The vendor is required to provide that third party administrator services for the county jail system (HCSO).
- The county operates two (2) jail facilities, with a geographic footprint of: (1) county regional jail west, located in the western portion of the county, this maximum-security facility has a capacity of 521 inmates, housing both male and female inmates and (2) county regional jail east, in county, which houses low to medium custody inmates, as well as our recovery in a secure environment (rise) program.
- Develop and maintain a statewide network of institutional and professional providers who, by contract, agree to accept discounted charges as payment in full for covered services.
- The credentialing of providers, maintenance of the network and communications with providers
- Negotiating and all contracting activities and requirements with providers to include but not limited to the following: hospitals, physicians, specialty providers, and other health care professionals to ensure that all services will be accessible without delay of treatment options for the inmates.
- Provide a dedicated customer service unit for county that will at a minimum provide:
• Customer service support to both county and network providers.
• Enrollment and billing support.
• Exclusive client service representative; and
• Dedicated account manager.
- Provide a dedicated provider network manager who will be responsible for (but not limited to):
• Evaluating and managing the county provider network in the surrounding metro areas.
• Recruitment of new providers.
• Negotiating and contracting with providers on behalf of county.
• Administer special provider arrangements between the county and selected providers.
• Ensure that providers rendering services to the county possess licenses and/or certifications, at their own expense, necessary to render medical services within the scope of this contract.
• Ensure that the providers continue to meet the contractors’ selection and screening criteria.
• Ensure that the providers maintain the appropriate liability insurance for services being rendered.
- Claims/billing administration:
• Ensure that the required county pre-authorization was provided to the providers before processing a claim.
• Administer claims reimbursement to ensure the best available rate of reimbursement.
• Process all claims incurred during the term of the contract.
• Determine liable party for all paid claims.
• Determine if the services provided were medically necessary
• Accept electronic files of eligible inmates from the current county jail management system (JMS)
• The successful offeror will be required to interface with Motorola offender then interface with the jail tracker data system when that JMS becomes operational.
• Suppress explanation of benefits (EOBS) and other member level correspondence
• Provide customized detail claims information, in both hard copy and via e-mail in microsoft excel format.
• Maintain a history of all claims paid.
- Contract Period/Term: 5 years
- Questions/Inquires Deadline: March 13, 2025