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MB-5248 - USA (Ohio) - Children with Medical Handicaps Pharmacy Claims Processing Services - Deadline June 2,2021

Product (RFP/RFQ/RFI/Solicitation/Tender/Bid Etc.) ID: MB-5248

Government Authority located in Ohio; USA based organization looking for children with medical handicaps pharmacy claims processing services.

[A] Budget: Looking for Proposals

[B] Scope of Service:

(1) Vendor needs to provide children with medical handicaps pharmacy claims processing services.
A. Work to transition between previous systems and load two years of claims history into the new system,
B. Provide a statewide electronic pharmacy claims billing system that can connect to CMH pharmacy providers,
C. POS system will be compliant with current national council for prescription drug standards for claims transactions,
D. Perform edits and checks on all claims in the POS system including, but not limited to, coordination of benefits (COB), excluded drug classes or individual drugs and active clients, using metrics specified by the program,
E. Provide customer service to facilitate claims transactions through a pharmacy call center which will be staffed, at a minimum, 12 hours per day, 7 days per week,
F. Accept inbound client eligibility, insurance carrier, pharmacy, prescriber, and drug files from the State daily (excluding weekends),
G. Send claims file to CMH daily (excluding weekends) containing approved, denied, and voided claims. Claims will be held for a 14-day period from the date of initial adjudication to allow for claims corrections, deletions, and third-party COB updates, in a format determined by the State,
H. Send daily CMH e-mail (on days on which files are transferred) with file containing the count of the approved, denied, and voided claims, along with the number of client records received,
I. Include CMH POS processing and customer service activities in disaster recovery plan and protocols,
J. Provide ad hoc reports as requested by the State or provide a reporting tool for the State to utilize, along with the associated training and manual to ensure the State can operate the reporting tool.
(2) All questions must be submitted no later than May 26,2021.

[C] Eligibility:

Onshore (US Organizations Only)

[D] Work Performance:

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

[E] Proposal Submission:

Response can be submitted digitally via Email or Online.

Expiry Date : Wednesday, 2 June, 2021

Question Answer Deadline : Wednesday, 26 May, 2021

Category : Medical Billing and Coding

Country : USA

State : Ohio

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