All Women Count! Program Claims Administrator

The South Dakota Department of Health's Office of Disease Prevention and Health Promotion is seeking a third-party administrator for the All Women Count! (AWC!) Program, a Breast and Cervical Cancer Early Detection Program located in Harding County. The selected vendor will be responsible for comprehensive claims processing and supporting services, including establishing a network of healthcare providers, hospitals, and radiology sites to facilitate procedural payments. Key deliverables include developing a robust claims processing system, providing system training, ensuring HIPAA policy compliance, and creating standardized processes and forms for efficient administration. Vendors must submit detailed proposals demonstrating their capability to manage a claims processing infrastructure with established provider networks and supporting technological systems. The procurement timeline requires proposal submissions by March 31, 2023, with an anticipated contract period from June 1, 2023, to May 31, 2024, and potential renewals for four additional one-year terms through May 31, 2028. Offerors are required to email any clarification inquiries to Sarah Quail at Sarah.Quail@state.sd.us with the specific subject line "RFP #23-0904006-017" by the designated deadline.

The contract opportunity does not explicitly outline specific set-aside designations or restrictions for disadvantaged enterprises. The vendor must provide a minimum 33% match of the total federal award amount received from the Centers for Disease Control and Prevention. The base contract amount is $550,000, which will be reimbursed directly to providers, with vendors expected to submit a detailed budget covering additional administrative fees necessary to execute the program's requirements. While no incumbent vendor is mentioned, the successful respondent must demonstrate an established healthcare provider network and the technological capability to process claims efficiently. Vendors will need to illustrate their ability to integrate with existing healthcare systems, maintain HIPAA compliance, and provide comprehensive claims processing services. The contract presents an opportunity for a sophisticated healthcare claims administration organization with robust technological infrastructure and extensive provider network capabilities.