Healthcare and Drug Prescription Programs Services

The agency is seeking a vendor to provide comprehensive healthcare and drug prescription programs services. The selected administrator must handle the automated processing and payment of medical and prescription drug claims in accordance with plan documents and contracted network reimbursement fee schedules. The required scope of work also includes utilization review, case management, stop loss reporting, third party recovery, and the coordination of medical coverage. To support plan administration, the agency requires the maintenance of a master file containing plan documents, summary plan descriptions, plan booklets, benefit provisions, and claims administration policies. The administrator must design, print, deliver, and periodically update all forms and form letters used in claims processing at their own expense. Additionally, the administrator must provide professional customer service to handle telephone, written, and in-person inquiries from plan participants, providers, and authorized legal counsel. The utilization review services must encompass hospital pre-admission certification, concurrent utilization review, length of stay monitoring, discharge planning, and preauthorization. The agency also requires a medical review system that utilizes acceptable medical professionals. Eligible bidders must be onshore organizations based in the United States, and the performance of the work will take place offsite. The agency is currently looking for proposals to determine the budget, and no specific evaluation criteria or key dates are provided in the source.