Posted Date : March 19,2020
Product (RFP/RFQ/RFI/Solicitation/Tender/Bid Etc.) ID : PHAR-0396
Government Authority located in Phoenix, Arizona; USA based organization looking for expert vendor for group medical and pharmacy benefits services.
[A] Budget: Looking for Proposal
[B] Scope of Service:
(1) Vendor needs to provide group medical and pharmacy benefits services to the government authority located in Phoenix, AZ.
- Account Management to ASRS the right to interview and agree to the intended replacement of the primary account manager, an account management team that is experienced in providing services for similar entities and groups, trained in ASRS Medical Plan requirements, accessible to ASRS geographically, and with sufficient capacity and authority to respond to ASRS issues in a timely
manner.
- A toll-free number or other free telephone service that is staffed with live customer service representatives from at least 7 a.m. to 9 p.m., Monday to Friday (excluding state holidays) state time, to assist participants with eligibility, claim filing, and medical plan questions, Customer service representatives shall have the ability to view information regarding claims and be trained to explain claim status and provider resources.
- A secure online/mobile tool for participants to review provider information including but not limited to: address, phone number, contracting status, licensing, specialty designation, education and background, and acceptance of new patients, obtain general plan, medical procedures, and cost information, access self-service capabilities to obtain current and historical claim information to track claim status, communicate with contractor regarding specific claim or treatment information.
- Claims Administration Have an established claims processing and management system that shall receive, maintain, and process Participant eligibility files – including retroactive enrolments - in
a secure, accurate and timely manner and in a format and timeframe established by agency, agency will provide a file on a scheduled basis, upon receipt of a claim, contractor shall undertake all necessary tasks to properly process and resolve issues, including but not limited to verify eligibility, verify participation status of provider of services, review claim history to determine whether services are covered and necessary, ensure coordination of benefits, and provide medical/clinical professional review of claims, as applicable, prior to adjudication, timely notification to participants and providers to request missing information that delays or prevents payment of a claim, claims investigations and record these investigations, reimburse participants for overpayments resulting from incorrect calculations, eligibility errors, incorrectly paid claims, system and/or programming errors or other errors or adjustments made by the contractor that are identified through internal or contracted audit, operational review, financial analysis, or other means.
(2) A pre-offer conference will be held on April 02, 2020.
(3) All question must be submitted no later than April 16, 2020.
[C] Eligibility:
- Onshore (USA Organization 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 30,2020
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 : PHAR-0396
Government Authority located in Phoenix, Arizona; USA based organization looking for expert vendor for group medical and pharmacy benefits services.
[A] Budget: Looking for Proposal
[B] Scope of Service:
(1) Vendor needs to provide group medical and pharmacy benefits services to the government authority located in Phoenix, AZ.
- Account Management to ASRS the right to interview and agree to the intended replacement of the primary account manager, an account management team that is experienced in providing services for similar entities and groups, trained in ASRS Medical Plan requirements, accessible to ASRS geographically, and with sufficient capacity and authority to respond to ASRS issues in a timely
manner.
- A toll-free number or other free telephone service that is staffed with live customer service representatives from at least 7 a.m. to 9 p.m., Monday to Friday (excluding state holidays) state time, to assist participants with eligibility, claim filing, and medical plan questions, Customer service representatives shall have the ability to view information regarding claims and be trained to explain claim status and provider resources.
- A secure online/mobile tool for participants to review provider information including but not limited to: address, phone number, contracting status, licensing, specialty designation, education and background, and acceptance of new patients, obtain general plan, medical procedures, and cost information, access self-service capabilities to obtain current and historical claim information to track claim status, communicate with contractor regarding specific claim or treatment information.
- Claims Administration Have an established claims processing and management system that shall receive, maintain, and process Participant eligibility files – including retroactive enrolments - in
a secure, accurate and timely manner and in a format and timeframe established by agency, agency will provide a file on a scheduled basis, upon receipt of a claim, contractor shall undertake all necessary tasks to properly process and resolve issues, including but not limited to verify eligibility, verify participation status of provider of services, review claim history to determine whether services are covered and necessary, ensure coordination of benefits, and provide medical/clinical professional review of claims, as applicable, prior to adjudication, timely notification to participants and providers to request missing information that delays or prevents payment of a claim, claims investigations and record these investigations, reimburse participants for overpayments resulting from incorrect calculations, eligibility errors, incorrectly paid claims, system and/or programming errors or other errors or adjustments made by the contractor that are identified through internal or contracted audit, operational review, financial analysis, or other means.
(2) A pre-offer conference will be held on April 02, 2020.
(3) All question must be submitted no later than April 16, 2020.
[C] Eligibility:
- Onshore (USA Organization 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 30,2020
Cost to Download This RFP/RFQ/RFI/Solicitation/Tender/Bid Document : 5 US$