Specifications include, but are not limited to: 1. Maintain a fully automated claims adjudication system in compliance with electronic transmission standards
and security requirements and all other regulations as required by HIPAA, provide web access to plan
participants that allows for claim status and offers various customer service functions.
2. Maintain records and management reports, including claims and accounting information as required by the
3. Provide timely response to inquiries from plan participants and providers regarding eligibility and status of
claim, correspondence, payment, and any other information requested by such parties in a manner that will
limit the City’s involvement in day-to-day inquiries.
4. Prepare and review with the Human Resources staff, and print summary plan documents, claim forms, and
any other communication material as required by the contract.
5. If vendor uses ID cards, the City prefers vendor to mail identification cards to the participant’s home address.
6. Deliver utilization reports. The City and its consultants need to be able to access standard reports online,
preferably in excel format.
7. Provide online access to additional standard or ad hoc reports as needed by the City. If a specific report
cannot be generated online, prepare and provide such to the City electronically.
8. Meet with representatives of the City’s Human Resources Department as often as deemed necessary by