Claims Management System

The Vendor is required to provide to procure a state-of-the-art, user-centric veteran claims management system (CMS).
- The envisioned CMS will serve as a cornerstone in revolutionizing how veteran claims are managed, filed, and processed, enhancing the overall service delivery to our veterans.
- The new CMS aims to provide an intuitive, seamless experience for administrators and veterans, thereby significantly improving operational efficiency and effectiveness.
- It will enable streamlined claim filing, real-time tracking, and robust management functionalities, facilitating quicker response times and higher satisfaction rates among veterans.
- A critical aspect of the CMS will be its rigorous adherence to the highest standards of data protection, ensuring the confidentiality and security of sensitive veteran information in compliance with all pertinent federal and state regulations. 
- The system will be designed with scalability and flexibility at its core, to accommodate future expansions and integrations without compromising service quality or data integrity.
- CMS tailored for veterans' services, including: 
•    CMS implementation: a fully functional CMS integrating key features for claim management, record keeping, service delivery, standard and ad-hoc reporting with seamless department integration. 
•    Documentation and training: comprehensive system documentation and training materials to support the state’s independent system management and maintenance. 
•    Customizable workflow management: advanced workflow management capabilities with analytics and reporting functions to monitor operational performance. 
•    Veteran record management: functionality for detailed veteran record management, ensuring data organization and accessibility. 
•    Claims and appeals tracking: robust tracking functionalities for managing applications, appeals, and reimbursements, with secure electronic submission and signature capabilities. 
•    Form integration: inclusion of non-VA and state-specific forms, ensuring automatic form population and compliance. 
•    Support and maintenance: ongoing system support and maintenance services to ensure compliance and system efficiency. 
•    Adaptability and change management: demonstrated system adaptability to project needs or challenges, with effective scope change management. 
•    Performance reporting: regular performance reports detailing project status, milestones, and risk management actions.
- System Capabilities and Services
•    Solution should be supplier-hosted with no subcontractors
•    Solution should submit claims directly to the veteran’s benefits management system.
•    Solution should have electronic signature capability.
•    Solution will support the scanning and/or importation of documents of no less than 100 MB.
•    Application shall provide secure, encrypted transmission of all data, which includes personally identifiable information (PII), federal tax information (FTI), and health insurance portability and accountability act (HIPAA) designated information.
•    Preparation, filing, and tracking: the solution shall support comprehensive preparation, filing, and tracking of VA benefits applications and appeals, ensuring regulatory compliance. It shall also facilitate pre-need determinations and pre-registrations for interments, integrating seamlessly with the veterans' benefits management framework.
•    Electronic submission of claims: the solution shall enable secure electronic submissions to the VA using APIS and support efficient management of various claim types, ensuring smooth claim processing and reimbursement workflows.
•    Data management and reporting: the solution shall feature advanced data analytics and customizable dashboards for monitoring metrics and outcomes, alongside sophisticated veteran record management including dependents' information, ensuring data organization and accessibility.
•    Comprehensive claims processing: the solution shall offer functionalities for efficient claim processing and management, including diagnostic code associations and future exam tracking, with advanced search capabilities for locating forms within the system.
•    Intuitive service delivery features: the supplier shall incorporate intuitive features such as reminders, case note entries, and batch pdf uploads to enhance service delivery and documentation management.
•    The solution shall have remote signature capabilities for an estimated 120 users.

- Contract Period/Term: 1 year
- Questions/Inquires Deadline: November 12, 2025