Wise Woman and Program Data Management and Claims Adjudication Services

The Vendor is required to provide the State’s need for data collection, maintenance and reporting as well as claim adjudication and provider reimbursement.
- Provide both quality data management and claims reimbursement services for department, chronic disease, cancer control, program and the program.
- Support for provider reimbursement for services rendered by state providers who are part of the wisewoman network. 
- The data management systems shall review remittance reports, communicate with department, regional coordinators and providers regarding payment discrepancies and payment status and pay claims on behalf of department.
- The State requires a modern, web-based system which supports a paperless claims process, the collection of essential data, and that is in full compliance with federal requirements.
- Web-based systems must be compliant with assistive technology standards (508 compliant) and describe compliance in their response.
- Provide secure data access including the ability for state staff, grantee, and contract staff to query and search identified program data for program needs, evaluation and public presentations as needed or requested. 
- Provide access to state and regional staff necessary for evidence-based patient services, patient navigation and staff query capability within program guidelines. 
- Comply with emerging Indiana Data requirement including but not limited to Indiana govramp.
- Maintain a system wherein women’s breast cancer, cervical cancer and cardiovascular disease risk factor outcomes can be tracked seamlessly to assure adequate case management, to encourage best clinical and lifestyle practices, to increase access to healthcare and to assure swift payment to providers.
- Provide ongoing training and support for system users at the state, regional and, dependent on system nature, provider levels.
- Data Review, Entry, and Management program
•    Manage all providers contact and financial information and support semi-annual updates of provider contact information
•    Provide for the secure submission of enrollment and diagnostic information including client signatures, client enrollment and preauthorization forms from state, regional and provider levels and file sharing by program state and grantee staff.
•    Provide secure ability to upload and store diagnostic reports, pathology, and medical documents.
•    Review all enrollment forms, bills, and reports to ensure accuracy and eligibility.
•    Support data submission and assure patient confidentiality.
•    Provide for the secure submission of enrollment and diagnostic information including client signatures, client enrollment and preauthorization forms from state, regional and provider levels and file sharing by program state and grantee staff for approximately 500 women.
•    Review all enrollment forms, bills, and reports to ensure accuracy and eligibility.