Posted Date : September 06,2019
Product (RFP/RFQ/RFI/Solicitation/Tender/Bid Etc.) ID : MB-3436
Government Authority Located in Nevada; USA based organization looking for expert vendor for pharmacy benefit manager services.
[A] Budget: Looking for Proposal
[B] Scope of Service:
(1) Vendor needs to provide pharmacy benefit manager services for service Medicaid pharmacy benefit including managing the pharmacy benefit programs, adjudication of pharmacy claims, call center operations, utilization management and drug utilization review programs, benefit design and clinical support, rebate management, and reporting and analysis,
- Innovative and proactive in employing business techniques that ensure enhanced quality of care under the pharmacy benefit while controlling the growth of pharmacy benefit expenditures,
- Develop and implement comprehensive data analytics plan that reviews, analyses, and reports drug usage and cost metrics for Medicaid pharmacy program, which includes managed care, and dually-eligible populations,
- Claims Processing and Operational Support for ensure claims processing policies and procedures are compliant with all applicable state and federal laws, regulations, rules, and policies,
- Claims adjudication is the responsibility,
- Pharmacy Point-of-Sale (POS) claims processing systems who will operate a real‐time (POS) online claims processing system with currents format and guidelines with an emphasis on drug utilization review, utilization management, prior authorization, messaging, processing and reimbursement for clinical services, 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,
- Denying payment for claims when a beneficiary is covered by one or more liable third party until the billing provider indicates the claim has been fully adjudicated,
- Process financial claims adjustments to pharmacy payments, such as corrective actions identified from post-payment audit findings and other adjustments,
- Pharmacy Network Management, Network Support, Call Center, and Portal:
- the first point of contact for providers with questions, concerns and complaints and must implement and maintain a provider contact and problem resolution tracking system,
- The system must, at a minimum, document and track contacts with providers, identify issues and describe problem resolution,
- Pharmacy Call Center/Help Desk Services:
- 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. Pharmacy Call Center Services include technology and/or services that provides:
- Integration of call center technologies including access by authorized users,
- A tracking mechanism for call center results, volume and efficiency,
- Functionality to process prior authorizations,
- Clinical key personnel to respond to all clinical questions and approval or denial of PA requests,
- Search capabilities that speed access to needed information across the system through easy-to-use search and phonetic matching,
- Integrated online help and training throughout the System,
- Ability to provide answers and responses to inquiries on System processes and System troubleshooting from providers, pharmacies and Contractor users,
- Application and Software support,
- Pharmacy Benefit Management services support the program in the following areas: drug benefit management services, drug utilization review, utilization management programs and management, all these services must encompass drugs processed through both the pharmacy benefit and those physician-administered drugs processed through the medical benefit, etc.
(2) All questions must be submitted no later than September 19, 2019.
[C] Eligibility:
Onshore (USA 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: October 09,2019
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-3436
Government Authority Located in Nevada; USA based organization looking for expert vendor for pharmacy benefit manager services.
[A] Budget: Looking for Proposal
[B] Scope of Service:
(1) Vendor needs to provide pharmacy benefit manager services for service Medicaid pharmacy benefit including managing the pharmacy benefit programs, adjudication of pharmacy claims, call center operations, utilization management and drug utilization review programs, benefit design and clinical support, rebate management, and reporting and analysis,
- Innovative and proactive in employing business techniques that ensure enhanced quality of care under the pharmacy benefit while controlling the growth of pharmacy benefit expenditures,
- Develop and implement comprehensive data analytics plan that reviews, analyses, and reports drug usage and cost metrics for Medicaid pharmacy program, which includes managed care, and dually-eligible populations,
- Claims Processing and Operational Support for ensure claims processing policies and procedures are compliant with all applicable state and federal laws, regulations, rules, and policies,
- Claims adjudication is the responsibility,
- Pharmacy Point-of-Sale (POS) claims processing systems who will operate a real‐time (POS) online claims processing system with currents format and guidelines with an emphasis on drug utilization review, utilization management, prior authorization, messaging, processing and reimbursement for clinical services, 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,
- Denying payment for claims when a beneficiary is covered by one or more liable third party until the billing provider indicates the claim has been fully adjudicated,
- Process financial claims adjustments to pharmacy payments, such as corrective actions identified from post-payment audit findings and other adjustments,
- Pharmacy Network Management, Network Support, Call Center, and Portal:
- the first point of contact for providers with questions, concerns and complaints and must implement and maintain a provider contact and problem resolution tracking system,
- The system must, at a minimum, document and track contacts with providers, identify issues and describe problem resolution,
- Pharmacy Call Center/Help Desk Services:
- 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. Pharmacy Call Center Services include technology and/or services that provides:
- Integration of call center technologies including access by authorized users,
- A tracking mechanism for call center results, volume and efficiency,
- Functionality to process prior authorizations,
- Clinical key personnel to respond to all clinical questions and approval or denial of PA requests,
- Search capabilities that speed access to needed information across the system through easy-to-use search and phonetic matching,
- Integrated online help and training throughout the System,
- Ability to provide answers and responses to inquiries on System processes and System troubleshooting from providers, pharmacies and Contractor users,
- Application and Software support,
- Pharmacy Benefit Management services support the program in the following areas: drug benefit management services, drug utilization review, utilization management programs and management, all these services must encompass drugs processed through both the pharmacy benefit and those physician-administered drugs processed through the medical benefit, etc.
(2) All questions must be submitted no later than September 19, 2019.
[C] Eligibility:
Onshore (USA 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: October 09,2019
Cost to Download This RFP/RFQ/RFI/Solicitation/Tender/Bid Document : 5 US$