Government Contract | California
Business Process Outsourcing (BPO) of Medicare Advantage Prescription Drug Plan and Dual Eligible Special Needs Plan Operations (DSNP)

Bid Information


Bid Alert No: 00000524097

Bid Title: Business Process Outsourcing (BPO) of Medicare Advantage Prescription Drug Plan and Dual Eligible Special Needs Plan Operations (DSNP)

Agency Bid No. Title: Not Stated

Received Date: 03/24/2016

Close Date: 04/18/2016

Purchase Type: Term:

Delivery Point: California

Delivery Date: Not Stated

Specifications

EnCal Health intends to award a contract for Business Process Outsourcing (BPO) for a Medicare Advantage with Prescription Drug (MAPD) and Medicare Advantage Prescription Drug Special Needs Plan (D-SNP) plan, which is a new line of business. The BPO service agreement will commence in 2017, with the actual plan coverage to members to be effective in 2018. We are seeking best practice for application software, IT infrastructure, tools, resources, and business processes aimed at compliantly, accurately, and effectively delivering a Medicare line of business.The issuance of this RFP, and the subsequent contract award, is intended to meet several objectives. Unless otherwise explicitly excluded, the successful bidder will be expected to provide staffing, administrative and clinical services to support all aspects of the MAPD and D-SNP business to ensure compliance with State and Federal regulations and requirements, maximize revenue and minimize cost. At a minimum, the following business functions must be supported:Eligibility, Enrollment, Disenrollment, Member ManagementFulfillment/Mail RoomPremium BillingCall Center [Customer Service, Provider Services] back-up only, primary in-houseMedical Claims Adjudication, including benefit and provider contract configurationCoordination of BenefitsMember ReconciliationFinancial ReconciliationOrganizational Determinations, Appeals and Grievances (ODAG)Coverage Determinations, Appeals and Grievances (CDAG)Information TechnologyMedical Management:Utilization Review,Disease Management,Case Management,Nurse Advice Line,Quality Assurance,HEDIS & StarsNo additional specifications were given.

Bid Related Documents

Download Solicitation Notice

Product Code: 95856

Agency Information


Issuing Agency: CenCal Health

State: California

Agency Type: State and Local

Contact: eff Januska

Email: jjanuska@cencalhealth.org

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