General Claims Audit – Request for Proposal Summary
The Federal Public Service Health Care Plan (PSHCP) Administration Authority is soliciting proposals from qualified consulting firms for a PSHCP general claims audit, which will verify and evaluate the accuracy of the paid claims processed as well as the systems and processes in place for the adjudication of PSHCP claims for each: Canada Life, and their sub-contractors (i) TELUS and (ii) MSH.
Key Details:
- Audit Period: January to June 2025
- Final Deliverable: June 27, 2025
- Proposal Submission Deadline: November 8, 2024
Scope and Objective:
The PSHCP Administration Authority is conducting the general claims audit to achieve the following objectives:
- To fulfil the audit requirements stated in the ASO Contract Statement of Work.
- To provide assurance that Canada Life and its sub-contractors (TELUS and MSH) are in compliance with the terms in the PSHCP Contract relating to claims processing and claims payment services.
- To determine the accuracy of claims adjudication with respect to Plan provisions.
- To ensure Contractor and sub-contractors’ adherence to and compliance with the PSHCP Directive, the PSHCP Statement of Work, claims processing Standard Operating Procedures and administrative manuals, and the Contractor’s Quality Assurance Program documentation.
Submission Instructions:
- Enquiries should be directed to Daniel Lockward at dlockward@pshcp.ca by November 1, 2024.
- Proposals must be submitted by November 8, 2024 by 5:00 P.M. (ET)
For detailed instructions, evaluation procedures, and contractual information, refer to the full RFP document.