questions must be submitted no later than October 31, 2023.

[*] Eligibility:

- Onshore (USA Only)

[*] Work Performance:

- Performance of the work will be Onsite or Offsite.

Expiry Date : Tuesday, 7 November, 2023

Question Answer Deadline : Tuesday, 31 October, 2023

Category : Medical Billing and Coding

Country : USA

State : Tennessee

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