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MB-6576 - USA (Maryland) - Medicare Administrative Contractor Service - Deadline August 15,2022

Product (RFP/RFQ/RFI/Solicitation/Tender/Bid Etc.) ID: MB-6576

Government Authority located in Maryland; USA based organization looking for expert vendor for medicare administrative contractor service.

[A] Budget: Looking for Proposal

[B] Scope of Service:

Vendor needs to provide medicare administrative contractor service to provide specified health insurance benefit administration services, including medicare claims processing and payment services, in support of the medicare program.
- Contractor will perform its responsibilities under the direction of the centers for medicare and medicaid services (CMS).
- Contractor will perform numerous functions to support health care services for Medicare beneficiaries, which include performing claims-related activities and establishing relationships with providers of health care services, both institutional and professional, for a defined geographic area or jurisdiction.
- Contractor will perform the requirements of this contract in accordance with applicable laws, regulations, medicare manuals, and CMS requirements to ensure the financial integrity of the medicare program.
- Contractor will receive and control Medicare claims from institutional and professional providers, suppliers, and beneficiaries within its jurisdiction and will perform standard or required editing on these claims to determine whether the claims are complete and should be paid.
- Contractor will calculate medicare payment amounts and arrange for remittance of these payments to the appropriate party.
- The contractor also will enroll new providers; conduct redeterminations on appeals of claims; operate a provider customer service program (PCSP) that educates providers about the Medicare program’s rules, regulations, and billing procedures; respond to provider electronic, telephone, and written inquiries; respond to complex inquiries from call center operations (CCOs); and make coverage decisions for new procedures and devices in local areas.
- Contractor shall furnish services to all the providers CMS designates as within the contractor’s workload. The contractor’s workload will, from time to time, contain out-of-jurisdiction providers.

[C] Eligibility:

- Onshore (USA ONLY);

[D] Work Performance:

Performance of the work will be Offsite.

Expiry Date : Monday, 15 August, 2022

Category : Medical Billing and Coding

Country : USA

State : Maryland

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