Posted Date : October 04,2021
Product (RFP/RFQ/RFI/Solicitation/Tender/Bid Etc.) ID : EXTRA-14670
Government Authority located in Indianapolis, Indiana; USA based organization looking for expert vendor for prior authorization and utilization management services.
[A] Budget: Looking for Proposals
[B] Scope of Service:
Vendor needs to provide prior authorization and utilization management services to the government authority located in Indianapolis, IN.
- the Prior Authorization function covers all enrollees including those enrolled in the managed care portion of the program for services that are carved-out of managed care. The PA function shall cover all products and services for which the State's medical policy requires PA. Pharmacy services PAs are the responsibility of the pharmacy benefits manager with the exception of some high cost, complex pharmaceuticals,
- These CoreMMIS capabilities and functionalities include the following:
- Maintains all PA requests on-line (the system stores all PA requests regardless of their current status, e.g., under evaluation, approved, denied)
- Decrements PA units during claims processing
- Maintains an authorization history for all recipients with a PA on file
- Links PAs to relevant claims history against the approved PA
- Maintains all PA administrative review information on-line
- Produces a variety of daily, monthly, and quarterly reports for use by PA and State staff; reports provide information used to evaluate and improve the PA process and monitor the timeliness of PA processing
- Produces approval, denial, and other status notifications sent to providers and members
- Provides an audit trail of changes to the PA file
- System supports authorization of dollars, units, and period of time
- The Contractor must work with the State’s MMIS contractor to develop the necessary understanding of the systems relevant to the Prior Authorization and Utilization Management functions. The State will actively monitor transition activities during the transition phase of the contract.
[C] Eligibility:
Onshore (USA organization Only)
[D] Work Performance:
Performance of the work will be Offsite. Vendor needs to carry work in their office premises.
Budget :
Deadline to Submit Proposals: October 28,2021
Cost to Download This RFP/RFQ/RFI/Solicitation/Tender/Bid Document : 5 US$
![]()
Product (RFP/RFQ/RFI/Solicitation/Tender/Bid Etc.) ID : EXTRA-14670
Government Authority located in Indianapolis, Indiana; USA based organization looking for expert vendor for prior authorization and utilization management services.
[A] Budget: Looking for Proposals
[B] Scope of Service:
Vendor needs to provide prior authorization and utilization management services to the government authority located in Indianapolis, IN.
- the Prior Authorization function covers all enrollees including those enrolled in the managed care portion of the program for services that are carved-out of managed care. The PA function shall cover all products and services for which the State's medical policy requires PA. Pharmacy services PAs are the responsibility of the pharmacy benefits manager with the exception of some high cost, complex pharmaceuticals,
- These CoreMMIS capabilities and functionalities include the following:
- Maintains all PA requests on-line (the system stores all PA requests regardless of their current status, e.g., under evaluation, approved, denied)
- Decrements PA units during claims processing
- Maintains an authorization history for all recipients with a PA on file
- Links PAs to relevant claims history against the approved PA
- Maintains all PA administrative review information on-line
- Produces a variety of daily, monthly, and quarterly reports for use by PA and State staff; reports provide information used to evaluate and improve the PA process and monitor the timeliness of PA processing
- Produces approval, denial, and other status notifications sent to providers and members
- Provides an audit trail of changes to the PA file
- System supports authorization of dollars, units, and period of time
- The Contractor must work with the State’s MMIS contractor to develop the necessary understanding of the systems relevant to the Prior Authorization and Utilization Management functions. The State will actively monitor transition activities during the transition phase of the contract.
[C] Eligibility:
Onshore (USA organization Only)
[D] Work Performance:
Performance of the work will be Offsite. Vendor needs to carry work in their office premises.
Budget :
Deadline to Submit Proposals: October 28,2021
Cost to Download This RFP/RFQ/RFI/Solicitation/Tender/Bid Document : 5 US$