Happy Holidays!!!
The Department of Vermont Health Access is seeking to establish service agreements with one (or more) companies that can provide Radiology benefit management. As part of 2011 Act 156 (SFY'11), the legislature allowed the Department of Vermont Health Access (DVHA) to institute a prior authorization (PA) process for high-tech imaging, including scans such as: computed tomography (CT), computed tomographic angiography (CTA), magnetic resonance imaging (MRI), magnetic resonance angiography (MRA), positron emission tomography (PET), and positron emission tomography-computed. A high-tech imaging prior authorization program was implemented on September 1, 2010 and to date all service performance indicators are positive. The Department of Vermont Health Access is now accepting proposals of Vendors who can provide to the State full radiology benefit management services for the entire Medicaid Fee-for-Service (FFS) population in Vermont, including:
• Management of all prior authorization requests submitted by VT-Medicaid providers on behalf of
VT-Medicaid clients including determining medical necessity and quality through application of
developed, proprietary evidence-based clinical guidelines
• Receipt and use of data files from HP Enterprise (HP), the Medicaid fiscal agent/claims
processing agent, for prior authorization processing
• Transmission of prior authorization data files to HP for uploading to the MMIS
• Performance reporting
• Adherence to HIPAA Privacy and Security Regulations and law
• Acceptance testing
The RFP posting can be located here: http://www.vermontbusinessregistry.com/BidPreview.aspx?BidID=9559
Schedule of Events:
RFP Posted
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December 21, 2012
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Bidder’s Questions Due
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January 7, 2013
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Dept. Response to Questions
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January 11, 2013
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Intent to Bid
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January 14, 2013
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Proposal Due/Closing Date
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January 28, 2013
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Bid Opening
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January 28, 2013
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Selection Notification
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March 1, 2013
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Commencement of Contract
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April 1, 2013
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All communications concerning this Request for Proposal (RFP) are to be addressed in writing to the attention of:
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