Health Insurance Database Management System

The vendor is required to provide health insurance database management system (DBMS) system will receive historical and ongoing claims data from the plan sponsor’s health plan administrators, as well as enrollment information from the plan sponsor, and allow plan sponsor (and its designees) and contractor to perform online, interactive, information retrieval and manipulation.  
- Requirements
•    Maintain appropriate, up-to-date data sharing and data access agreements with plan sponsor’s health plan administrators, data suppliers and consultants.
- Database services
1. Data architecture
•    Provide a DBMS with a pc-based user interface, compatible with microsoft windows, providing non-programming, menu-driven access to data and reporting capabilities, fully integrated with an online help system.
•    Store in the active and online database at least 63 months of historical plan sponsor data. 
•    The database(s) with current data at least monthly.  
•    The database(s) at one-month intervals.
•    Ensure monthly data updates are live in the database within 15 calendar days of receipt of clean data from the plan sponsor’s health plan administrators.
•    Accept data from plan sponsor’s health plan administrators within 15 days after the end of each reporting month. 
•    If data has not been received by the 15th of the month (or the next business day if the 15th falls on a Saturday, Sunday or state recognized holiday), contractor must contact the health plan administrator(s) and help facilitate the delivery of the data.
•    Accept all fields provided by plan sponsor’s health plan administrators.
•    Save purged data that goes back further than is maintained in the active, online database for easy retrieval and be made available to plan sponsor within 5 business days.
•    Software that is able to be updated based upon the needs of the plan sponsor.
•    Software that has the capability to build calculated fields upon request of the plan sponsor.
•    Maintain medical (inpatient, outpatient, professional, laboratory), pharmacy, and other data (dental, vision, hearing) record-specific detail to provide an audit trail back to the original claim.
•    Integrate eligibility and enrollment data with claims data.
•    Track individual patient and family experience.
•    Standardize data so that clinical, financial, and provider information can be compared to norms.
•    Classify claims data for analysis according to clinical classifications, including diagnosis groups and chapters and categories, procedure groups and categories, and episode groups.
•    Track a patient’s complete health care experience by linking medical, pharmacy, dental, and vision claims.
•    Create episodes of illness or injury, taking in all fields of claim data appropriate to condition treatments.
2. Data integrity and quality
•    Perform comprehensive data quality validations to ensure the accuracy and cleanliness of the data
•    Have processes in place to ensure ongoing data integrity
•    Provide continuous liaising and collaboration between the contractor, plan sponsor, and plan sponsor’s health plan administrators throughout the contract term to ensure data issues are being resolved expeditiously and to the satisfaction of all parties. 
•    Plan sponsor will not be responsible for any costs associated with troubleshooting data that is either inaccurate or unable to load into the database.

- Contract Period/Term: 1 year
- Questions/Inquires Deadline: September 22, 2025