Specifications include, but are not limited to: The Metropolitan Nashville Public Schools (MNPS) is requesting sealed proposals from qualified firms to provide Annual Medical Claims and Pharmacy audits. * The MNPS Teacher benefit plans consist of self-funded health benefits administered by CIGNA. In addition, MNPS utilizes Vanderbilt Medical for provision of onsite medical clinics. Vanderbilt submits claims for reimbursement to the carriers, and MNPS pays the balance between claim reimbursement and cost. * Annual claim and pharmacy audits for Third Party Administrative services provided by CIGNA. We are looking for an offeror to provide auditing services, once per year based on valid claim samples. We are not pursing a full claims review and analysis. * Annual audit of Vanderbilt claims and cost submissions to MNPS. Again – valid sample will suffice. As mentioned above, the scope of work under this RFP consists of annual medical claim and pharmacy audit, and audit of onsite medical vendor's billing/reimbursements to MNPS. MNPS claims totals for last year can be found in Attachment A - Claim Payments By Category. Around $5 million in claims were paid to our onsite vendor.
