MB-3541 - USA (Texas) - Employee Health Benefits Services - Deadline November 21,2019

Product (RFP/RFQ/RFI/Solicitation/Tender/Bid Etc.) ID: MB-3541

Government Authority located in Texas; USA based organization looking for expert vendor for employee health benefits services.

[A] Budget: Looking for Proposal

[B] Scope of Service:

Vendor needs to provide employee health benefits services
- Onshore administration of claims processing, member services, provider services, and all aspects of medical administration,
- Benefit determination, coordination of benefits and appeals (including external review),
- Provider contractual negotiations, including pay for performance,
- Online provider search tools that provide robust information on providers, their accreditations, outcomes, and patient satisfaction metrics,
- Claim abuse and fraud management services,
- Assistance with general plan administration,
- Claim accounting, draft reconciliation and provider 1099 reporting,
- Claim systems production and development,
- Claims testing during implementation to ensure set up is accurate,
- Client testing of systems and access including claims,
- Recorded calls,
- Underwriting services (including projections and reserve estimates),
- Billing and eligibility services,
- Billing reconciliation services,
- Administration, including payout if applicable, of plan performance guarantees,
- Administration of allowances including but not limited to Implementation, Communication, Wellness, and Audits,
- Tracking and payment of individual/specific stop loss claims,
- Underwriting services for annual renewal of stop loss and factors,
- Payment of ISL stop loss claims,
- Clinical evaluation of large claimants,
- Advance funding for individual stop loss,
- Coverage will include medical / prescription drug benefits in specific (individual) stop loss coverage,
- Development of policy that outlines coverage and premiums in effect during any given policy year,
- Coordination of life events and data to vendors,
- Coordination of files from Third Party Administrator (eligibility),
- COBRA Annual enrollment including creating and distributing packages; collecting and processing forms; updating premiums; invoicing; vendor data files; and eligibility management,
- All member-related correspondence should be customizable,
- Various methods to enroll and pay for coverage,
- Customer Service/Call Center.

[C] Eligibility:

- Onshore (USA Only);

[D] Work Performance:

Performance of the work will be Offsite. Vendor needs to carry work in their office location.

Expiry Date : Thursday, 21 November, 2019

Category : Medical Billing and Coding

Country : USA

State : Texas

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