HEALTH-1489 - USA (Minnesota) - Independent External Review of Adverse Determinations of Health Care Complaints - Deadline November 25,2019

Product (RFP/RFQ/RFI/Solicitation/Tender/Bid Etc.) ID: HEALTH-1489

Government Authority located in Minnesota; USA based organization looking for expert vendor for independent external review of adverse determinations of health care complaints.

[A] Budget: Looking for Proposal

[B] Scope of Service:

(1) Vendor needs to provide independent external review of adverse determinations of health care complaints to the government authority located in Minnesota.
- A determination by a health plan company that a hysterectomy is not medically appropriate for that patient,
- A determination that mental health services are not medically necessary for a child with oppositional defiant disorders or attention deficit hyperactivity disorder,
- A determination that a specific paediatric dental or vision service is not considered part of the essential health benefits and covered under the contract,
- A determination by a health care company that medical procedures to diagnose and treat a medical condition in an emergency room were not an emergency,
- A determination that continuing therapy, such as physical and occupational therapy for a child, is not medically necessary because the child is not making substantial improvement in terms of the therapy,
- A determination to not pay for out-of-network provider services at the same level of coverage as preferred network provider services because the health plan company believes the services are available from a preferred provider,
- A determination to apply the cost of an office visit or test to the deductible resulting in no payment and the consumer asserts that it was a preventive service that should be provided without cost sharing.
(2) All the questions must be submitted no later than November 14, 2019.

[C] Eligibility:

- Onshore (USA Only);

[D] Work Performance:

Not Applicable

Expiry Date : Monday, 25 November, 2019

Question Answer Deadline : Thursday, 14 November, 2019

Category : Health and Related Services

Country : USA

State : Minnesota

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