Posted Date : February 12,2021
Product (RFP/RFQ/RFI/Solicitation/Tender/Bid Etc.) ID : SW-40934
Government authority located in Nevada; USA, based organization looking for expert vendor for pharmacy benefit manager services and system.
[A] Budget: Looking for Proposal
[B] Scope of Service:
(1) Vendor needs to provide pharmacy benefit manager services and system.
- Pharmacy claims processing (including development and maintenance of benefit rules and required reference files).
- Develop and implement comprehensive data analytics plan that reviews, analyzes, and reports drug usage and cost metrics for Nevada’s Medicaid pharmacy program, that also includes FFS, managed care, and dually eligible populations
- claims systems capable of segregating rebate eligible claims to prevent manufacturer disputes over double counting
- ability to process and identify 340B claims for Medicaid programs
- claims processing system must be capable of adding, changing, or removing adjudication rules, edits, and customized transmission messages to accommodate required changes for its current and future pharmacy programs
- claims processing system may include point‐of‐sale durable medical equipment claims processing, such as diabetic supplies
- system must be capable of displaying the PDL status of a drug
- Coordinating benefits automatically with all primary payers including capturing and storing the primary payer’s data
- review the data submitted by providers, obtain any corroborating information, and prepare an analysis of the issues.
- Pharmacy Call Center Services will be accessible to providers to obtain answers to questions and get information on pharmacy claims via telephone, e‐mail, and the Web twenty‐four (24) hours a day, seven (7) days a week
- Search capabilities that speed access to needed information across the system through easy‐to‐use search and phonetic matching
- Capabilities to support graphical data (e.g., GIS) with presentation parameters configurable by the end‐user; drill‐down for more detailed information
- system must be capable of displaying the formulary status of a drug. The Vendor must describe their approach to providing a Point‐of‐Sale system.
- system must, at a minimum, document and track contacts with providers, identify issues and describe problem resolution
- Reduce the risk of adverse events
- Capabilities to export reporting data as seen in the report as well as the underlying data used to build the report in a variety of data formats.
(2) All questions must be submitted no later than February 25, 2021.
[C] Eligibility:
- Onshore (USA 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: March 18,2021
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 : SW-40934
Government authority located in Nevada; USA, based organization looking for expert vendor for pharmacy benefit manager services and system.
[A] Budget: Looking for Proposal
[B] Scope of Service:
(1) Vendor needs to provide pharmacy benefit manager services and system.
- Pharmacy claims processing (including development and maintenance of benefit rules and required reference files).
- Develop and implement comprehensive data analytics plan that reviews, analyzes, and reports drug usage and cost metrics for Nevada’s Medicaid pharmacy program, that also includes FFS, managed care, and dually eligible populations
- claims systems capable of segregating rebate eligible claims to prevent manufacturer disputes over double counting
- ability to process and identify 340B claims for Medicaid programs
- claims processing system must be capable of adding, changing, or removing adjudication rules, edits, and customized transmission messages to accommodate required changes for its current and future pharmacy programs
- claims processing system may include point‐of‐sale durable medical equipment claims processing, such as diabetic supplies
- system must be capable of displaying the PDL status of a drug
- Coordinating benefits automatically with all primary payers including capturing and storing the primary payer’s data
- review the data submitted by providers, obtain any corroborating information, and prepare an analysis of the issues.
- Pharmacy Call Center Services will be accessible to providers to obtain answers to questions and get information on pharmacy claims via telephone, e‐mail, and the Web twenty‐four (24) hours a day, seven (7) days a week
- Search capabilities that speed access to needed information across the system through easy‐to‐use search and phonetic matching
- Capabilities to support graphical data (e.g., GIS) with presentation parameters configurable by the end‐user; drill‐down for more detailed information
- system must be capable of displaying the formulary status of a drug. The Vendor must describe their approach to providing a Point‐of‐Sale system.
- system must, at a minimum, document and track contacts with providers, identify issues and describe problem resolution
- Reduce the risk of adverse events
- Capabilities to export reporting data as seen in the report as well as the underlying data used to build the report in a variety of data formats.
(2) All questions must be submitted no later than February 25, 2021.
[C] Eligibility:
- Onshore (USA 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: March 18,2021
Cost to Download This RFP/RFQ/RFI/Solicitation/Tender/Bid Document : 5 US$