S000000357 Attachment A- Document Types.pdf
PDF 414 KB Posted
- Attached to
- Plan Administration System and Related Services
- Solicitation number
- S000000357
- Issued by
- Arkansas
About this file
This document outlines the required documentation and data exchange specifications for a state and local government contract opportunity. The requested materials include various employee tax forms (W-2, 1095-C), plan documents (SPD, SBC, SMMs), HIPAA compliance documentation, claims processing details, enrollment forms, financial records, compliance documents, and data exchange requirements related to benefit enrollment, claims payment, eligibility inquiries, and healthcare service reviews. The contract appears to involve healthcare benefits administration and processing, with detailed security and reporting provisions. No specific project details, response dates, award information, or contract term are provided in the document.
The pricing terms, set-asides, incumbent providers, funding sources, and other salient commercial information are not detailed in this file. However, the comprehensive documentation and data requirements suggest this is a high-value contract with significant regulatory and operational complexities for the selected vendor(s).
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Other files
| File | Type | Posted |
|---|---|---|
| S000000357 Official Price Sheet.xlsx | XLSX spreadsheet | |
| S000000357 Plan Administration System RFP~2.pdf | ||
| S000000357 Attachment B- EBD Business Associate Agreement.pdf | ||
| S000000357 Contract and Grant Disclosure.pdf | ||
| S000000357 Q&A.pdf | ||
| S000000357 Response Packet.docx | DOCX document | |
| S000000357 Plan Administration System RFP REVISED.pdf |
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Text version
Document Types W-2
Box 12 Code DD: Total cost of employer-sponsored health coverage Box 1: Wages including taxable benefits Box 3 & 5: Social Security/Medicare wages including taxable benefits
1095-C Part I: Employee and Employer Information o Employee's name, SSN, address o Employer information including EIN o Contact phone number
Part II: Employee O er of Coverage o Line 14: O er of Coverage codes o Line 15: Employee Required Contribution o Line 16: Applicable Section 4980H Safe Harbor codes
Part III: Covered Individuals (if self-insured) o Names, SSNs, DOBs of all covered individuals o Coverage months for each person
Plan Documents Summary Plan Description (SPD) Schedule of Benefits Summary of Benefits and Coverage (SBC) Summary of Material Modifications (SMMs)
HIPAA Documentation Notice of Privacy Practices Business Associate Agreements Security and Privacy Policies Authorization Forms Breach Notification Procedures
Claims Processing Explanation of Benefits (EOB) Templates Claims Forms Appeals Forms and Procedures Coordination of Benefits Documentation
Enrollment Documentation Initial Enrollment Forms Open Enrollment Materials Qualifying Life Event Forms COBRA Notices and Forms
Financial Documentation Premium Rate Calculations Stop Loss Insurance Certificates Administrative Services Agreements Network Provider Agreements Actuarial Reports
Compliance Documentation ACA Compliance Records Section 125 Documentation (if applicable) Medicare Secondary Payer Documentation ERISA Required Notices State-Specific Required Notices
Data Exchange Specifications Benefit Enrollment and Maintenance Health Care Claim Payment/Advice Eligibility Inquiry and Response Health Care Services Review
Security Requirements HIPAA Security Rule Compliance Data Encryption Standards Access Control Specifications Audit Trail Requirements Backup and Recovery Procedures
Reporting Capabilities IRS Required Reports State-Required Reports Utilization Reports Claims Experience Reports Cost Trending Analysis
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