The vendor is required to provide all historical claims data (approximately six hundred thousand claim records) in agency current claims management software system that is to be converted to the proposed claims management software system.
- This is a cloud-hosted platform, and includes, but is not limited to, managing claims records, transaction records, check printing, centers for medicare and medicaid services reporting, EDI reporting general claims and claim financial reporting.
- System security:
• Must have data encryption for transfer and at rest.
• Claim information includes personally identifiable information;
• Must have multifactor authentication enabled on all access points;
• Must have a defined disaster recovery plan, test schedule and test results available on request;
• Must have redundancy built into their network, and must be able to fail over with minimal to no down time to agency;
• Must have a defined remediation plan in place for data breach and ransomware attacks;
• The claims management software system must have user access security, individual or group financial authority levels (check, payment, and reserve), and a built-in workflow for financial escalation and approvals;
• The claims management software system must have the ability to provide multi-level security access (full access, limited access, read only access, no access) to forms, notes, members (customers);
• Must provide agency with release notes and provide agency adequate notice of software updates and any new releases;
• Must test and provide QA on all releases that are pushed down to agency; and
• The claims management software system must work on all updated browsers of chrome, Firefox, internet explorer, Microsoft edge;
- Claims management software should be able to generate a variety of reports, including but not limited to claim summary reports, claim detail reports, repeaters reports, transactional reports, ADHOC reports, graph reports, trend analysis, and aggregation reports by members, by major coverages, by all coverages, and by the entire pool.
- Bill import and check printing
• The claims management software system must provide the ability to print checks on pre-printed check stock;
• The claims management software system must have an option to print consolidated checks;
• The claims management software system must have the ability to use multiple check templates for check printing.
• These templates must be easily modified if needed and accessible to agency;
• The claims management software system must have the ability to import data feeds for vendor payments;
• The claims management software system must have a bill approval process (queue) that can be used to evaluate bills prior to entering the bill payments workflow;
• The claims management software system must have the ability to use someone (bill payer) to enter bills, and the escalation follows the workflow of the adjusters’ authority levels;
• The claims management software system must have positive pay banking function.
• The claims management software system must have the ability to handle multiple managed care organizations and their medical providers;
• The claims management software system must be flexible enough to handle a variety of managed care fee calculation methodologies (e.g., flat rates per claim, percent savings on bills, etc.); • The claims management software system must accept data import feeds for claims data, financial data and banking check information from reinsurers and banking institutions.
- Contract Period/Term: 5 years
- Questions/Inquires Deadline: May 14, 2025