Schedule R Payment Discrepancy Report Template.xlsx
XLSX spreadsheet 16 KB Posted
- Attached to
- HMO Services for MPSERS
- Solicitation number
- RFP - 171 - 230000003226
- Issued by
- Ingham County, Lansing City, Michigan
About this file
This document is a Schedule R Payment Discrepancy Report Template associated with RFP No. 230000003226 for HMO health coverage services for the Medicare-Eligible Members and non-Medicare Eligible Members, including Retirees, beneficiaries, COBRA participants, and Dependents, of the Michigan Public School Employees' Retirement System (MPSERS), administered by the Michigan Office of Retirement Services (ORS). The RFP seeks proposals for fully-insured HMO offerings, including both non-Medicare and Medicare products inclusive of prescription drug coverage, to be provided and administered by the selected Contractor. The resulting contract will have a term of one (1) year, with four (4) one-year options.
The state and local jurisdictions involved are Ingham County and Lansing City. A revised Schedule M HMO Census Data document has been added, and a Question and Answer document is now posted. Bidder proposals must reflect fully-insured offerings only, and the Contractor must be able to provide the required products and services to the Eligible Members who elect enrollment in an HMO.
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Other files
| File | Type | Posted |
|---|---|---|
| 230000003226 HMO Services RFP.docx | DOCX document | |
| 230000003226 Questions Answers.pdf | ||
| Schedule I4 Medicare Prescription Drug Summary of Benefits.pdf | ||
| Schedule K 834 Use Case and Example.docx | DOCX document | |
| Schedule N Section 2 Solutions Table.xlsx | XLSX spreadsheet | |
| Schedule F Definitions.docx | DOCX document | |
| Schedule I2 PPO Medicare Summary of Benefits.pdf | ||
| Schedule L Benefit Comparison and Actuarial Attestation.xlsx | XLSX spreadsheet | |
| Schedule Q RFI Report Template.xlsx | XLSX spreadsheet | |
| Schedule G - Contractor Performance Evaluation Survey.doc | DOC document | |
| Schedule I1 PPO Non Medicare Summary of Benefits.pdf | ||
| Schedule P TRR Report Template.xlsx | XLSX spreadsheet | |
| Schedule H HMO Benefits Summary and Claims Paid Data.xlsx | XLSX spreadsheet | |
| Schedule B Pricing.xlsx | XLSX spreadsheet | |
| Schedule I3 Non-Medicare Prescription Drug Summary of Benefits.pdf | ||
| Schedule J Dependent Coverage.pdf | ||
| Schedule M HMO Census Data REVISED.xlsx | XLSX spreadsheet |
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Text version
Sheet1
| Schedule R Payment Discrepancy Report Template |
| RFP No. 230000003226 |
SUBSCRIBER NAME SSN MEMBER # MONTH OCCURRED DESCRIPTION/NOTES TYPE NOTES MONTH ADJ FOR AMOUNT BILLED GROUP PAYMENT AMOUNT BALANCE MPSERS RESPONSE
File details come from the government source that posted it. Updated .