CN-680000-HQA23.pdf

This document is a Standard Contract between the State of Florida, Agency for Health Care Administration (AHCA), and Maximus Federal Services, Inc., a State of Virginia corporation. The contract is designated as Contract No. HQA023 and is structured to provide a statewide provider and health plan claims dispute resolution program service. The contract is authorized under Section 408.7057, F.S., which requires the Agency to contract with a "qualified independent third-party claim dispute-resolution entity" to assist with contracted and non-contracted health care provider claims.

The contract is a no-cost agreement where Maximus Federal Services will provide claim dispute resolution services without direct compensation from AHCA. The vendor is required to review claim disputes submitted by health care plans, determine eligibility within ten calendar days, and provide recommendations to the Agency Contract Manager. Key operational requirements include maintaining a toll-free number for Florida Provider Appeals, operating Monday-Friday from 8:30 A.M. to 9 P.M. Eastern Time, and having an emergency operations plan for service interruptions. The contract period runs from execution through June 30, 2019, with potential renewal options not to exceed three years, subject to performance evaluations and fund availability. The vendor must comply with various state and federal regulations, including civil rights requirements, public records laws, and employment verification standards.