Forensic Medical Claims Negotiations Services

The vendor is required to provide forensic medical claims negotiations services for include:
- Claims processing activities and duties
•    Provide for the claim processing of approved expenses for sexual assault claims received by the state for the criminal justice institute’s fund.
•    Sexual assault claim data received by the contractor will include the claim number, invoice number, the medical provider information, the medical services charged, and the dates of service.
•    Medical service providers regarding the rate for the medical services charged on each claim to obtain a discounted rate.
•    Pharmacy benefit manager (PBM) to assist with the filling of medications as needed by sexual assault victims, pursuant.
- Reporting
•    Once negotiations have ended, the contractor will report to the state the original claim data, along with the amount each medical service provider will be paid and the discount the contractor obtained during negotiations with medical service providers and pharmacy benefit managers (PBMS).
•    Claims on an invoice with an itemized summary of the activities and services provided including the original claim data, medical services provided and the discount that was received for each negotiated service, along with the total cost reduction or discount negotiated.
•    The end of each month, provide the state with a written summary of all sexual assault claim data.
•    Summary will include the following information:
o    Each medical service provider paid that month and for which specific claims each medical service provider was paid. 
o    The invoices paid, and the total amount paid under each invoice. 
o    The total amount collectively discounted on each invoice. 
o    The number of total invoices not paid, not negotiated, or resolved at that time.

- Contract Period/Term: 5 years
- Pre-Proposal Conference Date: October 24, 2025
- Questions/Inquires Deadline: October 27, 2025