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MB-3622 - USA (Oregon) - All Payer Claims Database Solution and Related Services - Deadline December 31,2019

Product (RFP/RFQ/RFI/Solicitation/Tender/Bid Etc.) ID: MB-3622

Government authority located in Oregon; USA based organization looking for expert vendor for all payer claims database solution and related services.

[A] Budget: Looking for Proposal

[B] Scope of Service:

(1) Vendor needs to provide all payer claims database solution and related services that systematically collects and stores medical claims, pharmacy claims, subscriber billed premiums, member eligibility, and provider data from commercial health plans, licensed third party administrators, pharmacy benefit managers, Medicaid and Medicare including migrating the existing data from the current data vendor to a new proposed data management platform; securing and streamlining data collection and aggregation; processing and validating data extracted from health care claims and other related health care data systems; providing data access and reports to approved users; and optimizing data for a public-facing APAC website.
- Oregon’s All-Payer Claims Database (APCD) collects and stores information on alternative payment methodologies from certain health plans.
• Determining the distribution of health care resources in Oregon;
• Evaluating the effectiveness of intervention programs in improving health outcomes;
• Comparing the costs and effectiveness of various treatment settings and approaches;
• Allowing health care policymakers to make informed choices;
• Providing information to consumers and purchasers of health care;
• Improving the quality and affordability of health care and health care coverage; and
• Evaluating health disparities.
- APAC Data Submission and Timeline:
• Medical Claims File
• Eligibility File
• Dental Claims File (begins July 2020)
• Provider File
• Pharmacy Claims File
• Control Totals for Claims and Eligibility
• Subscriber Billed Premium File
• Provider Level Alternative Payment Methodology (APM) Summary File
• Control Totals for the Provider Level APM Summary
• Reporting to support federal grants and initiatives;
• Health insurance rate review activities by Oregon’s Department of Consumer and Business Services (DCBS);
• Quantitative assessments of the spread of the Coordinated Care Model;
• Policy planning and reporting on OHA’s healthcare transformation efforts;
• Public health surveillance activities; and
• Identifying Medicaid clients with unreported third-party insurance.
- The high-level categories for the functional and non-functional Solution requirements are below.
• Documentation management
• Data collection and compliance tracking
• Data management
• Data processing and validation
• Data storage and availability
• Data use
• Data enhancements
• Role based access
• Data request fulfilment
• Data security in compliance with federal and state requirements
• Communication and management
(2) A pre-proposal conference will be held on November 21, 2019.
(3) All question must be submitted no later than December 4, 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 : Tuesday, 31 December, 2019

Pre-proposal Conference Date : Thursday, 21 November, 2019

Question Answer Deadline : Wednesday, 4 December, 2019

Category : Medical Billing and Coding, Software, System and Application

Country : USA

State : Oregon

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