DOCUMENT

RFP - Group Health/Dental Plan 2004

  • YEAR CREATED: 2004
  • ENTITY TYPE: K-12
  • TYPE OF DOCUMENT: RFP - Request for Proposals
This document is a Request for Proposal (RFP) form for the McAllen Independent School District in Texas. The RFP is for the selection of an Administrative Services Only (ASO) Claim Administration provider for the district's Group Health/Dental Plan on a self-insured basis. The form includes various questions and requirements that the potential provider must address in their proposal. The document begins with questions regarding any unresolved claims filed against the business entity and any bankruptcy filings by the business entity or its owners, members, or partners in the past seven years. It also asks if the business entity is willing to provide an audited financial statement upon request. The form then asks the potential provider to describe their claim administration experience, including the number of clients and covered employees. It also requires the provider to provide three client references, preferably from school districts. Next, the document asks for information about the provider's insurance coverage, including a copy of their insurance certificate. It also asks if the provider will allow the district to modify their standard administration contract and if they agree to process 98% of all submitted claims within fifteen business days with a minimum of 98% overall accuracy. The form includes questions about the provider's customer service accuracy, willingness to allow a third-party claims audit, and agreement to hold the district harmless in case of negligence in benefits administration. It also asks if the provider will provide a specimen copy of their administration contract upon request. The document then asks for details about the provider's claim payment services, including the location of their office for claim settlement, assignment of a specific analyst to the account, availability of on-site claims handling, and the availability of a toll-free telephone number for checking claim status. Other questions in the form cover topics such as appeal procedures for contested claims, screening for unbundling of provider charges, payment for printing costs of checks and explanation of benefits, and the provider's banking arrangements for claim reimbursement. The form also asks about the provider's basis and procedure for determining Reasonable and Customary charges, the date of the last third-party claim audit, and their procedures for subrogation investigation and recovery. It concludes with questions about prescription drug card services, other additional services offered, and the availability of online services. Overall, the document provides a comprehensive set of requirements and questions for potential ASO Claim Administration providers to address in their proposals for the McAllen Independent School District's Group Health/Dental Plan.
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