Contracted System Administrator Services

The Vendor is required to provide contracted system administrator services for include:
1. Administrative requirements:
• Work model;
• Personnel;
• Training;
• Identifying health insurance and accessing benefits;
• Department and children’s system of care (CSOC) only coverage;
• Third party liability (TPL) and coordinating medical coverages;
• Fiscal requirements and accountability;
• Claims processing; and
• Audit reviews.
2. Customer service and call center:
• 24 hours per day/seven (7) days per week/365 days per year call center;
• Access to care;
• Call center procedures and training;
• Call center it;
• Staffing;
• Customer service functions;
• Call center and customer service performance standards
• Customer service desk
• Website;
• Marketing plan;
• Member information;
• Youth and family guide;
• Written notices;
• Communications with family members; and
• Information dissemination, including record release when requested.
3. Management of care:
• Utilization management;
• Outlier management;
• Care coordination:
o Authorizations;
o It requirements for service authorizations
o Care plans and assessments;
o Complaints, reconsiderations, and appeals;
o Coordination of medical coverage - including 3560 Medicaid program; and
• Support for network development.