1-RFC Bidder Cover Summary Fillable PDF (2).pdf
PDF 49 KB Posted
- Attached to
- SLCo SHE130921-1 Medicaid 1115 Waiver - RFC
- Solicitation number
- SLCo SHE130921-1 Medicaid 1115 Waiver - RFC
- Issued by
- Salt Lake County, Utah
About this file
This is a Request for Bids (RFC) cover summary form issued by Salt Lake County, Utah, through its Contracts and Procurement division on behalf of the Sheriff's Office Jail Health Services Division. The County is soliciting qualified contractors to provide Medicaid claim submission and management services under the 1115 Medicaid Waiver for incarcerated individuals. The selected vendor will be responsible for preparing, submitting, and managing eligible Medicaid claims for inmates who received Medicaid-covered services or medications during the final 90 days of incarceration. Initial implementation will focus on approximately 90 Medication-Assisted Treatment (MAT) participants, with planned expansion to all inmates receiving Medicaid-eligible medical care. The contractor must interface seamlessly with the County's Saphire Health EHR system, comply with all County IT standards and security protocols, and provide staff training on identifying and validating Medicaid-eligible claims. The contractor is required to provide a dedicated Account Manager and additional billing specialists based on claim volume, submit monthly reports detailing claim submissions and reimbursements, attend quarterly performance review meetings, and provide annual compliance audit summaries.
The RFC form itself is a fillable PDF document that requires bidders to provide their legal supplier name, DBA if applicable, ordering address, contact person information, and authorized representative signature. The final funding for services is contingent upon funding levels and approval by the Salt Lake County Mayor. The form includes standard certification language whereby the supplier's authorized representative attests to the accuracy and completeness of the bid and confirms legal authority to commit to a contractual agreement. Contract execution requires signatures from both the supplier's authorized representative and the Salt Lake County Mayor or designee, with space provided for the execution date.
View the file
Other files
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
Text version
Request for Bids Resulting Contract (RFC)
Legal Supplier Name
DBA (if applicable)
Ordering Address
City State Zip Code
Supplier Contact Person Telephone Number
Supplier E-mail Contact
I certify that to the best of my knowledge the information contained in this bid is accurate and complete and that I have the legal authority to commit this Supplier to a contractual agreement. I realize the final funding for any service is based upon funding levels and the approval of the Mayor for Salt Lake County.
Supplier Authorized Representative
Date
Position or Title
Electronic Signature acceptable for electronic submission.
IN WITNESS WHEREOF, the Parties have executed this agreement this ______ day of _______________, 20___.
X
SALT LAKE COUNTY
Mayor or Designee
| Legal Supplier Name: |
| DBA if applicable: |
| Ordering Address: |
| City: |
| State: |
| Zip Code: |
| Supplier Contact Person: |
| Telephone Number: |
| Supplier Email Contact: |
| Supplier Authorized Representative: |
| Date: |
| Position or Title: |
File details come from the government source that posted it. Updated .