MB-10516 - USA (Virginia) - Administrative Services for Medical, Pharmacy, Stop Loss, Dental, Vision Benefit Plans - Deadline November 17,2026

(1) Vendor needs to provide administrative services for medical, pharmacy, stop loss, dental, vision benefit plans.• Medical administration services: claims adjudication and payment administration for the county self–funded medical plan.• Claims appeals, coordination of benefits, prior authorization administration and aca–required external appeals.• Provide a dedicated toll–free member service number exclusive to County members and maintain escalation access for complex claims, eligibility and provider issues. • Call center operations and issue resolution support.• Customer service representatives based in the States during standard business hours, with interactive voice response routing, average speed–to–answer standards, call abandonment reporting, and multilingual support.• HIPAA, Transparency in Coverage, Mental Health Parity, No Surprises Act and applicable compliance support.• Dedicated implementation manager and implementation team.• Development and maintenance of a mutually agreed implementation project plan.• Coordination with County payroll, HR, and benefit administration systems.• Utilization management, case management, disease management and care coordination.• Population health programs, digital engagement tools, predictive analytics and care gap identification.• High–cost claimant identification and intervention.(2) All the questions must be submitted no later than Nov 10, 2026.