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 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.