RFI_25-70008_Responses_to_Questions_11-17-25.docx

This document is a Responses to Questions file for Request for Information (RFI) No. DDS RFI 25-70008 issued by the California Department of Developmental Services (DDS). The RFI seeks to identify solution alternatives to replace the existing drug claims billing solution and focuses on Medicare Part D claims processing services. The primary objective is to submit HIPAA-compliant claims and receive reimbursements from Medicare Part D claims processing, with the scope addressing the translation of claims and payments data from the Cost Recovery System (CRS) to various Pharmacy Benefit Plans (PDPs). RFI vendor responses are due January 9, 2026 at 2:00 PM PST, though the posting will remain viewable on the California State Contracts Register until February 6, 2026 at 5:00 PM PST. The anticipated implementation timeline for this project is July 2026. The required deliverables include a pharmacy claims editor with specific functionalities, conversion of standard 835 payment data transactions to CRS-compatible formats, and provision of supplemental drug billing data including CRS account information, service dates, bill amounts, and PDP plan identifiers.

The current vendor performing Medicare eligibility verification and facilitating the Part D billing process is Experian. The anticipated contract value is unknown at this time. DDS has indicated openness to expanding the scope beyond Part D to include replacement of the entire CRS system or Medicare claims processing for Parts A, B, and D; however, the priority remains the Part D pharmacy billing platform. Drug charges and diagnoses are submitted to CRS by Developmental Centers and State Hospitals, which then generate monthly drug billing extracts forwarded to the vendor application for formatting and submission to PDPs. The vendor will be responsible for handling constant and qualifier values for D.0 claims after receiving variable drug billing data from CRS.