Third-Party Administrator (TPA) System & Services/SD Medicaid Program

The South Dakota Department of Social Services (DSS) has issued a Request for Information (RFI) for a Third-Party Administrator (TPA) system and services specifically targeting the South Dakota Medicaid program's expansion population. The procurement seeks a comprehensive TPA solution to manage medical, behavioral health, and long-term support services (LTSS) claims adjudication, provider services, customer services, and detailed healthcare utilization reporting. The RFI requires potential vendors to provide detailed information about their proposed solutions, including experience, potential implementation challenges, data file layouts, and cost estimates. Key deliverables include claims processing, recipient enrollment verification, third-party liability management, prior authorization handling, and data exchange capabilities with the state's data warehouse. The procurement is time-sensitive, with all RFI responses required to be submitted by 5:00 pm on February 3, 2023, either via mail to the DSS office in Pierre, SD, or by email to Kirsten Smart with a specific subject line designation. Vendors are expected to demonstrate their ability to meet all federal and state requirements for Medicaid claims processing and payment services.

The RFI appears to be open to a wide range of potential vendors without specific set-aside designations or enterprise restrictions. The procurement targets supporting an estimated 52,000 Medicaid expansion recipients, with funding structured as 90% federal and 10% state contributions. While no incumbent vendors are explicitly mentioned, the DSS indicates flexibility in vendor responses, welcoming submissions that cover one or more of the five categorized third-party administration functions. The RFI suggests the potential for future expansion, with vendors encouraged to describe capabilities for potentially extending services to the traditional Medicaid population. Although specific budget ranges are not detailed, the document implies a significant operational scope with potential for a comprehensive contract. The DSS has not yet determined a specific timeline for a full solicitation release, indicating this RFI is a preliminary information-gathering step to inform a future comprehensive procurement process for TPA services.