Posted Date : February 25,2020
Product (RFP/RFQ/RFI/Solicitation/Tender/Bid Etc.) ID : ACCT-8644
Government authority located in Topeka, Kansas, USA; based organization looking for expert vendor for audit services for the state employee health plan.
[A] Budget: Looking for Proposal
[B] Scope of Service:
(1) Vendor needs to provide audit services for the state employee health plan to the government authority located in Topeka, KS.
- Comprehensive financial and benefit audit that reconciles dispensing fees, discounts and contract guarantees. Review of plan limits, step therapy, prior authorizations, point of sale rebates and drug exclusions
- Retail Transparency of pharmacy reimbursements to validate pass through pricing including doing a sampling of actual pharmacy payments by contacting retail pharmacies to validate the actual payments made. This audit requires the auditors to contact a sample of pharmacies to verify actual PBM payments
- Comparison of pricing across channels to evaluate the PBM’s pricing across retail and mail settings
- Retail Pharmacy Recoupment Audit to review adjustments, reversals and review claims audits done by the PBM and compliance with contract audit requirements for Kansas pharmacies
- able to effectively address questions, concerns and problems through the audit vendor’s corporate structure
- maintain secured e-mail communications protocols to facilitate project operations
- review of the self-funded plans, the vendor will be expected to document, evaluate, and comment
- audit process for Items to be audited
- understand the current eligibility and premium payment processes in place and reconciliation of payments received to actual covered members.
(2) All questions must be submitted no later than March 9, 2020.
(3) Contract period will be three years.
[C] Eligibility:
- Onshore (USA Only);
[D] Work Performance:
Performance of the work will be Offsite. Vendor needs to carry work in their office location.
Budget :
Deadline to Submit Proposals: April 06,2020
Cost to Download This RFP/RFQ/RFI/Solicitation/Tender/Bid Document : 5 US$
![]()
Product (RFP/RFQ/RFI/Solicitation/Tender/Bid Etc.) ID : ACCT-8644
Government authority located in Topeka, Kansas, USA; based organization looking for expert vendor for audit services for the state employee health plan.
[A] Budget: Looking for Proposal
[B] Scope of Service:
(1) Vendor needs to provide audit services for the state employee health plan to the government authority located in Topeka, KS.
- Comprehensive financial and benefit audit that reconciles dispensing fees, discounts and contract guarantees. Review of plan limits, step therapy, prior authorizations, point of sale rebates and drug exclusions
- Retail Transparency of pharmacy reimbursements to validate pass through pricing including doing a sampling of actual pharmacy payments by contacting retail pharmacies to validate the actual payments made. This audit requires the auditors to contact a sample of pharmacies to verify actual PBM payments
- Comparison of pricing across channels to evaluate the PBM’s pricing across retail and mail settings
- Retail Pharmacy Recoupment Audit to review adjustments, reversals and review claims audits done by the PBM and compliance with contract audit requirements for Kansas pharmacies
- able to effectively address questions, concerns and problems through the audit vendor’s corporate structure
- maintain secured e-mail communications protocols to facilitate project operations
- review of the self-funded plans, the vendor will be expected to document, evaluate, and comment
- audit process for Items to be audited
- understand the current eligibility and premium payment processes in place and reconciliation of payments received to actual covered members.
(2) All questions must be submitted no later than March 9, 2020.
(3) Contract period will be three years.
[C] Eligibility:
- Onshore (USA Only);
[D] Work Performance:
Performance of the work will be Offsite. Vendor needs to carry work in their office location.
Budget :
Deadline to Submit Proposals: April 06,2020
Cost to Download This RFP/RFQ/RFI/Solicitation/Tender/Bid Document : 5 US$