SW-27630 - USA (South Carolina) - Integrated Early Intervention Case Management System - Deadline November 1,2019

Product (RFP/RFQ/RFI/Solicitation/Tender/Bid Etc.) ID: SW-27630

Government authority located in South Carolina, USA; based organization looking for expert vendor for integrated early intervention case management system.

[A] Budget: Looking for Proposal

[B] Scope of Service:

(1) Vendor needs to provide integrated early intervention case management system for Early Intervention services for children aged birth to three who are diagnosed with developmental
delays and/or disabilities.
Accept child referrals daily from Parent Guardian and Professional Referral Web Portal
• Receive and display both Medicaid-eligible and IDEA Part C-only children daily for case management from benefit eligibility determination system
• Receive and display child participation in Managed Care Organization (MCO) plan and plan eligibility time spans
• Generate and maintain an Individualized Family Service Plan (IFSP) for each child receiving services
• Receive private insurance information from third-party liability (TPL) system and display relevant information in the case management system
• Manage primary and secondary payor information for each child
• Generate and deliver daily electronic prior authorization (PA) files to individual fee-for-service providers and MCOs for services recorded on a child’s
• Capture information about individual providers and services rendered as part of the approved IFSP
• Generate and distribute daily a claiming file for services rendered to Claims adjudication system,
• Receive a remittance file daily from MMIS and display relevant payment information in the case management system
• Enable authorized case management system users to edit Claim records that have already been adjudicated in MMIS
• Enable authorized case management system users to void and replace records for Claims paid by gross-level adjustment (GLA) to adjust previous Claims transactions
• Establish and maintain traceability of each claim from the IFSP through remittance for auditing and compliance purposes
• Provide mandated operational and federal compliance reports per the requirements of OSEP
• Deliver daily extracts of the case management system database to analysis
- support business and technology transformation efforts across the enterprise without disrupting daily Medicaid operations and data processing activities
- The central integration point for web services, messaging, and file exchanges utilizes an enterprise
service bus (ESB) to facilitate loose coupling of components.
(2) A pre-proposal conference will be held on October 2, 2019.
(3) All questions must be submitted no later than October 2, 2019.

[C] Eligibility:

- Onshore (USA Only);

[D] Work Performance:

Performance of the work will be Offsite. Vendor needs to carry work in their office location.

Expiry Date : Friday, 1 November, 2019

Pre-proposal Conference Date : Wednesday, 2 October, 2019

Question Answer Deadline : Wednesday, 2 October, 2019

Category : Software, System and Application

Country : USA

State : South Carolina

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