Posted Date : November 26,2020
Product (RFP/RFQ/RFI/Solicitation/Tender/Bid Etc.) ID : MB-4738
Government Authority located in Carson City, Nevada; USA based organization looking for expert vendor for health plan auditor service.
[A] Budget: Looking for Proposals
[B] Scope of Service:
Vendor needs to provide health plan auditor service who can provide all the listed audits to the government authority located in Carson City, NV.
- Third Party Claims Administrator (PPO Plan) (Little Rock, AR) for two self-funded health plans and one self-funded dental plan, HSA, HRA, FSA Administration, National PPO Medical Network, 2nd MD, Doctor on Demand and Healthcare Bluebook;
- Agency health claim auditor is required to attend all agency board meetings where audit findings are presented, typically once per quarter.
- The final quarterly audit results will be used to measure the Third-Party Administrators Performance Guarantees for the following: Financial Accuracy; Payment Accuracy; Claim Processing Turnaround Time; Customer Service Telephone Response Time and Telephone Abandonment Rate;
- Third party administrator the random selection of claims will be a statistically valid sampling of individual medical, dental and vision claims and will be audited for payment accuracy at a minimum, in the following areas.
- Auditor must be able to measure one hundred percent (100%) of RX claims within the PBM audit per agency negotiated metrics including determining the Average Wholesale Pricing (AWP) as recognized by MediSpan.
- Agency contracts with Morneau Shepell Ltd. to lease their eligibility and enrollment system. Agency is the system of record regarding participant eligibility; this means that agency has the responsibility for eligibility final determination, maintenance of eligibility records and reporting of eligibility for its participants and their dependents.
[C] Eligibility:
- Onshore (US Organization Only);
[D] Work Performance:
Performance of the work will be Offsite. Vendor needs to carry work in their office location.
Budget :
Deadline to Submit Proposals: December 22,2020
Cost to Download This RFP/RFQ/RFI/Solicitation/Tender/Bid Document : 5 US$
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Product (RFP/RFQ/RFI/Solicitation/Tender/Bid Etc.) ID : MB-4738
Government Authority located in Carson City, Nevada; USA based organization looking for expert vendor for health plan auditor service.
[A] Budget: Looking for Proposals
[B] Scope of Service:
Vendor needs to provide health plan auditor service who can provide all the listed audits to the government authority located in Carson City, NV.
- Third Party Claims Administrator (PPO Plan) (Little Rock, AR) for two self-funded health plans and one self-funded dental plan, HSA, HRA, FSA Administration, National PPO Medical Network, 2nd MD, Doctor on Demand and Healthcare Bluebook;
- Agency health claim auditor is required to attend all agency board meetings where audit findings are presented, typically once per quarter.
- The final quarterly audit results will be used to measure the Third-Party Administrators Performance Guarantees for the following: Financial Accuracy; Payment Accuracy; Claim Processing Turnaround Time; Customer Service Telephone Response Time and Telephone Abandonment Rate;
- Third party administrator the random selection of claims will be a statistically valid sampling of individual medical, dental and vision claims and will be audited for payment accuracy at a minimum, in the following areas.
- Auditor must be able to measure one hundred percent (100%) of RX claims within the PBM audit per agency negotiated metrics including determining the Average Wholesale Pricing (AWP) as recognized by MediSpan.
- Agency contracts with Morneau Shepell Ltd. to lease their eligibility and enrollment system. Agency is the system of record regarding participant eligibility; this means that agency has the responsibility for eligibility final determination, maintenance of eligibility records and reporting of eligibility for its participants and their dependents.
[C] Eligibility:
- Onshore (US Organization Only);
[D] Work Performance:
Performance of the work will be Offsite. Vendor needs to carry work in their office location.
Budget :
Deadline to Submit Proposals: December 22,2020
Cost to Download This RFP/RFQ/RFI/Solicitation/Tender/Bid Document : 5 US$