Specifications include, but are not limited to: The District shall require that the vendor provide all necessary services including, but not limited to the following: 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 contract. 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 District’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 District prefers vendor to mail identification cards to the participant’s home address. 6. Deliver utilization reports. The District 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 District. If a specific report cannot be generated online, prepare and provide such to the District electronically. 8. Meet with representatives of the District’s Human Resources Department as often as deemed necessary by the District but not less than twice per year to discuss overall service performance and vendor/client relationship.
