Data Consolidation and Missed Opportunity Capture Services

The vendor is required to provide to consolidate data sources as well as capture of ineligible claims using machine learning to make data-driven decisions to grow our health center.
- TPAs and wholesalers using different platforms has made consolidating data, maintaining program oversight, identifying revenue and service line opportunities, and making date driven decisions for organizational growth a difficult task.
- General requirements:
•    A single platform for 340b audits, discover missed savings opportunities, referral capture, 340b ESP claims submissions with configurable rules engine and automation logic
•    Strong reporting tools and dashboard analytics. 
•    Preference will be given to solutions that use ai or automation to:
o    Support claims processing for the proposed 340b rebate model
o    Audit 100% of eligible and ineligible claims and give rationale behind findings
o    Connect our disparate data sources into one dashboard.
o    Review ineligible claims for savings recapture opportunities
o    Ability to identify and capitalize on savings opportunities through referral capture in alignment with federal regulations and policy
o    Automate files for 340b rebate model and 340b ESP reporting
- Services required:
•    Using pre-existing data connections, the bidder will provide a solution that is able to combine our disparate data sources--from contract pharmacy third party administrators, wholesalers and inhouse pharmacy data--into one unified platform that allows agency to access analytics across our entire 340b universe: TPA comparisons, capture rate, provider analytics, and trending data. 
•    The platform should act as a compliance tool and use machine learning to audit 100% of all eligible and ineligible claims and provide rationale for the findings and opportunities for additional claims recapture. 
•    Provide this solution at a flat fee with no revenue-sharing or consulting fees.

- Contract Period/Term: 1 year
- Questions/Inquires Deadline: October 07, 2025