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LAGOS STATE HEALTH MANAGEMENT AGENCY (LASHMA) EXPRESSION OF INTEREST FOR THIRD-PARTY ADMINISTRATOR AND MARKETING AGENT IN LAGOS STATE HEALTH INSURANCE SCHEME (LSHS)

1.    INTRODUCTION

Lagos State Health Management Agency (LASHMA is a Government Agency established to promote, regulate, supervise and ensure the effective administration of the Lagos State Health Scheme (LSHS). Lagos State Health Scheme (LSHS) was passed into law on the 25th of May 2015, to implement affordable and quality health care services to all Lagos residents. To this end, LASHMA intends to engage the services of Third Party Administrators and Marketing Organizations that are interested.

2.       SCOPE OF WORK FOR THIRD-PARTY ADMINISTRATOR

The Third Party Administrator is expected to provide:

  1.   Dedicated customer service team, customer service claims processing, and general administration.
  2.   Dedicated customer service team which shall be staffed by customer service representatives who shall handle telephone and email inquiries on verification of eligibility, plan of benefits and the status of claims with language capability in English, Yoruba, Hausa, Igbo and Pidgin.
  3. Dedicated claim processing team that would be thoroughly familiar with Medical Plan design, with the assurance of continued quality and consistent claim adjudication through the provision of continuing and comprehensive training.
  4. Established methods to detect claim fraud and pursue recovery.
  5. Patient case management to assist members dealing with serious/terminal and chronic illness.
  6. Access to professional medical expertise/medical advisory board.
  7. Management capabilities to Develop quality controls and surveys, performance standards, periodic reporting, and metrics in agreement with LASHMA.
  8. A robust internal quality assurance system (QAS) or equivalent with QAS staff working independently of the utilization management, claims processing, customer service, and account management functions.

3.    MANDATORY REQUIREMENT FOR THIRD-PARTY ADMINISTRATOR

  1.  5 years’ experience in providing similar service with organization capacity
  2.  Must have call centre
  3.  Evidence of corporate governance
  4.  Should have a medical advisory board

4.    SCOPE OF WORK FOR HMO AND MARKETING ORGANISATIONS

  1. Demand Generation
  2. Registration and Enrollment
  3. Market and Business Development
  4. Enrollee Management and Retainership
  5. Conduct Sensitization/awareness campaigns.

5.  MANDATORY REQUIREMENT FOR MARKETING ORGANISATIONS

  1. Experience in [1] informal sector marketing and Retail development [ 10 years]
  2. Experience in formal sector marketing [10year]
  3. Existing retail structure or field force chain is mandatory
  4. Existing Agency structure is mandatory
  5. A wiliness to develop SBU [special business unit] for the LSHS
  6. Showcase of existing informal sector portfolios not less than 5,000 enrollees and formal not less than 20,000

 6.  EXPRESSION OF INTEREST SUBMISSION

  1.     An interested organization must provide evidence of company registration with CAC including ownership structure form CO2 and Co7
  2. Organizational Structure
  3. A detailed description of the location of the organization
  4. Expression of Interest to be submitted in 2 sealed envelopes addressed to the:
General Manager
Lagos State Health Management Agency
16/19, Kaffi street,
Omotshola Building
Alausa Ikeja.

  7. CLOSING DATE

    An interested organisation must be registered with Lagos State Public Procurement Agency as of 15th of January, 2021 being the advert closing date.

  8. ADDITIONAL INFORMATION

  1.  This advert shall neither be construed as a commitment on the part of LASHMA to award any contract to interested organisations.
  2. Kindly visit LASHMA website www.lashma.com. and LASHMA notice board for this advert and other information.

 

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