SLCo Medicaid 1115 Waiver Services

Work Requested

Salt Lake County is seeking a qualified and experienced contractor to provide comprehensive Medicaid claim submission and management services under the 1115 Medicaid Waiver. The contractor's responsibilities will include: - Preparing, submitting, and managing all eligible Medicaid claims for incarcerated individuals who received Medicaid-covered services or medications during the final 90 days of their incarceration. - Ensuring accurate and timely claim processing to support the County's goals of improving continuity of care, enhancing reimbursement accuracy, and maintaining compliance with State and Federal Medicaid requirements. - Focusing initially on Medication-Assisted Treatment (MAT) participants (approximately 90 inmates), with the scope expanding to all inmates receiving Medicaid-eligible medical care as the program develops.

Requesting Entity

This solicitation is issued by Salt Lake County Contracts and Procurement, on behalf of the Salt Lake County Sheriff's Office Jail Health Services Division.

Background

This initiative is designed to support Salt Lake County's efforts to improve the management and reimbursement of Medicaid claims for eligible incarcerated individuals, particularly during the critical transition period prior to release. The program will begin with MAT participants and expand as the process matures.

Contract Requirements

- Seamless interface with the County's Saphire Health EHR system for secure data exchange, eligibility verification, and claim submission. - Compliance with all County IT standards, security, and privacy policies related to inmate health data. - Provision of training to County staff on identifying and validating Medicaid-eligible claims. - Assignment of a dedicated Account Manager to oversee all billing operations, with the addition of billing specialists as needed based on claim volume. - Submission of monthly reports detailing claim submissions, reimbursements, denials, and resolution timelines. - Attendance at quarterly performance review meetings with Health Services representatives. - Provision of an annual compliance audit.

Instructions on Submission

Interested and qualified contractors should prepare their proposals in accordance with the requirements outlined above. Ensure that all aspects of claim management, EHR integration, compliance, and reporting are addressed in your submission.