Government Contract | Idaho
Medical Claims Processing

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Bid Information

Bid Alert No: 00000516195

Bid Title: Medical Claims Processing

Agency Bid No. Title: RFP16000035

Received Date: 03/18/2016

Close Date: 04/25/2016

Purchase Type: 1 year term

Delivery Point:

Delivery Date: Not Stated

Special Notices: Other Optional 03/22/2016 05:00 PM: Registration, Pre-Bid Conference Optional 03/23/2016 01:00 PM, Questions Due By Optional 03/30/2016


Specifications include, but are not limited to:: Claims Management: (SOW III.B.11) The Contractor shall provide TPA to manage claims and provide critical data and reports to the Department in compliance with federal HIPAA standards. The Contractor shall complete claims within ten (10) business days of receipt with reports submitted prior to submission of weekly flat file.Required Level of Expectation: 100% Method of Monitoring: The Department will review reports, monitor customer complaints, and monitor annual reports.Strategy for Correcting Non-Compliance: The Department will document deficiencies and notify the Contractor in writing if they do not meet the Required Level of Expectation. The Department may meet with the Contractor to discuss the issues and potential resolutions. The Contractor shall have ten (10) business days after receipt of the written notification to submit a written response to the Department identifying how they will correct the findings. The Department may also require the Contractor to submit a Corrective Action Plan which meets Department approval. The Corrective Action Plan shall be submitted within ten (10) business days after the Contractor has been notified in writing of the findings. Continued non-compliance may result in additional actions outlined in the Remedies section of the Special Terms and Conditions, up to and including termination of the contract.Metric Description: Communications: (SOW IV.A.6) The Contractor shall share claims database with the Department in an acceptable electronic format for the purpose of reconciling claims data with Department databases containing client outcome data.Required Level of Expectation: 100%

Product Code: 95327

Agency Information

Issuing Agency: State of Idaho - Department of Health and Welfare

State: Idaho

Agency Type: State and Local

Contact: Bev Berends

Phone: 208-334-6635

Fax: 208-334-5694




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