Specifications include, but are not limited to: The successful bidder will be responsible for administering and processing pharmacy claims for eligible services in accordance with the BHS/MSN program guidelines. BHS and MSN utilize separate formularies to adjudicate claims in their respective programs. MSN utilizes a four (4) tiered medication co-payment structure while BHS has no tiered medication designations or co-pay requirements because BHS pays all out-of-pocket cost for our clients. The provider shall not be a plan fiduciary and shall not exercise discretion, authority, or control regarding administration of the Benefit Plan Design. The provider shall provide the services as stated and required by the Benefit Plan Design with responsibilities including, but not limited to: 1. Benefit Plan Design a. Make modifications to Benefit Plan Design, as specified by BHS/MSN Program Manager or designee(s), to meet federal, state, or BHS/MSN requirements. The provider is expected to establish a Benefit Plan Design and assist with financial modeling of Benefit Plan Design modifications and formulary changes. 1) Upon signed request by BHS/MSN to provider, BHS/MSN may initiate Benefit Plan Design changes, network modifications, or add other services. Dependent on the complexity and breadth of the Benefit Plan Design parameter change, provider will implement a change as soon as possible or practicable but shall not take longer than five (5) working days without written consent of the BHS/MSN Program Manager or designee(s). 2) Services shall be provided in accordance with the modified Benefit Plan Design.
