California eProcure #26-70009-000

Statewide healthcare provider network and administration services for California DSH

The California Department of State Hospitals is seeking an integrated statewide healthcare provider network and administration program for its five hospitals and patients. - Buyer: California Department of State Hospitals (DSH), Procurement and Contract Services Section. - Requested service: One integrated HCPN/TPA/PA/UM program, including a community-based provider network, third-party administration, utilization management, and prior authorization. No part number is specified. - Scope: Develop and credential medical, behavioral health, specialty, hospital, and ancillary providers; administer claims and payment coordination; conduct prior authorization and medical reviews; and provide supporting systems, portals, reporting, audits, training, implementation, and help-desk support. - Key requirements: Support access in rural and urban areas; prioritize Medicare-first billing; maintain claims accuracy and timeliness; enable electronic authorization and claims matching; protect health information; and meet enforceable performance guarantees. - OEMs and named vendors: No product OEMs or commercial vendors are identified. No hardware is requested.

Description

The Department of State Hospitals is seeking proposals to provide a Health Care Provider Network of community-based specialty medical services providers. The scope includes Third Party Administration, a Utilization Management system, and Prior Authorization services. The anticipated contract term is up to three years, with up to two optional one-year extensions, for a maximum total duration of five years.

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