Ohio Procurement Portal #SRC0000041414

Ohio Department of Behavioral Health seeks pharmacy adjudication services for FY27/28.

The Ohio Department of Behavioral Health is seeking pharmacy adjudication services to support Ohio Pharmacy Services for fiscal years 2027 and 2028. - Government Buyer: - Ohio Department of Behavioral Health (DBH) - Located in Columbus, Franklin County, Ohio - Services Requested: - Online adjudication of prescription claims for a network of retail, specialty, and compounding pharmacies - Emergency prescription fills, specialty, and compounded medications - Support for same-day local retail pharmacy fills - Robust auditing and reporting methodologies - Electronic claims invoicing, detailed billing, and account statements - Emergency override procedures - Staff training, secure data management, and transition planning for future contractors - Requirements: - Compliance with HIPAA and Ohio Revised Code Chapter 4729.80 - Vendors must have experience with at least three relevant projects in the past five years - No unresolved findings for recovery under Ohio law - OEMs and Vendors: - No specific OEMs or vendors are named in the solicitation - Notable Requirements: - Emphasis on secure data management, emergency procedures, and transition planning - Demonstrated experience and compliance with state and federal regulations

Description

The Ohio Department of Behavioral Health (DBH) is seeking prescription adjudication services to reimburse a broad network of pharmacies including retail, specialty, and compounding pharmacies. The services focus on emergency prescription fills with restrictions and specialty and compounded medications. The scope includes online adjudication of prescription claims, auditing methodologies for compliance and reporting, and electronic claims invoicing. The project requires compliance with HIPAA, Ohio Revised Code, and other applicable regulations, and includes detailed billing and reporting requirements. The solicitation also outlines implementation, transition plans, and minimum qualifications for bidders.

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