Specifications include, but are not limited to: provide PEBP analysis and reporting required to administer PEBP health plans effectively and with cost efficiency. The services shall include but are not limited to the following: Coordinate all follow-up care covered by the program in a manner consistent with the initial care Process claims in a timely manner and assist patients in understanding their responsibility as appropriate. This includes coordinating with PEBP’s TPA to apply benefit accumulators and other cost sharing plan provisions determined by PEBP. Provide member Explanation of Benefits Provide reporting to members for tax purposes. Provide quarterly, and year end, reporting to PEBP including period over period utilization, total costs and savings by type of service. Provide ad hoc reporting as requested Provide detailed claims and utilization data to PEBP and its actuary as requested Provide member cost and utilization data to other PEBP vendors for purposes of administering benefit accumulators and providing care management services Assist PEBP with communicating and educating PEBP membership to increase awareness and understanding Assist PEBP, as requested, in reviewing and drafting Master Plan Document language Attend PEBP Board or strategy meetings as necessary, in person or virtually as requested by PEBP Provide qualified service team with experience in serving other group plans similar in nature and complexity as PEBP Provide the necessary implementation support to facilitate a smooth and timely implementation, both initially and when there are new programs or services added. Accept payment on a monthly invoice basis. Support audits by PEBP to ensure accurate claims processing, appropriate operations, appropriate savings calculations and accurate invoicing. Maintain systems and data security that are HIPAA or NIST compliant, with all data remaining in the United States at all times. Accept eligibility file from PEBP, or its administrator, in a mutually agreed format Coordinate with PEBP’s current second opinion vendor when appropriate Maintain a member portal that provides access to, at a minimum: Network provider list Current case status Past claims activity Tax statements for last 2 full calendar years Contact information for Member Services Contact information for PEBP and other PEBP vendors
