Posted Date : October 14,2021
Product (RFP/RFQ/RFI/Solicitation/Tender/Bid Etc.) ID : SW-49382
Government Authority located in Nevada; USA based organization looking for expert vendor for medicaid managed information system and supportive services.
[A] Budget: Looking for Proposal
[B] Scope of Service:
(1) Vendor needs to provide medicaid managed information system and supportive services.
- Call Center and Contact Tracking business functions include processes related to Vendor’s operation of a call center staffed with customer service representatives who possess appropriate speaking skills and knowledge of Medicaid policy and system(s) operation sufficient to assist, accurately document, and resolve questions and/or other matters posed by applicants, providers, recipients, and others (callers), including but not limited to Enrollment, Claims, and/or Pharmacy related inquiries.
- Claims function utilizes information from multiple MMIS areas to accurately edit, price, and adjudicate claims for payment to providers. The Claims function supports adjustments, provides control and reporting, and includes encounter processing.
- Claims processing capability and functional components includes, receipt through adjudication: the unique identification, editing and auditing, pricing, claim resolution, claim adjustment processing, tracking, controlling, and reporting of every claim transaction as it progresses through all facets of the claims engine.
- MMIS uses Contact Tracking Management Software (CTMS), a comprehensive system that tracks inbound and outbound interactions with providers, members, and other entities, that provides DHCFP a complete and accurate record and evidence of interactions, instructions, and other communications related to operations of Nevada Medicaid and the Qualified Improvement Organization (QIO)-like Vendor. CTMS serves as the secure, centralized repository to manage and note contacts and their detailed narrative related to inquiries and how they were resolved electronically, whether they are received through telephone, email, web portal, Interactive Voice Response (IVR), mail, fax, or other channels. Users view the contacts in the CTMS interface and can search through a Contact Tracking Number (CTN) assigned to each entry.
- Electronic Data Interchange (EDI) system is an interface into the MMIS for external entities. The system allows trading partners, such as Nevada Medicaid providers, Managed Care Organizations (MCO), billing agents, or other external entities to submit transactions using standardized communication protocols and data structures. The external entities communicate to the MMIS Engine through the EDI system which contains the communications hardware that directs traffic to a Web Server or directly to the MMIS. The MMIS receives files sent via Secure File Transfer Protocol (SFTP), as mandated by the HIPAA national standard, as well as proprietary or mutually defined data structures.
- Portal is the hub for interaction with providers, including but not limited to communication (Web Announcements, Notices/Letters, Billing Manual), data exchange, self-service tools, group and/or individual enrollment management, claims submission and provider advice access, and prior authorization requests.
(2) All question must be submitted no later than October 04, 2021.
[C] Eligibility:
- Onshore (USA Organization Only);
[D] Work Performance:
Performance of the work will be Offsite. Vendor needs to carry work in their office location.
Budget :
Deadline to Submit Proposals: November 22,2021
Cost to Download This RFP/RFQ/RFI/Solicitation/Tender/Bid Document : 5 US$
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Product (RFP/RFQ/RFI/Solicitation/Tender/Bid Etc.) ID : SW-49382
Government Authority located in Nevada; USA based organization looking for expert vendor for medicaid managed information system and supportive services.
[A] Budget: Looking for Proposal
[B] Scope of Service:
(1) Vendor needs to provide medicaid managed information system and supportive services.
- Call Center and Contact Tracking business functions include processes related to Vendor’s operation of a call center staffed with customer service representatives who possess appropriate speaking skills and knowledge of Medicaid policy and system(s) operation sufficient to assist, accurately document, and resolve questions and/or other matters posed by applicants, providers, recipients, and others (callers), including but not limited to Enrollment, Claims, and/or Pharmacy related inquiries.
- Claims function utilizes information from multiple MMIS areas to accurately edit, price, and adjudicate claims for payment to providers. The Claims function supports adjustments, provides control and reporting, and includes encounter processing.
- Claims processing capability and functional components includes, receipt through adjudication: the unique identification, editing and auditing, pricing, claim resolution, claim adjustment processing, tracking, controlling, and reporting of every claim transaction as it progresses through all facets of the claims engine.
- MMIS uses Contact Tracking Management Software (CTMS), a comprehensive system that tracks inbound and outbound interactions with providers, members, and other entities, that provides DHCFP a complete and accurate record and evidence of interactions, instructions, and other communications related to operations of Nevada Medicaid and the Qualified Improvement Organization (QIO)-like Vendor. CTMS serves as the secure, centralized repository to manage and note contacts and their detailed narrative related to inquiries and how they were resolved electronically, whether they are received through telephone, email, web portal, Interactive Voice Response (IVR), mail, fax, or other channels. Users view the contacts in the CTMS interface and can search through a Contact Tracking Number (CTN) assigned to each entry.
- Electronic Data Interchange (EDI) system is an interface into the MMIS for external entities. The system allows trading partners, such as Nevada Medicaid providers, Managed Care Organizations (MCO), billing agents, or other external entities to submit transactions using standardized communication protocols and data structures. The external entities communicate to the MMIS Engine through the EDI system which contains the communications hardware that directs traffic to a Web Server or directly to the MMIS. The MMIS receives files sent via Secure File Transfer Protocol (SFTP), as mandated by the HIPAA national standard, as well as proprietary or mutually defined data structures.
- Portal is the hub for interaction with providers, including but not limited to communication (Web Announcements, Notices/Letters, Billing Manual), data exchange, self-service tools, group and/or individual enrollment management, claims submission and provider advice access, and prior authorization requests.
(2) All question must be submitted no later than October 04, 2021.
[C] Eligibility:
- Onshore (USA Organization Only);
[D] Work Performance:
Performance of the work will be Offsite. Vendor needs to carry work in their office location.
Budget :
Deadline to Submit Proposals: November 22,2021
Cost to Download This RFP/RFQ/RFI/Solicitation/Tender/Bid Document : 5 US$