Medicaid Dental Adjudication and Admin Services

The South Dakota Department of Social Services, Division of Medical Services, is issuing Request for Proposal (RFP12174) for Medicaid Dental Adjudication and Administrative Services. The procurement seeks a vendor to provide comprehensive dental and orthodontic claims processing and administrative services for the state's Medicaid dental benefits program. The contractor will be responsible for adjudicating approximately 127,000 annual claims, including 8,000 Indian Health Service (IHS), 12,000 Federally Qualified Health Center (FQHC), and 107,000 private practice claims. Key program objectives include increasing enrolled children's comprehensive oral evaluations to 49%, dental visits by age 2 to 28%, and enrolled adult comprehensive evaluations to 25%. The vendor must achieve network adequacy goals of 85% Medicaid provider enrollment and ensure 35% of enrolled dentists see 100+ Medicaid recipients within 24 months of contract initiation. Proposals are due by March 13, 2025, at 5:00 PM CST, with a contract term from June 1, 2026, to May 31, 2029, including options for two one-year renewals. Critical deadlines include a Letter of Intent due January 2, 2025, and offeror questions due January 16, 2025.

The RFP documents do not explicitly indicate specific set-aside designations or restrictions for disadvantaged enterprises. The contract will reimburse the vendor 100% of actual claims payment amounts for correctly adjudicated claims, with administrative services compensated through a fixed monthly fee. The administrative services budget must include a minimum of $150,000 annually for network development, care coordination, outreach, education, and access initiatives. Vendors must comply with extensive security requirements outlined in the Bureau of Information & Telecommunications (BIT) Information Technology Security Policy, including detailed security questionnaires, vulnerability scanning authorizations, and strict data protection protocols. The vendor will be expected to provide comprehensive system capabilities, including robust identity and access management, application development security, and incident response procedures. While specific budget ranges are not explicitly stated, the contract's scope suggests a significant annual investment in dental claims administration and network management services.