The vendor is required to provide medicare insurer reporting services that ensures compliance with medicare, Medicaid, and act insurer reporting requirements, conditional payment resolution and medicare set-asides for the city’s self-insured and self-administered workers’ compensation (WC) and public liability programs (PL).
- Reporting services
• Provide an overview of the proposer’s organization, size and experience; areas of expertise; approximate number of staff assigned to the project; unique qualifications of the proposer; and other matters that the proposer feels would assist the city in the evaluation process.
• Provide a description and sample of the reports that would be available to the city and how they would benefit compliance, and transparency in, the reporting process.
• Their proposed solution to a successful transmission of the claims response file from the center for medicare services (CMS) into the city’s claim platform
• Proposer must describe method(s) used to verify medicare beneficiary status and what follow-up is provided if the client error threshold exceeds 20%.
• Proposer shall describe the standard reports and ad-hoc capabilities available.
• Their process will accurately and timely identify medicare beneficiaries and what best practices you will provide to the city in doing so.
• The process and any additional fees applicable if the city changes its claims software.
- Medicare set-aside.
• Provide service for rush assignments, rated age verification, social security eligibility verification, and zero allocated medicare set-aside’s
- Training.
• Provide training to the city's staff for any changes in legislation that result in a change of process for reporting, conditional payments, and medicare set-aside’s.
• Training must also be provided to city staff on navigating any software systems utilized by provider that will be accessed by city staff.
• Training must be conducted on site or via on-line platform at no charge to the city.
- Cooperative work environment
• Proposer must work closely with the risk management and other city staff; daily contact may be necessary during the performance of some of the core requirements but is not typical
• The proposer is required to foster a cooperative and responsive work environment with the risk management department and any other city staff.
- Customer service
• All levels of the proposer’s personnel must respond to all telephone and e-mail inquiries by the city’s risk management department within 24 hours.
- Cooperation and transition
• at the end of this contract, proposer must cooperate with the city and the incumbent contractor, to accomplish a smooth phase-out and transition of responsibility, including transferring of historical data maintained by proposer.
- Contract Period/Term: 2 years
- Questions/Inquires Deadline: April 08, 2025