All Women Count! Program Claims Administrator.
Closed State & local contract opportunity Posted
- Solicitation number
- 23RFP23-0904006-024
- State
- South Dakota
- Responses due
Opportunity facts
- Jurisdiction
Opportunity details come from postingboard.esmsolutions.com. Updated .
About this opportunity
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 must provide comprehensive claims processing and supporting services, including establishing a network of healthcare providers, hospitals, and radiology sites within South Dakota capable of making procedural payments. The vendor is required to develop and implement a processing system, provide system training, ensure strict adherence to HIPAA policies, and create standardized processes and forms for efficient claims administration. Proposals are due by May 24, 2023, with inquiries to be submitted via email to Sarah Quail at Sarah.Quail@state.sd.us using the subject line "RFP #23-0904006-024". Potential vendors must demonstrate capability in managing a complex healthcare claims ecosystem, with robust technological infrastructure and comprehensive administrative support.
The procurement does not specify explicit set-aside designations or restrictions on responding organizations. The contract period is initially structured for July 1, 2023 through May 31, 2024, with potential renewal options for four additional one-year increments extending potentially to May 31, 2028. The base contract includes a $550,000 allocation for direct provider reimbursements, with vendors expected to submit detailed budgets covering administrative fees beyond this base amount. Vendors must transparently outline potential cost increases for subsequent contract years and demonstrate a comprehensive understanding of claims processing requirements. The total contract value suggests a sophisticated administrative services requirement, with expectations of sophisticated claims management technology, extensive provider network coordination, and robust administrative capabilities in supporting breast and cervical cancer screening programs across South Dakota.
Opportunity text
The South Dakota Department of Health's Office of Disease Prevention and Health Promotion is seeking proposals for a vendor to serve as a third-party administrator in claims processing and supporting services for the All Women Count! (AWC!) Program, South Dakota's Breast and Cervical Cancer Early Detection Program. The vendor must have an established network of providers, hospitals, and radiology sites in South Dakota to make procedural payments on behalf of the AWC! Program. In addition, the vendor must be able to provide a processing system, providing training of processing system, follow HIPAA policies, have supporting services, processes, and forms in place for the standardization and efficiency as a third-party administrator in claims processing.
Offerors may email inquiries concerning this RFP to obtain clarification of requirements. No inquiries will be accepted after the date and time indicated in the Schedule of Activities. Inquiries must be emailed to Sarah Quail at Sarah.Quail@state.sd.us with the subject line "RFP #23-0904006-024".
The SD Department of Health, Office of Disease Prevention and Health Promotion will respond to offeror's inquiries (if required) via e-mail. In addition, all inquiries and the State's response will be posted on the state's e-procurement system. Offerors may not rely on any other statements, either of a written or oral nature, that alter any specification or other term or condition of this RFP. Offerors will be notified in the same manner as indicated above regarding any modifications to this RFP.
Files
| File | Type | Posted |
|---|---|---|
| RFP Document.pdf |
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