SLCo SHE130291 Medicaid 1115 Waiver - RFC

Salt Lake County Contracts and Procurement, on behalf of Salt Lake County Sheriff's Office Jail Health Services Division, is requesting proposals for Medicaid claim submission and management services under the 1115 Medicaid Waiver, with proposals due June 24, 2026 and a virtual pre-bid conference scheduled for June 10 at 1:00 p.m.

The contractor must prepare, submit, and manage eligible Medicaid claims for incarcerated individuals who received Medicaid-covered services or medications during the final 90 days of incarceration. Initial implementation focuses on approximately 90 Medication-Assisted Treatment (MAT) participants, with planned expansion to all inmates receiving Medicaid-eligible medical care. The contractor must interface seamlessly with the County's Saphire Health EHR system, comply with all County IT standards and security policies governing inmate health data, and provide staff training on claim identification and validation. A dedicated Account Manager is required, with additional billing specialists added as needed based on claim volume.

Five measurable performance benchmarks apply: submit 95 percent of clean claims within five business days and high-priority claims (exceeding $10,000 or near filing deadlines) within two business days; initiate follow-up on 100 percent of unpaid claims within 30 calendar days; conduct denial review and appeal initiation within 10 business days; achieve an average denial resolution time of 30 or fewer calendar days; and maintain 100 percent timely filing compliance under Utah Medicaid's 12-month filing limit. Monthly reports detailing claim submissions, reimbursements, denials, and resolution timelines are required, along with attendance at quarterly performance review meetings and annual compliance audit summaries with process improvement recommendations.

The County estimates an annual cost of $10,000 for informational purposes only and does not guarantee usage levels. Pricing must be submitted as a percentage of final amounts received for each settled claim; award goes to the lowest responsive, responsible bidder. The contract term is six years effective upon execution. Bidders must have a minimum of three years' experience submitting Medicaid-eligible claims, be licensed and insured in Utah, and provide two professional references. Background checks are mandatory; original Bureau of Criminal Investigation criminal histories are required for all employees with access to medical records, due no later than 10 business days after bid closing. Comprehensive insurance including workers' compensation, commercial general liability of $1,000,000 per occurrence with $2,000,000 aggregates, and commercial automobile liability of $1,000,000 per occurrence is required, with the County named as additional insured. The contract is non-exclusive; the County reserves the right to purchase services from other sources. Two scoring preferences are available: Employee Health Care Preference and Veterans and Companywide Hiring Preference, each worth one additional point if claimed with supporting documentation at proposal submission.