MB-2578 - USA (Ohio) - Health, Dental RX and Stop Loss Coverage Services - Deadline November 2,2018

Product (RFP/RFQ/RFI/Solicitation/Tender/Bid Etc.) ID: MB-2578

Government Authority located in Ohio; USA based organization looking for expert vendor for health, dental RX and stop loss coverage services.

[A] Budget: Looking for proposal

[B] Scope of Service:

(1) Vendor needs to provide conventionally insured employee group life insurance, health, HMO, prescription drug, dental, and patient cantered medical home coverage for employees, administrative services, medical management and specific stop-loss reinsurance for the self-insured county health, HMO, prescription drug, dental and patient cantered medical home programs.
- Claims administration services for self-insured medical, dental and prescription drug coverage.
- Claims processing including receiving and adjudicating claims from medical providers and employees, validating enrollment in the plan, determining medical necessity, providing concurrent and retrospective review, validating legitimate expenditures, authorizing payments, cutting and mailing the actual checks and explanation of benefits (EOB) forms, and providing routine monthly and quarterly reports according to the informational requirements specified in Section III (General Plan Provisions), as well as any reporting required by federal, state, and/or local statutes applicable to funding arrangements of this type.
- Third Party administrators that are recommending a network of preferred providers must include a letter from that network indicating that their administrative capabilities have been audited by that network and that the full value of the network negotiated contracts with the medical providers of that network will be realized by the county.
(2) All question must be submitted in written no later than October 19, 2018.

[C] Eligibility:

Onshore (USA Only)

[D] Work Performance:

Performance of the work will be Offsite. Vendor needs to carry work in their office premises.

Expiry Date : Friday, 2 November, 2018

Question Answer Deadline : Friday, 19 October, 2018

Category : Medical Billing and Coding, Uncategorized

Country : USA

State : Ohio

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