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MB-3883 - USA (Ohio) - Pharmacy Benefit Manager Claims Audit Services - Deadline March 26,2020

Product (RFP/RFQ/RFI/Solicitation/Tender/Bid Etc.) ID: MB-3883

Government Authority located in Ohio; USA based organization looking for expert vendor for pharmacy benefit manager claims audit services.

[A] Budget: Looking for Proposal

[B] Scope of Service:

(1) Vendor needs to provide pharmacy benefit manager claims audit services
- The audit shall cover claims incurred January 1, 2016 through December 31, 2017 for the commercial group plan,
- Determine if pharmacy claims are being adjudicated in accordance with the correct pricing terms (e.g. discounts, dispensing fees, administrative fees) for each review period,
- Determine the accuracy of pharmacy claims adjudication with respect to plan design provisions (including by way of example only, co-payments, coinsurance, quantity limits, excluded medications, prior authorizations, step therapy programs, reversed and reprocessed claims, Medicare B),
- Evaluate the accuracy of manufacturer rebates received by the Rx Administrator and credited to OPERS,
- Claims Pricing (Discount) Accuracy Review, which requires analyzing 100 percent of the claims incurred in the time period of the audit to confirm pricing accuracy,
- Plan Design Accuracy Review, which requires analyzing the claims for each time period of the audit to determine whether prescription drug claims were processed according to OPERS’ prescription drug coverage,
- Rebate Review, which requires identification of the top five specialty drug manufacturers and the top five traditional drug manufacturers comparing the rebates credited to OPERS for the audit review period under each manufacturer’s contract with the Rx Administrator.
(2) A pre-proposal meeting will be held on February 20, 2020.
(3) All the questions must be submitted no later than February 24, 2020.

[C] Eligibility:

- Onshore (USA Only);

[D] Work Performance:

Performance of the work will be Offsite. Vendor needs to carry work in their office location.

Expiry Date : Thursday, 26 March, 2020

Pre-proposal Conference Date : Thursday, 20 February, 2020

Question Answer Deadline : Monday, 24 February, 2020

Category : Medical Billing and Coding, Auditing, Finance and Accounting, Pharmaceutical, Pharmacy & Related Services

Country : USA

State : Ohio

Cost to Download This RFP Document : $ 5

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