The Vendor is required to provide interested in maintaining a long-term strategy that incorporates plan management and exceptional member services.
- Deliver accurate, responsive and timely claims payment
- Provide effective and accurate, customer-focused member services
- Provide timely, standard reporting to assist county in managing its plan(s).
- Reject any proposal received
- Communicate or negotiate exclusively with one or more of the organizations invited to submit proposals
- Request one or more of the quoting organizations to clarify its proposal, supply additional information, or expand upon its original submission
- Enter into agreements or arrangements not specified herein
- Base selection of the finalist(s) on factors such as adequacy of service personnel, claim adjudication services, reporting, IT capabilities and willingness to enter into a long-term relationship.
- Criteria used for claims denial and appeals
- Dedicated service representative should be assigned to county’s account for employer and member customer service and claims adjudication
- Aca/health care reform and other state or federal compliance assistance
- HIPAA compliance
- Bidding companies will be required to provide performance guarantees to the plan for member service, administration, and claims adjudication services; see performance guarantees
- Bidding companies are expected to provide toll-free access to claims and customer service personnel as follows:
• 8:00 am – 8:00 pm (Eastern Standard Time) Monday through Friday
- Provide employee communication materials for implementation of new administrator process, open enrollment support, support county with employee communication materials for new plan(s)
- Drafted SPDS must be submitted to county within 30 days of the plan’s effective date; completed SPDS must be available to plan participants within 90 days of the effective date of the plan
- Provide template member communications.
- Contract Period/Term: 1 year
- Questions/Inquires Deadline: April 23, 2025