Div of Medical Services Health Home Recipient Monthly Attribution
Closed State & local contract opportunity Posted
- Solicitation number
- 24RFP10472
- State
- South Dakota
- Responses due
Opportunity facts
- Jurisdiction
- NIGP codes
- UNSPSC codes
- 71161611 Technical consultant services for claim management
- 78142101 Claim management
- 84111500 Accounting services
- 71161612 Technical consultant services for asset integrity information and data control
- 81162309 Payroll process as a service
- 84111507 Inventory accounting service
- 84131613 Claims payment processing or administration
- 81162301 Accounts payable process as a service
- 84111505 Payroll accounting services
- 93151606 Government accounting services
Opportunity details come from postingboard.esmsolutions.com. Updated .
About this opportunity
The South Dakota Department of Social Services (DSS), specifically the Division of Medical Services, is seeking a vendor to conduct monthly reviews of Medicaid claims and determine recipient eligibility for the Health Home Program in Harding County. The primary objective is to select a contractor who will systematically review claims data, assign eligible Medicaid recipients to appropriate Health Home Tiers, and determine their continuity of care providers using the CDPS system. The selected vendor must provide a monthly file to DSS with comprehensive results, including both new enrollments and annual updates for current participants. The RFP (RFP10472) requires the vendor to process and analyze 15 months of Medicaid claims data, with specific file retention requirements to address potential DSS inquiries. Proposal submissions are due by April 3, 2024, at 5:00 PM CST, with potential site visits scheduled between April 22-26, 2024. The evaluation will include independent assessments of technical and cost proposals, with the State reserving the right to reject any or all submissions. Potential vendors must submit email inquiries by March 20, 2024, to Kirsten.Blachoff@state.sd.us, with responses posted on the DSS website by March 27, 2024.
The contract is structured for an initial three-year term from June 1, 2024, through May 31, 2027, with options to renew for two additional one-year periods. While no specific set-aside designations are explicitly mentioned, the RFP includes requirements for non-discrimination and restrictions on entities owned by certain foreign governments. Vendors must also comply with regulations regarding boycotts of Israel. The solicitation does not specify the incumbent vendor or provide a precise budget range for the contract. Offerors are allowed to submit multiple cost proposals, suggesting flexibility in pricing structures. The successful vendor will be required to integrate with existing DSS systems and processes for managing Medicaid recipient health home attributions. Compliance with state and federal regulations will be a critical component of the contract, and the vendor must demonstrate technical capability to perform the monthly claims reviews and reporting requirements effectively.
Opportunity text
The purpose of this RFP is to select a vendor to conduct a monthly review of claims and then deem Medicaid recipients eligible for the Health Home Program. The vendor will also determine the Tier and continuity of Care provider of the recipients using the CDPS system. The vendor will provide a monthly file to DSS with the results.
DSS requires other reports as outlined in the SCOPE in section 3.0.
Offerors may email inquiries concerning this RFP to obtain clarification of requirements. No inquiries will be accepted after March 20, 2024. Email inquiries must be sent to Kirsten.Blachford@state.sd.us with the following wording, exactly as written, in the subject line: RFP10472 Questions.
The Department of Social Services (DSS) will respond to offerors' inquiries by posting offeror aggregated questions and Department responses on the DSS website at http://dss.sd.gov/keyresources/rfp.aspx no later than March 27, 2024. For expediency, DSS may combine similar questions. 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 |
|---|---|---|
| Response to Offeror Questions document.pdf | ||
| RFP Document.pdf |
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