Specifications include, but are not limited to: The Alaska Native Tribal Health Consortium (ANTHC) is soliciting detailed proposals from Contractors interested in managing its Purchased Referred Care (PRC) financial accountability and responsibilities toward its external providers as a Fiscal Intermediary (FI). ANTHC’s PRC Program desires to modernize specific components and functionality of its claims processing and Purchased Orders (P.O.) payment and applications to achieve ANTHC’s desired outcomes: • Increase patient satisfaction. • Replace inefficient system-driven processes. • Transition away from a system that supports a heavily manual process. • Integrate with its clinical Electronic Health Record (E.H.R.) and financial Enterprise Resource Planning (E.R.P.) systems. The new service model will require minimal customization and will aid ANTHC in transitioning to a partially or fully electronic administrative workflow to process and pay for PRC referred care. The FI may include modules to validate and manage payment of health claims submitted by external providers according to various fee schedules and claim types, adjudication to adjust for repricing, catastrophic health emergency fund (CHEF) cases prioritization, reporting, patient and provider portals, EDI transmissions, and other related functionalities for integration to ANTHCs E.H.R. and E.R.P. systems. The Contract term will be determined based on the project schedule in the selected vendor’s proposal but shall not exceed 3 years.
