Posted Date : December 12,2020
Product (RFP/RFQ/RFI/Solicitation/Tender/Bid Etc.) ID : MB-4773
Government Authority located in Tennessee; USA based organization looking for expert vendor for employee assistance program and behavioral health organization services.
[A] Budget: Looking for Proposals
[B] Scope of Service:
Vendor needs to provide employee assistance program and behavioral health organization services
a. Abandoned Call: A call in which the caller elects an option and is either not permitted access to that option or disconnects from the system.
b. Account Executive: Dedicated full-time employee of the Contractor who has primary oversight and management of the Contract and all services, deliverables, and requirements within.
c. Account Manager: Dedicated full-time employee of the Contractor who supports the Contract primarily handling member services and issues including claims, benefits, and provider concerns.
d. Advanced Practice Psychiatric Nurses: Health care professionals licensed to practice as specialists in psychiatric mental health. The advanced practice psychiatric nurse may be certified in psychiatric mental health (PMH), as a psychiatric mental health clinical nurse specialist (PMHCNS-BC), or as a psychiatric mental health nurse practitioner (PMHNP-BC).
e. Affiliate: A business organization or entity that, directly or indirectly, is owned or controlled by the Contractor, or owns or controls the Contractor, or is under common ownership or control with the Contractor.
f. Agency Benefits Coordinator (“ABC”): An Agency Benefits Coordinator serves as the liaison between the Plan and Members. There is at least one ABC in every employer agency/entity.
g. At-Risk Performance Payment: Contractor’s payment based on KPI performance listed on the SLA Scorecard set forth in Contract Attachment D. The payment is calculated based on the SLA Scorecard quarterly score and percentage of the administrative fees at risk.
h. Average Speed of Answer (“ASA”): The average waiting time between (a) the moment at which a caller to the Contractor’s call center first hears an introductory greeting and enters the queue and (b) the time at which a Member services representative at the call center answers the call. For this definition, the term “answer” shall mean begin an uninterrupted dialogue with the caller. If a member services representative asks the caller to hold during the first sixty (60) seconds of the dialogue, the Contractor shall not consider the call to be answered for purposes of this definition until the member services representative returns to the caller and begins an uninterrupted dialogue.
i. Balance Bill or Billing: Seeking payment from a member for any charged amounts(s) over and above the MAC or contract rates.
j. Benefits Administration (“BA”): The division of the Tennessee Department of Finance & Administration that administers the Public Sector Plans.
k. Behavioral Health Services: Mental health and substance use services.
l. BHO: Behavioral Health Organization.
m. Business Days: Traditional workdays, including Monday, Tuesday, Wednesday, Thursday, and Friday. State Holidays are excluded.
n. CFR: Code of Federal Regulations.
o. Clean Claim: A claim received by the Contractor for adjudication that requires no further
information, adjustment, or alteration by the provider in order to be processed and paid by the Contractor. In addition to the provider, this includes information, adjustment, or alteration by the Member, the Subscriber, third-party payers (i.e. – Medicare), and/or Plan Sponsor.
p. Coinsurance – The percentage of the MAC for each service provided to the Member that is the responsibility of the Member.
q. Copayment - The portion of the MAC (flat dollar amount) for each service provided to the Member that is the responsibility of the Member.
r. Deductible: The amount that must be paid by each member prior to payment of any covered benefits by the Contractor.
s. Denied Claim: A claim that is not paid for reasons such as eligibility and coverage rules. t. Decision Support System (“DSS”): A database and query tool containing health care information and claims data which allows for analytics and executive decision making.
u. EAP: Employee Assistance Program. Up to five (5) counseling sessions (5 visit model), per separate issue, per individual, per year.
v. Edison: The State’s enterprise resource planning system, which supports human resources, payroll, insurance, contracting, procurement and other agency functions.
w. Flexible Spending Arrangement (“FSA”): A health flexible spending arrangement allows employees to be reimbursed for medical expenses. FSAs are usually funded through voluntary salary reduction agreements with employers. No employment or federal income taxes are deducted from employee contributions. The employer may also contribute.
x. Generic Product Identifier (“GPI”): The Medi-Span Generic Product Identifier can be comprised of up to a 14-digit code and description or as few as two digits - dependin
[C] Eligibility:
- Onshore (USA Organization Only);
[D] Work Performance:
Performance of the work will be Offsite. Vendor needs to carry work in their office location.
Budget :
Deadline to Submit Proposals: March 22,2021
Cost to Download This RFP/RFQ/RFI/Solicitation/Tender/Bid Document : 5 US$
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Product (RFP/RFQ/RFI/Solicitation/Tender/Bid Etc.) ID : MB-4773
Government Authority located in Tennessee; USA based organization looking for expert vendor for employee assistance program and behavioral health organization services.
[A] Budget: Looking for Proposals
[B] Scope of Service:
Vendor needs to provide employee assistance program and behavioral health organization services
a. Abandoned Call: A call in which the caller elects an option and is either not permitted access to that option or disconnects from the system.
b. Account Executive: Dedicated full-time employee of the Contractor who has primary oversight and management of the Contract and all services, deliverables, and requirements within.
c. Account Manager: Dedicated full-time employee of the Contractor who supports the Contract primarily handling member services and issues including claims, benefits, and provider concerns.
d. Advanced Practice Psychiatric Nurses: Health care professionals licensed to practice as specialists in psychiatric mental health. The advanced practice psychiatric nurse may be certified in psychiatric mental health (PMH), as a psychiatric mental health clinical nurse specialist (PMHCNS-BC), or as a psychiatric mental health nurse practitioner (PMHNP-BC).
e. Affiliate: A business organization or entity that, directly or indirectly, is owned or controlled by the Contractor, or owns or controls the Contractor, or is under common ownership or control with the Contractor.
f. Agency Benefits Coordinator (“ABC”): An Agency Benefits Coordinator serves as the liaison between the Plan and Members. There is at least one ABC in every employer agency/entity.
g. At-Risk Performance Payment: Contractor’s payment based on KPI performance listed on the SLA Scorecard set forth in Contract Attachment D. The payment is calculated based on the SLA Scorecard quarterly score and percentage of the administrative fees at risk.
h. Average Speed of Answer (“ASA”): The average waiting time between (a) the moment at which a caller to the Contractor’s call center first hears an introductory greeting and enters the queue and (b) the time at which a Member services representative at the call center answers the call. For this definition, the term “answer” shall mean begin an uninterrupted dialogue with the caller. If a member services representative asks the caller to hold during the first sixty (60) seconds of the dialogue, the Contractor shall not consider the call to be answered for purposes of this definition until the member services representative returns to the caller and begins an uninterrupted dialogue.
i. Balance Bill or Billing: Seeking payment from a member for any charged amounts(s) over and above the MAC or contract rates.
j. Benefits Administration (“BA”): The division of the Tennessee Department of Finance & Administration that administers the Public Sector Plans.
k. Behavioral Health Services: Mental health and substance use services.
l. BHO: Behavioral Health Organization.
m. Business Days: Traditional workdays, including Monday, Tuesday, Wednesday, Thursday, and Friday. State Holidays are excluded.
n. CFR: Code of Federal Regulations.
o. Clean Claim: A claim received by the Contractor for adjudication that requires no further
information, adjustment, or alteration by the provider in order to be processed and paid by the Contractor. In addition to the provider, this includes information, adjustment, or alteration by the Member, the Subscriber, third-party payers (i.e. – Medicare), and/or Plan Sponsor.
p. Coinsurance – The percentage of the MAC for each service provided to the Member that is the responsibility of the Member.
q. Copayment - The portion of the MAC (flat dollar amount) for each service provided to the Member that is the responsibility of the Member.
r. Deductible: The amount that must be paid by each member prior to payment of any covered benefits by the Contractor.
s. Denied Claim: A claim that is not paid for reasons such as eligibility and coverage rules. t. Decision Support System (“DSS”): A database and query tool containing health care information and claims data which allows for analytics and executive decision making.
u. EAP: Employee Assistance Program. Up to five (5) counseling sessions (5 visit model), per separate issue, per individual, per year.
v. Edison: The State’s enterprise resource planning system, which supports human resources, payroll, insurance, contracting, procurement and other agency functions.
w. Flexible Spending Arrangement (“FSA”): A health flexible spending arrangement allows employees to be reimbursed for medical expenses. FSAs are usually funded through voluntary salary reduction agreements with employers. No employment or federal income taxes are deducted from employee contributions. The employer may also contribute.
x. Generic Product Identifier (“GPI”): The Medi-Span Generic Product Identifier can be comprised of up to a 14-digit code and description or as few as two digits - dependin
[C] Eligibility:
- Onshore (USA Organization Only);
[D] Work Performance:
Performance of the work will be Offsite. Vendor needs to carry work in their office location.
Budget :
Deadline to Submit Proposals: March 22,2021
Cost to Download This RFP/RFQ/RFI/Solicitation/Tender/Bid Document : 5 US$