Posted Date : June 20,2019
Product (RFP/RFQ/RFI/Solicitation/Tender/Bid Etc.) ID : MB-3225
Government Authority located in Louisiana; USA based organization looking for expert vendor for healthcare claims management services.
[A] Budget: Looking for Proposals
[B] Scope of Service:
(1) Vendor needs to provide healthcare claims management services to obtain competitive proposals from bona fide, qualified proposers who are interested.
- Provide non-primary off-site health care to its offender population for many years
- Provided by these hospitals were moved to private operation under cooperative endeavour agreements between health services division and private entities
- Department of public safety and corrections is currently receiving around 11,054 claims totalling over $14,000,000 per month
- Ability to provide claims aging and inventory level reports on a monthly basis
- Ability to provide a monthly standard reporting package for the department of public safety and corrections by fiscal years, which captures offenders individual claim data, cost and utilization data by correctional institution and correctional center, medical care provider data, contracted and non-contracted provider utilization and financial data, utilization and financial data graphed, large dollar claims data, top volume medical procedures by coding, and any other aggregate financial and utilization experience data reports as requested by the department of public safety and corrections on an ad-hoc basis within an appropriate timely turn-around
- Ability to breakdown reports provided to department of public safety and corrections by the following offender types: department of public safety and corrections offenders at department of public safety and corrections facilities, department of public safety and corrections offenders at local correctional facilities, non-department of public safety and corrections offenders at local correctional facilities, office of juvenile justice offenders, and eastern state mental health system offenders, and any other covered persons as deemed necessary by department of public safety and corrections
- Ability to provide and maintain a monthly database of all claims received on behalf of department of public safety and corrections including traceable history from receipt through end result of each claim
- Ability to provide a monthly claim log financial analysis report of all paid claims data
- Ability to provide financial summary reports for financial analysis, including payments, refunds and adjustments, denied claims with denial reasons and other appropriate financial data
- Ability to implement and utilize standardized state medicaid and medical claims processing systems for claims adjudication
- Ability to utilize standardized medical coding systems in the claims adjudication system, including all modifiers, anaesthesia coding, dental coding for oral surgery services, medical coding for ancillary services coding
- Ability to receive and adjudicate compliant electronic claim transactions from medical providers throughout the state and possibly from any out-of-state vendor if providing services to the target population
- Capability to utilize payment review systems such as the correct coding initiative, modifier payment reductions and the application of specific state medicaid and Medicare medical policy payment guidelines as determined by the department of public safety and corrections medical and mental health director
- Ability to apply various claims edits in your claims adjudication system
- Ability to provide ongoing claim controls and tracking so that a claim can be identified through the adjudication system for claim location and status
- Ability to maintain claims data files for offender claim history, claim payment history by offender, including any claim adjustments, payment refunds, etc
- Ability to provide online claim history file access for the designated department of public safety and corrections liaison for claim history look-up including any claim adjustments and refunds.
(2) The term of the contract shall be one year.
[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: July 25,2019
Cost to Download This RFP/RFQ/RFI/Solicitation/Tender/Bid Document : 5 US$
![]()
Product (RFP/RFQ/RFI/Solicitation/Tender/Bid Etc.) ID : MB-3225
Government Authority located in Louisiana; USA based organization looking for expert vendor for healthcare claims management services.
[A] Budget: Looking for Proposals
[B] Scope of Service:
(1) Vendor needs to provide healthcare claims management services to obtain competitive proposals from bona fide, qualified proposers who are interested.
- Provide non-primary off-site health care to its offender population for many years
- Provided by these hospitals were moved to private operation under cooperative endeavour agreements between health services division and private entities
- Department of public safety and corrections is currently receiving around 11,054 claims totalling over $14,000,000 per month
- Ability to provide claims aging and inventory level reports on a monthly basis
- Ability to provide a monthly standard reporting package for the department of public safety and corrections by fiscal years, which captures offenders individual claim data, cost and utilization data by correctional institution and correctional center, medical care provider data, contracted and non-contracted provider utilization and financial data, utilization and financial data graphed, large dollar claims data, top volume medical procedures by coding, and any other aggregate financial and utilization experience data reports as requested by the department of public safety and corrections on an ad-hoc basis within an appropriate timely turn-around
- Ability to breakdown reports provided to department of public safety and corrections by the following offender types: department of public safety and corrections offenders at department of public safety and corrections facilities, department of public safety and corrections offenders at local correctional facilities, non-department of public safety and corrections offenders at local correctional facilities, office of juvenile justice offenders, and eastern state mental health system offenders, and any other covered persons as deemed necessary by department of public safety and corrections
- Ability to provide and maintain a monthly database of all claims received on behalf of department of public safety and corrections including traceable history from receipt through end result of each claim
- Ability to provide a monthly claim log financial analysis report of all paid claims data
- Ability to provide financial summary reports for financial analysis, including payments, refunds and adjustments, denied claims with denial reasons and other appropriate financial data
- Ability to implement and utilize standardized state medicaid and medical claims processing systems for claims adjudication
- Ability to utilize standardized medical coding systems in the claims adjudication system, including all modifiers, anaesthesia coding, dental coding for oral surgery services, medical coding for ancillary services coding
- Ability to receive and adjudicate compliant electronic claim transactions from medical providers throughout the state and possibly from any out-of-state vendor if providing services to the target population
- Capability to utilize payment review systems such as the correct coding initiative, modifier payment reductions and the application of specific state medicaid and Medicare medical policy payment guidelines as determined by the department of public safety and corrections medical and mental health director
- Ability to apply various claims edits in your claims adjudication system
- Ability to provide ongoing claim controls and tracking so that a claim can be identified through the adjudication system for claim location and status
- Ability to maintain claims data files for offender claim history, claim payment history by offender, including any claim adjustments, payment refunds, etc
- Ability to provide online claim history file access for the designated department of public safety and corrections liaison for claim history look-up including any claim adjustments and refunds.
(2) The term of the contract shall be one year.
[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: July 25,2019
Cost to Download This RFP/RFQ/RFI/Solicitation/Tender/Bid Document : 5 US$