1) Vendor needs to provide third-party administrator system and services for medicaid program.
- Funding for expansion includes 90% from the federal government for healthcare services and 10% from the state.
- In the long term, there are discussions of migrating away from the existing system toward a modular system. The feasibility of this long-term transition to modules in the future should be considered in response.
- Verify recipient enrollment prior to claims payment
- Manage accurate for services rendered to Medicaid expansion recipients according to state policy. However, prefers to manage out-of-state internally
- Send providers electronic or paper remittance advice information, as requested by providers.
- Pay providers for clean claims
- Provide customer service to providers related to eligibility of recipients, claims, prior authorizations
- Provide customer service support for medicaid expansion recipients regarding required co-pays, and disputes or issues related to claims; must include online information and self-service capability.
- Deliver provider services and supports related to covered benefits recipient eligibility verification, coordination, claims submission and payment issues; must include online information and self-service capability.
- Collect data, conduct analysis, and develop in-depth reports on expansion recipient utilization and costs.
- Work collaboratively with staff to identify opportunities for process improvement or innovations that will increase operational efficiencies and reduce costs for the expansion population.
↧