Product (RFP/RFQ/RFI/Solicitation/Tender/Bid Etc.) ID: MB-7895

Government Authority located in New Jersey; USA based organization looking for expert vendor for self-insured medical plan administrative services.

[*] Budget: Looking for Proposals

[*] Scope of Service:

Vendor needs to provide self-insured medical plan administrative services
- Administrative services for the County’s medical program covering active, COBRA and retired members. The program covers approximately 3,650 subscribers and their families utilizing the self-insurance funding mechanism
- Claim administration, stop-loss insurance and related services to the County
- Direct receipt of claims from employees and providers
- Maintenance and/or access to provider network(s) for all medical services covered
- Toll-free member service lines, answered by a dedicated service unit
- A field marketing representative that will retain overall responsibility for service to the County
- The capability to receive monthly updates of eligibility from the County and provide check lists, as required
- Utilization reports – report that includes the major diagnostic codes that show the number of in-patient days and network utilization.
- Stop-loss reports – Monthly reports that explain the utilization of the stop-loss protection, which include, but not limited to large claims that exceed the $350,000 pooling point. For claims that exceed the specific pooling point, explain when reimbursement for the excess claim payment is made
- Claim turnaround time – for a clean claim, it is expected that claims will be paid within ten (10) working days.

[*] 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, 29 November, 2023

Category : Medical Billing and Coding

Country : USA

State : New Jersey

RFP Expired

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