Government Contract | New Jersey
MEDICAL INSURANCE CARRIER CLAIM AUDIT

Bid Information


Bid Alert No: 00000396416

Bid Title: MEDICAL INSURANCE CARRIER CLAIM AUDIT

Agency Bid No. Title: Not Stated

Received Date: 10/19/2015

Close Date: 11/17/2015

Purchase Type: Not Stated

Delivery Point:

Delivery Date: Not Stated

Special Notices: Bidder Preregistration

Specifications

Specifications include, but are not limited to:The objectives of this audit are to evaluate the administration of claims for Medicare eligible members against industry and contract standards for accuracy, timeliness and quality of operation and service, to recommend improvements and to identify performance issues for future contracts. The operational review will focus on operational issues, which pose potential risks to the Funds assets through claim adjudication. A statistical claim audit will involve on-site testing of a sample of claims at a level of accuracy consistent with industry standards. Specifically, the review should answer the following questions: What is the accuracy of eligibility data resident on providers' claims systems utilized to process claims? What is the accuracy of medical claim payments and how does that accuracy compare to internal standards, contractual guarantees and generally accepted industry standards? Is Coordination of Benefits (COB) between Medicare and Horizon properly applied? Is COB properly applied when there is a third carrier primary or secondary to Horizon? Does the claim system fully support automatic claim adjudication? Are claim processing duties and responsibilities appropriately segregated? Is claim documentation appropriately protected from loss or damage? A r e p e o p l e , p r o c e s s a n d t e c h n o l o g y f u l l y i n t e g r a t e d t h r o u g h o u t t h e c l a im area to support and encourage accurate claim processing? Does the system accurately protect the confidentiality of employees in compliance with regulations? Is the system in compliance with the regulations applicable to TPAs of the New Jersey Department of Banking and Insurance and Department of Community Affairs

Bid Related Documents

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Bid Related Attachments

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Product Code: 94620

Agency Information


Issuing Agency: Middlesex County Joint Health Insurance Fund

State: New Jersey

Agency Type: State and Local

Contact: 75 Bayard Street, New Brunswick, New Jersey

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