Specifications include, but are not limited to: The New Hampshire Department of Health and Human Services, Division of Medicaid Services (“Department”) is seeking responses to this Request for Proposals from qualified vendors who are accredited as an independent review organization by the Utilization Review Accreditation Commission (URAC), with demonstrated written and verbal skills to conduct independent clinical reviews of the Medicaid Preferred Drug List (PDL) as well as provide independent reviews of specialty services that may or may not be covered by Medicaid, including but not limited to: Access to physician clinical expertise to conduct specialty reviews of specific Medicaid cases. Consultation regarding medical claims reviews. Ability to analyze data to determine medical necessity or appropriateness of proposed treatments. Ability to conduct reviews of emerging experimental and investigational treatments to provide assistance with Medicaid benefits decision-making.
