Specifications include, but are not limited to: 1. Implementation – Implementation resources including resource commitments, continuity of care provisions, plans to minimize disruption, and resources provided to members. 2. Claims Processing – Resources for promoting and providing the appropriate incentives around encouraging best practices, consistency, and accountability with respect to the timely and accurate processing of claims, and effectively communicating with members regarding their benefits and how to successfully navigate the claims process. 3. Member Advocates – The selected vendor shall be responsible for providing Advocate Support, including but not limited to: helping members understand their health benefits as listed in the Evidence of Coverage; assisting members with claims support, disputes, and resolutions with providers; documenting member complaints and taking the necessary steps to resolve them; reviewing member health-related paperwork for accuracy and completeness; and informing members of their patient rights within the required rules and regulations of their health insurance. 4. Billing & Eligibility – Ability to work effectively with LACERS’ benefits administration with respect paper enrollments and data file transfers, as well as each vendor’s reliability and competence in billing and payment processing and requirements. Have the ability to grow with LACERS should they implement a benefits administration system. 5. Plan Sponsor Services – Plan sponsor services including electronic and written reporting capabilities, new member processing requirements and timeframes, processing of identification (ID) cards, and other administrative processes involving LACERS and the vendor...
