DDS RFI 25-70008 Medicare Part D Claims Services

The California Department of Developmental Services (DDS) has issued a Request for Information (RFI) 25-70008 seeking solution alternatives to replace its existing Medicare Part D drug claims billing system. The procurement aims to procure a comprehensive pharmacy claims processing solution capable of handling HIPAA-compliant claims submission, converting pharmacy claim transactions into NCPDP D.0 claims files, and interpreting 835 drug payment files from multiple Prescription Drug Plans (PDPs). Key deliverables include a pharmacy claims editor with specific functionalities, a graphical user interface for back-end claim processing, and the ability to handle complex billing scenarios including coordination of benefits and third-party liability requirements. The current legacy system is a 30-year-old application written primarily in COBOL with NATURAL language programs, utilizing VSAM files and ADABAS database structures. Respondents must complete Attachment A-RFI Response Worksheet and submit responses via email. Critical procurement dates include November 7, 2025, as the last day to submit questions, November 17, 2025, for question responses, January 9, 2026, at 2:00 PM PST for RFI responses, and product demonstrations beginning February 5, 2026.

The RFI explicitly states that this is an informational process and does not constitute a binding solicitation or create any contractual obligations for either party. The current vendor has provided these proprietary custom software services since 2006, with Experian currently performing Medicare eligibility verification. The department processed approximately 4,218,507 transactions in the recent 12-month period, with Medicare Part D claims averaging 180 monthly at DDS and declining volumes at the Department of State Hospitals (DSH), ranging from 843 to 219 monthly claims. While no specific set-aside designations are mentioned, the RFI emphasizes that responses may become public information under the Public Records Act, and vendors should avoid including proprietary information. The procurement covers systems for both DDS and DSH, requiring separate processing of claims and payments, and must implement Coordination of Benefits regulations for Medi-Cal as the payer of last resort. Although the exact contract value is not specified, the RFI requests non-binding budgetary pricing information for planning purposes, with the understanding that this pricing will not be considered a binding proposal or bid.