Offeror shall: Transmit billing, re-billing, and reversals for pharmacy claims in compliance with NCPDP standards. Must have the ability to transmit eligibility and billing requirements to third party processors (such as: PBM “Pharmacy Benefit Managers”). Must support claim submissions and rejected claims resolution via TCP/IP protocol. The company must agree to be a secondary switch provider and provide what is required to provide that service. For example: if a minimum of submissions is required to be contracted then that number must be provided to Parkland. Have the ability to perform in real time eligibility queries for Medicare/Medicaid/Commercial/Co-Pay Cards/Coupons, etc. for the current date of service and for Medicare for past date of services. Additionally perform eligibility queries for Medicare with SSN (social security number), Medicare ID (identification number), and MBI (Medicare Beneficiary Identifier). Provide ability to send E1 (eligibility query) to 025417 DRTXPROD, obtain coverage and a return a REJECTED response for Traditional Texas Medicaid queries. Allow historical reporting of any claim activity to be maintained in electronic format for retrieval by Pharmacy staff. Provide on line access to claims and claims data. Provide on line access to run eligibility queries for current date and past dates for Medicare Provide timely communication when a payor is down, and communication again when that payor is back up. Conform to security and privacy rules and regulations (not limited to JIPAA and HITECH). Provide data storage in a secure HIPAA compliant environment. Adherence to relevant regulations and guidelines, such as HIPAA and NCPDP standards. Provide Procedures for managing and mitigating risks associated with claims processing...
