Posted Date : February 03,2020
Product (RFP/RFQ/RFI/Solicitation/Tender/Bid Etc.) ID : MB-3828
Government Authority located in Louisiana; USA based organization looking for expert vendor for self-funded health plans administrative service.
[A] Budget: Looking for Proposal
[B] Scope of Service:
(1) Vendor needs to provide a self-funded health plans administrative service
- these tasks include:
- Implementation services,
- General ASO Support Services,
- Network services and medical claims administration, and
- Wellness and population health management, including disease management
- Implementation Services:
- Assign a dedicated implementation team to manage the implementation process and the
transition of services from the incumbent contractor,
- Provide file data in a layout format designated to include, but not limited to, check register file, population health participation, wellness participation, medical claims file, provider files, code files, out of pocket maximum, and adjusted claims file,
- Integrate with selected contractor as defined for the administration of the Plan, including the health claims administrator and COBRA administrator, for the purpose of out-of-pocket maximum accumulation,
- Provide ten read only access codes to the online eligibility, claims payment and or
standard and ad hoc reporting systems,
- Provide Administrative Service Only Plan Third Party Administration for each self-funded plan offering including, but not necessarily limited to, general support and advisory services regarding the self-funded ASO plans and implementation, formulary management for the HSA plan, network management, administrative and claims processing services, clinical management programs, reporting, marketing, customer service, quality management, and utilization management functions,
- Establish, arrange, and maintain physician allied health and hospital provider networks
through contractual arrangements with participating hospitals, allied health providers and
physicians,
- Provide a national network of pharmacies for the Pelican HSA 775 Plan offering,
- Support the high deductible health plan options (Pelican HSA 775 and Pelican HRA 1000)
with an aggregate individual and family deductible and an embedded out-of-pocket
maximum,
- Prohibit participating Providers from balance billing Plan Participants for covered services
when requested charges exceed negotiated fees,
- Perform all aspects of claims processing, coordination of benefits including non-Medicare
and Medicare, claims reimbursement, adjudication, and payment, the contractor shall
verify benefits and eligibility before paying claims,
- Perform all aspects of claims processing, coordination of benefits including non-Medicare
and Medicare, claims reimbursement, adjudication, and payment,
- Provide 24/7 access to online portal, except for scheduled maintenance, to Plan Participants
for activities such as Claim submission, account monitoring, communications requested
and approved.
(2) All the questions must be submitted no later than February 26, 2020
[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: April 02,2020
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-3828
Government Authority located in Louisiana; USA based organization looking for expert vendor for self-funded health plans administrative service.
[A] Budget: Looking for Proposal
[B] Scope of Service:
(1) Vendor needs to provide a self-funded health plans administrative service
- these tasks include:
- Implementation services,
- General ASO Support Services,
- Network services and medical claims administration, and
- Wellness and population health management, including disease management
- Implementation Services:
- Assign a dedicated implementation team to manage the implementation process and the
transition of services from the incumbent contractor,
- Provide file data in a layout format designated to include, but not limited to, check register file, population health participation, wellness participation, medical claims file, provider files, code files, out of pocket maximum, and adjusted claims file,
- Integrate with selected contractor as defined for the administration of the Plan, including the health claims administrator and COBRA administrator, for the purpose of out-of-pocket maximum accumulation,
- Provide ten read only access codes to the online eligibility, claims payment and or
standard and ad hoc reporting systems,
- Provide Administrative Service Only Plan Third Party Administration for each self-funded plan offering including, but not necessarily limited to, general support and advisory services regarding the self-funded ASO plans and implementation, formulary management for the HSA plan, network management, administrative and claims processing services, clinical management programs, reporting, marketing, customer service, quality management, and utilization management functions,
- Establish, arrange, and maintain physician allied health and hospital provider networks
through contractual arrangements with participating hospitals, allied health providers and
physicians,
- Provide a national network of pharmacies for the Pelican HSA 775 Plan offering,
- Support the high deductible health plan options (Pelican HSA 775 and Pelican HRA 1000)
with an aggregate individual and family deductible and an embedded out-of-pocket
maximum,
- Prohibit participating Providers from balance billing Plan Participants for covered services
when requested charges exceed negotiated fees,
- Perform all aspects of claims processing, coordination of benefits including non-Medicare
and Medicare, claims reimbursement, adjudication, and payment, the contractor shall
verify benefits and eligibility before paying claims,
- Perform all aspects of claims processing, coordination of benefits including non-Medicare
and Medicare, claims reimbursement, adjudication, and payment,
- Provide 24/7 access to online portal, except for scheduled maintenance, to Plan Participants
for activities such as Claim submission, account monitoring, communications requested
and approved.
(2) All the questions must be submitted no later than February 26, 2020
[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: April 02,2020
Cost to Download This RFP/RFQ/RFI/Solicitation/Tender/Bid Document : 5 US$