Posted Date : June 03,2019
Product (RFP/RFQ/RFI/Solicitation/Tender/Bid Etc.) ID : MB-3163
Government Authority located in Nebraska; USA based organization looking for expert vendor for administrative support services.
[A] Budget: looking For Proposal
[B] Scope of Service:
(1) Vendor needs to provide administrative support services for the employee health care benefits plans.
The State currently has the following self-insured medical plan designs:
1. Regular Plan
2. Consumer Focused Health Plan (with Health Savings Account Eligibility)
3. Well Nebraska (with or without incentive)
- Medical Administration files are:
1. Census data for active employees, COBRA participants and pre-65 retirees;
2. Claims data for the most recent 12-month period;
3. Enrollment data for the most recent 36-month period;
4. Large loss information for the most recent 36-month period;
- Pharmacy Benefit Administration files are:
1. Census data for active employees, COBRA participants and pre-65 retirees;
2. Claims data for the most recent 12-month period.
- Provide complete administrative and support services for the medical administration including but not limited to:
a. Access to nationwide network of providers with uniform quality of care and services;
b. Cost effective contracting arrangements that can be demonstrated to represent direct savings to the State;
c. Comprehensive set of medical management services
d. Show strong financial stability
e. Demonstrate innovative and quality-oriented medical claims administration
f. Provide excellent communication services
g. Provide superior account service to the State and excellent customer support to members
h. Provide seamless implementation of the program for the State and its members
i. Account Executive to be available at any time by phone or email and in-person meeting a minimum of once per week. Including but not limited to weekly in-person meetings, quarterly and
annual reviews, open enrollment on-site meetings and additional contacts as needed.
- Provide complete administrative and support services for the prescription drug administration - including, but not limited to:
a. Claims Adjudication
b. Member Enrollment and Eligibility Maintenance
c. ID Card Production and Distribution
d. Patient and Provider Education
e. Systematic Prospective, Concurrent and Retroactive Drug Utilization Review
f. Account Management Services (including standard/custom reporting and online systems)
g. Member Services (including call center, website and portal)
h. Formulary Management and Rebate Sharing
i. Clinical and Utilization Management Programs
j. Network Pharmacy Management
k. Mail Service Pharmacy
l. Specialty Pharmacy Program
m. Ability to share claims data with other State healthcare and data analytics vendors as needed
(2) All questions must be submitted no later than June 23, 2019.
(3) Contract period will be for 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 premises.
Budget :
Deadline to Submit Proposals: August 08,2019
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-3163
Government Authority located in Nebraska; USA based organization looking for expert vendor for administrative support services.
[A] Budget: looking For Proposal
[B] Scope of Service:
(1) Vendor needs to provide administrative support services for the employee health care benefits plans.
The State currently has the following self-insured medical plan designs:
1. Regular Plan
2. Consumer Focused Health Plan (with Health Savings Account Eligibility)
3. Well Nebraska (with or without incentive)
- Medical Administration files are:
1. Census data for active employees, COBRA participants and pre-65 retirees;
2. Claims data for the most recent 12-month period;
3. Enrollment data for the most recent 36-month period;
4. Large loss information for the most recent 36-month period;
- Pharmacy Benefit Administration files are:
1. Census data for active employees, COBRA participants and pre-65 retirees;
2. Claims data for the most recent 12-month period.
- Provide complete administrative and support services for the medical administration including but not limited to:
a. Access to nationwide network of providers with uniform quality of care and services;
b. Cost effective contracting arrangements that can be demonstrated to represent direct savings to the State;
c. Comprehensive set of medical management services
d. Show strong financial stability
e. Demonstrate innovative and quality-oriented medical claims administration
f. Provide excellent communication services
g. Provide superior account service to the State and excellent customer support to members
h. Provide seamless implementation of the program for the State and its members
i. Account Executive to be available at any time by phone or email and in-person meeting a minimum of once per week. Including but not limited to weekly in-person meetings, quarterly and
annual reviews, open enrollment on-site meetings and additional contacts as needed.
- Provide complete administrative and support services for the prescription drug administration - including, but not limited to:
a. Claims Adjudication
b. Member Enrollment and Eligibility Maintenance
c. ID Card Production and Distribution
d. Patient and Provider Education
e. Systematic Prospective, Concurrent and Retroactive Drug Utilization Review
f. Account Management Services (including standard/custom reporting and online systems)
g. Member Services (including call center, website and portal)
h. Formulary Management and Rebate Sharing
i. Clinical and Utilization Management Programs
j. Network Pharmacy Management
k. Mail Service Pharmacy
l. Specialty Pharmacy Program
m. Ability to share claims data with other State healthcare and data analytics vendors as needed
(2) All questions must be submitted no later than June 23, 2019.
(3) Contract period will be for 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 premises.
Budget :
Deadline to Submit Proposals: August 08,2019
Cost to Download This RFP/RFQ/RFI/Solicitation/Tender/Bid Document : 5 US$