YH19-0025_Amendment_6_Fully_Executed_with_all_Attachments.pdf

CONTRACT AMENDMENT

1. AMENDMENT #:

2. CONTRACT #:

YH19-0025

3. EFFECTIVE DATE OF AMENDMENT:

Date of Last Signature

4. PROGRAM:

DHCM

5. CONTRACTOR/PROVIDER NAME AND ADDRESS:

Sandata Technologies 26 Harbor Park Drive

Port Washington, NY 11050

6. PURPOSE: To extend the contract for three months (3) from June 1, 2022 to August 31, 2022. In addition, to increase funding for the following change requests CS – 116 Companion Care Per Diem Code, CS – 134 Care 1st SFTP Transition, CS – 111 Removal of Resolution Code, CS – 126 ALT EVV Interface Manuel Edits, and CR – 020 BI Tool ACCESS For MCO’s. The total five year contract value will be increased from $44,822,361.44 to $45,165,156.44.

7. THE ABOVE REFERENCED CONTRACT IS HEREBY AMENDED AS FOLLOWS:

1. CS - 116 Companion Care Per Diem Code AZ $46,405.00

2. CS - 134 Care 1st SFTP Transition AZ $9,000.00

3. CS - 111 Removal of Resolution Code HI $6,000.00

4. CS - 126 ALT EVV Interface Manuel Edits HI $1,950.00

5. CR - 020 BI Tool ACCESS For MCO’s AZ/HI $279,440.00

Total $342,795.00

Therefore,

1. Sandata change orders for increased services are attached.

2. All other contract terms and methodology remain in effect.

8. EXCEPT AS PROVIDED FOR HEREIN, ALL TERMS AND CONDITIONS OF THE ORIGINAL CONTRACT NOT HERETOFORE CHANGED AND/OR

AMENDED REMAIN UNCHANGED AND IN FULL EFFECT.

IN WITNESS WHEREOF THE PARTIES HERETO SIGN THEIR NAMES IN AGREEMENT.

9. NAME OF CONTRACTOR/PROVIDER:

Sandata

10. ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM

SIGNATURE OF AUTHORIZED INDIVIDUAL:

SIGNATURE:

TYPED NAME:

Akshay Bhandari

TYPED NAME:

Meggan LaPorte, CPPO, MSW

TITLE:

CFO

TITLE:

Chief Procurement Officer

DATE: DATE:

Meggan LaPorte (May 24, 2022 13:09 PDT)Akshay Bhandari (May 24, 2022 21:23 EDT) https://azahcccs.na1.echosign.com/verifier?tx=CBJCHBCAABAAR2mihgFPSgapflHtGvZUwFT4vDYJ57RF https://na1.documents.adobe.com/verifier?tx=CBJCHBCAABAAR2mihgFPSgapflHtGvZUwFT4vDYJ57RF

CS-111

Sandata Technologies, LLC sandata.com

Paige Gibson, Customer Success Manager pgibson@sandata.com 516-484-4400 ext. 4022

Hawaii Med-QUEST

Change Request Technical Requirements

Remove Requirement for Resolution Code in EVV (CR CS- 111) mailto:pgibson@sandata.com

Change Request Technical Requirements |

Table of Contents

Revision History

Change Request Tracking

Med-QUEST Change Request

Change Request

System/Functionality Enhancement Requested

Sandata Responsibilities

Reference Materials

Pricing

Revision History

Date Version # Author Description of the Document Updates

Requires Update to Business Rules?

10/14/21 1.0 Paige Gibson Initial Draft Yes

10/26/21 1.1 Judy Ross Technical Review Yes

11/1/21 1.2 Douglas Forsell Updated with comments Yes

11/5/21 1.3 Paige Gibson Updated with Judy’s comments Yes

12/1/21 1.4 Brian Lawson General clean-up, pricing, and legal review

No

4/18/22 1.5 Judy Ross / Brian Lawson

Updated to remove resolution codes entirely

Yes

Change Request Tracking

Reference Ticket Number Notes

ZenDesk 293095

JIRA SEVV-36273 Epic to track estimates and work

CRB CS-111

Other

Med-QUEST Change Request

Change Request

This Change Order is being issued pursuant to contract YH19-0025 between the Arizona Health Care Cost Containment System (“AHCCCS”) and Sandata Technologies, LLC (“Sandata”) for Electronic Visit Verification.

System/Functionality Enhancement Requested

Med-QUEST no longer wants to require the Resolution Code Written Documentation Maintained.

The removal of the requirement should apply to both Agency and Self Direct accounts across the program.

The request is to remove the Resolution code for the program.

Sandata Responsibilities

To support the scope changes listed in the Change Request, Sandata will provide the following:

# Item Dev

(hrs)

QA

(hrs)

1 Remove ‘Written Documentation Maintained’ resolution code.

24 8

2 PM Support 8

Testing Considerations/Requirements

• Internal QA testing to ensure change is made appropriately.

Sandata EVV:

• Remove ‘Written Documentation Maintained’ resolution code.

Alt EVV:

• Update Hawaii Addendum.

• Change validation to make resolution code optional.

Data Warehouse Feed:

• Update Hawaii Addendum to note that this field could be blank

Reference Materials

This section contains any external documentation or reference materials that support the change request, or are revised/impacted as part of this change request.

Reference Item Name Description Version Revision Required?

Sandata_Program_Information_ Workbook_HI-Med-QUEST Business Rules document V14 Yes

Addendum_HI_alt EVV Alt EVV specification V1.7 Yes

Addendum_HI_DataWarehouse Data Warehouse File specification V1.6 Yes

Customer Responsibilities

This section defines the aspects of this change that are the responsibility of the payer program customer, their MMIS vendor, or other related program stakeholder entity. These may include policy updates, system alterations, provider outreach items, or other activities that may be required to have this change request realized. Where possible, the dependencies between Sandata responsibilities and the customer responsibilities should be defined.

To support the activities and deliverables defined in this change request, PA-DHS will be required to provide the following:

Outreach

• The state, together with Sandata, will conduct appropriate outreach to notify all program participants of the program changes

Once this change has been approved by the AZ AHCCCS Change Advisory Board, Sandata will provide an estimated release date.

Pricing

One-Time Fees

Description Fees

Change Request Fee $6,000

Pricing Notes Fees to be invoiced and due 50% once available in UAT and 50% due once completed and available in Production.

Approval

Approved By:

Signature/Title Date

Acceptance and approval of this Change Request will initiate the described work (and invoice submission, if applicable).

05/24/2022

Change Request – CS116 | 0

CS-116 AZ AHCCCS

Alignment of Service/Modifier Combination/Addition of Companion Care Change Request Technical Proposal

April 2022 sandata.com

Paige Gibson Customer Success Manager

516.484.4400 ext. 4022 pgibson@sandata.com

Brian Lawson VP, Sales Solution Design

516.484.4400 ext. 3131 blawson@sandata.com

Change Request – CS116 | 1

Date Version # Author Description of the Document

Updates Requires Update to Business Rules?

11/17/21 1.0 Paige Gibson Initial Draft Yes

12/20/21 1.1 Paige Gibson Updates from Dara Yes

2/28/22 1.2 Paige Gibson Conversion to new format Yes

3/25/22 1.3 Brian Lawson Edits and comments No

4/14/22 1.4 Paige Gibson Updates based on feedback Yes

4/18/22 1.5 Judy Ross Updates Yes

4/20/22 1.6 Brian Lawson Final Edits and Pricing Yes

4/20/22 1.7 Brian Lawson Corrected Pricing Error Yes

Reference Information Reference Ticket Number Notes

ZenDesk 305514 Tracking item for Change Order

JIRA SEVV-37601

Other CS116

Change Request – CS116 | 2

Change Request

Background

Issue:

Enhancement:

Service Changes:

Who is Impacted:

Benefits:

Timing:

Proposed Solution

Detailed Work Items

Customer Responsibilities

Reference Materials

Pricing

Approval

Change Request – CS116 | 3

Change Request

This Change Order is being issued pursuant to contract YH19-0025 between the Arizona Health Care Cost Containment System (“AHCCCS”) and Sandata Technologies, LLC (“Sandata”) for Electronic Visit Verification.

Background

Issue:

AHCCCS needs to add a new Service/Modifier Combination to the program. This effort should include the following:

-Recording/Translation for Telephony (TVV) and Mobile Device (SMC)

-Documentation Updates

• Service Listing Update

• Supplemental Guide Update

-Vendor Communication Required for Alt EVV Agencies

• Vendors/Agencies will need notification of the effective date of the Service

• Updated to Alt EVV Addendum will be required

• Vendors may require time to configure their systems for changes.

Enhancement:

Service Changes:

Table 1: All Changes. Notes field indicates action required:

Payer Program HCPCS Modi-fiers

Desc Contingency Plan Default Value

Selection for Mobile/SMC

Telephone Prompt

Telephony Prompt

Billing units of Measure

AZCCCS

,AZDDD

,AZACH

,AZBUFC

,AZCHP

,AZMCC

,AZMYC

,AZSHC

,AZUCP

,AZCDMP

AHCCCS S5136 Companion Care, adult, per diem

CP01 Companion per diem

Companion per diem

Rule 2

Change Request – CS116 | 4

Who is Impacted:

AZ providers and their vendors and AZ AHCCCS users are impacted by this change and the consumption of the data.

Benefits:

AZ providers will be able to use EVV for Companion Care services.

Timing:

There is no specific requirement on when this change is needed.

Proposed Solution Sandata will add 1 new service (S5136) for all 10 program payers in the Arizona HCCCS program.

The prompt will be translated (SMC) and recorded (telephony) in each of the program languages and deployed for use.

Appropriate documentation and validation for interfaces as appropriate.

Detailed Work Items

The following includes all work items required to implement the proposed solution as defined.

Table 1: Work Item List – Option 1 – Enable Rejection if Change Log is not Provided for Certain Cases

Item # Type Description Hours

1 Documentation Update Business Rules to Add New Service 4

2 Documentation Update Alt EVV Addendum to Add New Service 4

3 Documentation Update DWH Addendum to Add New Service 4 4 Documentation Update Open EVV Addendum to Add New Service 4

5 Documentation Update Authorization Addendum to Add New Service 4

6 Documentation Update Service Listing 8 7 Documentation Update Supplemental Guide 24

8 Configuration Add 1 new service mapped to 1 existing program and 10 existing payers using existing Units Rule - All AZ Accounts 73

9 Provider Interface Deploy new Service Listing in Welcome Kit 18

10 Alt EVV Interface Update Validation to include new service 14

11 Open EVV Interface Update Validation to include new service 14

12 Authorization Interface Update Validation to include new service 14

Change Request – CS116 | 5

Item # Type Description Hours

13 Translations Translate 1 new service (5 words) into 11 languages 2

14 Translations Record 1 new service (5 words) into 12 languages with English 2

15 SMC Deploy 12 new translations (1 per language) 5 16 TVV Deploy 12 new recordings (1 per language) 5

17 Operations Redeploy Welcome Kit with all updated content 24

18 Operations Project Management / UAT Support 40

To support the delivery and implementation of this Change Request, the Customer must agree to the following:

Please specify the current version of each specification below.

Table 2: Reference Information

Reference Specification Version

Addendum Version

Description of Changes

Business Rules V21 V21 Update to Services

Alt EVV 7.17 1.10 Update to Services

Open EVV 7.16 1.9 Update to Services

Member 1.0 None

Authorization 7.8 1.1 Update to Services

Providers 7.17 1.1 None

Data Warehouse 7.15 1.9.2.3 None

Claims Validation 7.15 1.5 None

Change Request – CS116 | 6

Reference Specification Version

Addendum Version

Description of Changes

Plan of Care 7.6 None

Change Request – CS116 | 7

Change Request Fee – Development/Configuration $39,450

Change Request Fee – Translation Services ($535 per language for 13 languages)

$6,955

Pricing Notes Fees to be invoiced and due 50% upon completion of the Business Rules update (Task 1) and 50% due upon completion of the remaining tasks under this Change Request.

Recurring Fees

This new service will add transactions to the recurring fee. Visits captured for this new service will be billed using the Claims Transaction Costs as per the RFP.

AZ AHCCCS

Printed Name

Title

Acceptance and approval of this Change Request will initiate the described work (and invoice submission, if applicable).

05/24/2022

Tracey Thomas

Procurement Manager

Exhibit Name | 0

CS-126 HI MedQUEST

Manual Edits on Verified Visits using Alt EVV Vendors

March 2022

Paige Gibson Customer Success Manager

516.484.4400 ext. 4022 pgibson@sandata.com

Exhibit Name | 1

Date Version Author Description 11/18/21 1.0 Paige Gibson Initial Draft

12/27/21 1.2 Douglas Forsell Draft updated/Renamed

12/29/21 1.3 Paige Gibson CS number and JIRA added

12/29/21 1.4 Paige Gibson Conversion to new CR format per request.

1/4/22 1.5 Judy Ross Technical Review

2/9/22 1.6 Paige Gibson Added contractual language

2/18/22 1.7 Judy Ross Clarifications added based on questions

2/28/22 1.8 Paige Gibson HI MQD selected Option A

3/29/22 1.9 Brian Lawson Final version with Pricing

Reference # Description

CRB Tracking # CS-125

Zendesk 319059

JIRA SEVV-37815

Issue Log #

Customer ID #

Exhibit Name | 2

Change Request

Background

Issue:

Enhancement:

Who is Impacted:

Benefits:

Timing:

Proposed Solution

Detailed Work Items

Assumptions

Customer Responsibilities

Reference Materials

Pricing

Approval

Exhibit Name | 3

This change request (CS-126) is being issued pursuant to the Statement of Work, as amended (“SOW”) between MedQUEST and Sandata Technologies, LLC for the Hawaiian program dated November 16, 2018, as amended. The SOW is governed by the terms of Contract YH19-0025.

Med-QUEST needs to report on Alt EVV visits that were manually altered before transmission via Alt EVV. Today, Alt EVV visits cross in a Verified state without indication of manual edits.

This value is needed for Hawaii’s KPI reporting to CMS. Med-QUEST would like to add a field that identify/inform when the visit was Manually modified before getting to a Verified state.

DOMO currently displays this field as “Verified Type”, the request is to add that field on the Alt- EVV visit upload record layout so vendors can pass the status.

Med-QUEST would like to add a field that inform/transmit when the visit was Manually modified before getting to a Verified state. DOMO currently displays this field as “Verified Type”, the request is to add that field on the Alt-EVV visit upload record layout so vendors can pass the status.

Note that Sandata EVV has the capability to force Alt EVV vendors to provide a Change Log Segment in certain cases where a change must have occurred (manual calls and/or adjusted times provided). This feature could be enabled.

HI Alt-EVV providers and their vendors and MedQUEST DOMO users are impacted by this change and the consumption of the data.

MedQUEST will be able to report on the KPI in DOMO.

There is no specific requirement on when this change is needed.

Exhibit Name | 4

Enable the option for all vendors for Sandata to reject visits that clearly need a Change Log segment but do not have them. This would reject any visit with adjusted times on the visit without a Change Log.

defined.

Table 1: Work Item List – Option 1 – Enable Rejection if Change Log is not Provided for Certain Cases

Item # Type Description Hours

Product & Engineering

PE1 Configuration Enable option to reject Visits where there is no Change Log Segment when there are manual calls or adjusted times in the visit.

Outreach OT1 Outreach Inform providers of the upcoming change. 2

Assumptions

Sandata has made the following assumptions in providing the work items for this Change Request:

• Recertification of vendors will not be required.

• UAT is included above specific to the User Interface changes and new BI information to be provided.

Exhibit Name | 5 agree to the following:

• Participate in UAT testing

• Participate in Provider and Vendor outreach

Table 2: Reference Information

Reference Specification Version

Addendum Version

Description of Changes

Alt EVV 1.7 1.4

Both will need to be updated to add the new field along with information about how to populate the information.

Exhibit Name | 6

Change Request Fee – Development/Configuration $1,950

Pricing Notes Fees to be invoiced and due upon completion of the tasks under this Change Request.

This new service will add transactions to the recurring fee. Visit captured for this new service will be billed using the Claims Transaction Costs as per the RFP.

AZ AHCCCS

submission, if applicable).

05/24/2022

CS-134- AZ AHCCCS- Care1st/Centene Interface Changes | 0

CS-134 AZ AHCCCS

Care1st/Centene Interface Changes

April 2022

Paige Gibson Customer Success Manager

516.484.4400 ext. 4022 pgibson@sandata.com

Brian Lawson VP, Sales Solution Design

516.484.4400 ext. 3131 mailto:blawson@sandata.com

CS-134- AZ AHCCCS- Care1st/Centene Interface Changes | 1

Date Version Author Description 2/24/2022 1.0 Paige Gibson Initial Draft

3/24/2022 1.1 Tessie Austin Technical requirements updated

4/4/2022 1.2 Tessie Austin/Clella Newcomb/Jason Feder

Estimation

4/5/2022 1.3 Andrea Huffman Formatting, content review

4/18/2022 1.4 Judy Ross Technical Review

4/20/2022 1.5 Brian Lawson Final Edits and Pricing

Reference # Description

CRB Tracking # CS-134

Zendesk 340163

JIRA SEVV-40337

Issue Log #

Customer ID #

CS-134- AZ AHCCCS- Care1st/Centene Interface Changes | 2

Change Request

Background

Issue:

Enhancement:

Who is Impacted:

Benefits:

Timing:

Proposed Solution

Detailed Work Items

Assumptions

Customer Responsibilities

Reference Materials

Approval

CS-134- AZ AHCCCS- Care1st/Centene Interface Changes | 3

This change request (CS-134) is being issued pursuant to the Statement of Work, as amended (“SOW”) between Arizona Health Care Cost Containment System Administration (“AHCCCS”) and Sandata Technologies, LLC. The SOW is governed by the terms of Contract YH19-0025.

Care1st is undergoing a platform migration from their legacy platform to the Centene platform.

They will be setting up the SFTP for authorizations and Service Confirmation Portal files. As well as migrating their claims API. They will need a new API setup for test and prod for claims validation as they currently use batch claims. They will require authorization/claims and control file testing in tandem with Sandata along with Cutover Planning and Support. Timeline for this change is July 1, 2022. ETA on Sandata testing would be approximately April 2022.

• Testing changes on AZCHP’s end for authorizations in UAT and PROD

• Enabling an API connection for claims, moving from batch submission

• Testing changes to claims submission in UAT and PROD via API

AHCCCS and Care1st (AZCHP).

Care1st (AZCHP) will maintain a secure connection for accurate authorization transmission to Sandata EVV.

April – July 2022.

PAYER - AZCHP

For Authorizations

1. No changes from current folder structure being used for Arizona Complete Health (AZACH). We will plan to use this same folder structure for migrating Care1st to Centene platform. AZACH will differentiate the two separate files for AZACH and AZCHP

CS-134- AZ AHCCCS- Care1st/Centene Interface Changes | 4 with our Control-M job scheduler but everything will come into Sandata on the same path it does today.

For Claims

1. We will need to enable the AZCHP API in TEST and PROD for Care1st claims validation – changing this from today’s process from batch to API.

2. Credentials will be provided to the Centene team.

defined.

Table 1:

Task # Type Description Hours

Product & Engineering 1 UAT Creation of Test Cases for Authorization and Claims 4

2 Configuration Update/Enable API credentials for UAT and Prod (Claims)

3 Configuration Disable Batch credentials in UAT and Prod 8 4 UAT Testing of authorization/claims in UAT 8

Project Management / Implementation Support

PM1

Project Management Support

TAM support with initial connectivity and testing via calls/emails for 8 weeks agree to the following:

CS-134- AZ AHCCCS- Care1st/Centene Interface Changes | 5

Table 2: Reference Information

Reference Specification Version

Addendum Version

Description of Changes

Addendum_AZ_Authorization v1.4.docx

Current AZ Authorization Addendum

1.4 No

OpenEVV-Authorization – 7.3 FINAL.pdf

Current OpenEVV Authorization Specification

7.3 No

Change Request Fee $9,000

Pricing Notes Fees to be invoiced and due 50% upon completion of the Task 1 and 50% due upon completion of the remaining tasks under this Change Request.

CS-134- AZ AHCCCS- Care1st/Centene Interface Changes | 6

AHCCCS

Signature Date submission, if applicable).

05/24/2022

June 10, 2021

Paige Gibson, Customer Success Manager pgibson@sandata.com 516-484-4400 ext. 4022

Brian Lawson, RVP, Business Development

516-484-4400 ext. 3131

Revision History

Change Request Tracking

AHCCCS/Med-QUEST Change Request

Change Request

Background

System/Functionality Enhancement Requested

Sandata Responsibilities

Customer Responsibilities

Pricing

06/02/21 1.0 Brian Lawson Initial Draft No

06/03/21 1.1 Brian Lawson Legal Edits No

06/09/21 1.2 Brian Lawson Added Staging Card Details

No

ZenDesk

JIRA

Other

This section defines the grounds on which the change request is being made, including the contract which is being updated, and any applicable purchase orders from the payer that are referenced/applicable to the EVV program.

This change request (this “Change Request”) is being issued pursuant to Contract YH19-0025 between the Arizona Health Care Cost Containment System Administration (“AHCCCS”) and Sandata Technologies, LLC (“Sandata”).

AHCCCS and Med-QUEST have requested the ability to provide their Managed Care Organizations (“MCO”s) with access to the Sandata Business Intelligence (“BI”) platform.

AHCCCS and Med-QUEST have also requested new cards to provide insight into the staging system and allow MCOs to also have access to these cards once available.

This section provides context to the EVV Program, its scope, and how the need for this change request originated (what is the impact based on this change).

Currently, for both AHCCCS and Med-QUEST, MCOs have access to the Sandata Aggregator, but not the Sandata Business Intelligence platform. AHCCCS and Med-QUEST would like to provide access to the BI module to give them insight into the dashboards that the states also have access to.

In addition to the standard dashboards, this packager will also provide the MCOs with the full suite of enhanced features of the BI platform allowing them to create Dashboards, schedule reports, create alerts, and export data for their membership.

In addition, Sandata will be creating new dashboard cards to provide insight into the staging database.

Material changes in the configuration and behavior will include:

Sandata Business Intelligence for MCOs:

• Setup and configure an account and user license for the MCO that provides access only to their members.

• MCO account should include all standard dashboards for their state (Arizona or Hawaii) as well as the new Staging dashboard.

• Provide remote training to the MCO for the standard dashboards and BI tools.

• Provide Help Desk support to the MCO user in accordance with the Contract.

• Provide updates and product maintenance in accordance with the Contract.

Staging System BI Cards:

Sandata will create cards in the Business Intelligence tool to provide visibility into the staging system as part of this Change Request. Access to this report will be granted to AHCCCS, Med-QUEST, and all MCOs once complete.

**Please note that the descriptions provided below are based on the current report. The type of visualization may change in Sandata’s discretion once the item is being worked on.

Authorization Summary Card Purpose: Show the number of authorizations broken out by payer and status.

Status (based on sample report):

• total authorizations loaded

• total not loaded

• number of auths that failed validation

• auths awaiting match

• JSON error

• other issues

Aging Summary - Authorizations with Issues Card Purpose: Lists the number of authorizations in the status selected by the user. Data will be broken out by payer, based on the following aging buckets:

• 0-7 days

• 8-14 days

• 15-30 days

• 30+ days

This will replace the “Awaiting Match – Record Aging” and “Failed Validation – Record Aging” reports

Actions/Next Steps Card Purpose: List all authorizations with issues, broken out by payer and status Status (based on sample report):

• Auths not loaded

• Auth Failed Validation

• Missing Provider (Set 2 - Distinct provider IDs that appear in authorizations but do not appear in the EVV system's provider set)

• Missing Provider and also client records

• Missing Provider and also client record failed to load

• Missing Client (Set 3 - Distinct client IDs that appear in authorizations, but do not appear in the set of clients delivered to EVV to date)

• Client failed format (Set 4 - Distinct clients delivered and linked to an authorization, but the client record had formatting/data issues that prevented it from loading correctly)

• JSON Client Load Issue

• Needs further investigation (auth has valid format, for a provider in EVV, with a valid client loaded, but still in Awaiting Match status

Authorization Validation Errors Card Purpose: Lists the different validation errors that occurred during the reporting date range, broken out by payer.

This section defines the aspects of this change that are the responsibility of Sandata to perform or deliver. These may include functional alterations to the EVV system, updates to the program parameters or configurations for this customer, as well as training and support considerations that would fall under Sandata’s responsibilities for the program as defined in the contract.

To support the scope changes listed in the Change Request, Sandata will provide the following work for each MCO:

# Item

1 Setup and configuration of the system

2 Create 1 User License

3 Setup and configuration of the system for the MCO

4 Configuration and QA of the standard dashboards limited to the MCOs members

Configuration and QA of Access to Dashboard Creation, Dashboard Scheduling, Dashboard Sharing, Dashboard Alerts, Dashboard Data Export

One day (up to 8 hours in total) of remote webinar training on standard dashboards and dashboard creation

Customer Support, in accordance with the Contract, for questions on existing dashboards and BI features

8 Product Maintenance in accordance with the Contract

9 Provide access to the new Authorization Summary Card

10 Provide access to the new Aging Summary - Authorizations with Issues Card

11 Provide access to the new Actions/Next Steps Card

12 Provide access to the new Authorization Validation Errors Card

This section defines the aspects of this change that are the responsibility of the payer program customer, their MMIS vendor, or other related program stakeholder entity. These may include policy updates, system alterations, provider outreach items, or other activities that may be required to have this change request realized. Where possible, the dependencies between Sandata responsibilities and the customer responsibilities should be defined.

This Change Requests provides one license (user) per MCO. If additional licenses or additional trainings are desired by any MCO, they will need to reach out to Sandata to purchase those additional licenses.

Assumptions

• HI will require 1 license package for each of their 5 MCOs

• AZ will require 1 license package for each of their 9 MCOs

Description Fees Fees after FMAP

MCO BI – Enhanced package

$ 19,960 per MCO per year

$4,990 per MCO per year after 75% FMAP

Total for 14 MCOs: $279,440 per year

$69,860 per year after 75% FMAP

Pricing Notes

Recurring Fees will be due upon completion of the Change Request (completion means setup and delivery of credentials for the MCOs) and due annually thereafter.

Acceptance and approval of this Change Request will initiate the described work (and invoice submission, if applicable).

05/24/2022