Workflow Management System

The Vendor is required to provide to design, develop, test, and implement a salesforce-based, vendor-hosted workflow management system (WFMS) for the Health Coverage Access, Administration, and Appeals (HCA3) Bureau.
- The system will automate and streamline the management of independent external reviews (IERs) for consumers and members of commercial insurance, managed care organizations (MCOs), and independent review organizations (IROs).
- The new Salesforce solution will replace the current manual SharePoint and Excel-based process, improving efficiency, security, scalability, and accuracy in handling IER cases.
- The new solutions shall provide an automated workflow to improve efficiency, security, reduce errors, and ensure scalability.
- System must have the ability to generate business rule logic when a case is saved or submitted for processing.
- Users must have the ability to manually create cases in the WFMS enabling data entry of fields with some minimal field logic (internal and one external user group, functionality by role).
- System should not create a case number unless all the mandatory data entry fields have been data entered. 
- System should generate a unique temporary id for case creations that are pending or incomplete. 
- During manual case creation, users (internal and external) should have the ability to add notes and attachments to the case.
- System must have the ability to display the Market type (MCO or Commercial) in large RED letters across the top of the UI when displaying Case Details. The market type is manually entered when creating the case or provided in the portal data files.
- Users must have the ability to select from a list of letter templates in the system
- System must have the ability to populate case information into letter templates.
- System must have the ability to generate work items (tasks) on cases based on when specific activities occur on a case, such as status change, attachment added, or tasks become overdue.

- Contract Period/Term: 5 years
- Questions/Inquires Deadline: December 22, 2025