Medicaid Dental Benefit Third Party Administrator Services

The Vendor is required to provide dental services are administered through risk bearing dental benefit program managers the state is evaluating the feasibility of transitioning to a centralized non-risk bearing third party administrator (TPA) model.
- Explore this alternative model for the administration of state directed fee-for-service dental benefits for approximately 1.4 million eligible beneficiaries.
- Capacity to implement and manage large-scale dental programs
- Timeline to implement with a state Medicaid agency
- Network Management
•    Approach to recruiting and retaining dental providers, including specialists
•    Strategies for increasing provider participation in underserved areas
- Enrollee Services
•    Description of administrative functionality to address beneficiary concerns and awareness of dental benefits.
•    Describe resources for beneficiaries to access plan information, benefits, locate dentist and review claim history
•    Capabilities to operate a beneficiary call center for the above-mentioned services and care coordination.
- Claims Processing and Utilization Management
•    Capabilities for timely and accurate claims adjudication
•    Utilization review and cost containment strategies
•    Description of service authorization process including clinical staffing requirements
•    Capabilities to operate a provider call center for assisting with the above-mentioned services.
- Care Coordination
•    Approaches to integrate care coordination for medically complex, high-need, or special needs beneficiaries
- Data and Technology
•    Overview of data systems and interoperability with state systems
•    Reporting capabilities and performance monitoring tools
- Quality Improvement
•    Experience with quality assurance programs and dental health outcomes
•    Metrics used to evaluate program success
- Compliance and Program Integrity
•    Strategies for fraud, waste, and abuse prevention
•    Mechanisms for regulatory compliance and audit readiness
- Implementation and Transition Planning
•    Timeline and methodology for transitioning from current administration to a TPA-led model
•    Risk mitigation strategies

- Contract Period/Term: 3 years
- Questions/Inquires Deadline: August 29, 2025