Get Mt Bcbs Third Party Administrator Questionnaire 2019-2025

The MT BCBS Third Party Administrator Questionnaire is a vital document for entities seeking to provide administrative services on behalf of Blue Cross Blue Shield of Montana. This guide offers a step-by-step approach to effectively complete the questionnaire online, ensuring all necessary information is accurately captured.

Follow the steps to complete the questionnaire online.

1. Click the ‘Get Form’ button to access the questionnaire. This action will open the form in your online editor for completion.
2. Begin by entering the name of the entity in the designated field, followed by the entity's address, city, state, and zip code.
3. Provide primary contact information, including the name, title, address, city, state, email, phone, and fax. Ensure accuracy for all contact details.
4. Enter secondary contact information in the same format as the primary contact fields.
5. Fill in the Tax ID number of the entity and state of domicile.
6. Indicate the formal structure of the entity, such as S-Corp, C-Corp, Partnership, etc. Also, provide the state of incorporation.
7. Answer whether the entity is owned in whole or in part by another business; if applicable, specify ownership details.
8. Estimate the percentage of the entity’s business that involves administrative support and indicate the states where administrative business is conducted.
9. Indicate whether the entity is licensed as a TPA in each state and explain if it is not.
10. Respond to questions regarding the entity's TPA license history, including revocation or probation status, and provide the current status.
11. Confirm if the entity posts a bond, and if so, describe the type, amount, and issuer of the bond.
12. List the insurance carriers for general liability, excess liability, and errors & omissions, and attach relevant certificates.
13. Include the insurance carriers for whom the entity performs administrative services.
14. Identify the target market for the administrative services offered by the entity.
15. State the number of employers and members administered by the entity, alongside lines of coverage managed.
16. Indicate how long the entity has supported lines of coverage for Life, Disability, and Dental.
17. Detail the monthly, quarterly, or annual premium amounts handled for TPA-related duties.
18. Check applicable TPA functions performed by the entity.
19. Outline the specific functions the entity will perform on behalf of Blue Cross and Blue Shield, including descriptions for specific tasks.
20. Describe the communication process regarding delinquent groups and any fees charged to certificate holders.
21. Explain the data management and communication processes including census information format and frequency.
22. Clarify the entity's data security transmission process.
23. Confirm if the entity is able to send compliant 834 file feeds and outline compliance status with target dates.
24. Discuss the existence of a formal training process for new employees and desk procedures for TPA functions.
25. Describe the entity's policies for privacy notifications, disaster recovery, security, and record retention.
26. If applicable, specify whether the entity maintains a fiduciary account and detail any co-mingling of funds.
27. Conclude the questionnaire by ensuring all responses are accurate and complete. Users can now save changes, download, print, or share the completed form.

We encourage you to complete the MT BCBS Third Party Administrator Questionnaire online for efficient processing.