0 SCOPE OF WORK The Department of Social Services strives to meet its mission of strengthening and supporting individuals and families by promoting cost effective and comprehensive services in connection with our partners that foster independent and healthy families. We believe that strong families are South Dakota’s foundation and future. An efficient and robust Medicaid program is essential to that mission, and one of the key components of South Dakota’s Medical Services program is a comprehensive dental benefit for children and adults, with medically necessary orthodontic services as a benefit for qualifying children. The offeror selected as a result of this RFP will act in the capacity of an administrative service organization to the Division of Medical Services. Respondents must provide a response describing how the offeror intends to meet each of the following requirements. Respondents are strongly encouraged to propose innovative solutions targeted at meeting South Dakota Medicaid recipient needs in alignment with Department-specified objectives for the dental program. The anticipated cost of any innovative solutions must be included in the cost proposal. 3.1 Receive South Dakota Medicaid dental claims directly from South Dakota Medicaid dental providers: • Approximately 8,000 IHS dental claims annually; • Approximately 12,000 FQHC dental claims annually; and • Approximately 107,000 private practice claims annually. 3.2 Adjudicate and pay South Dakota Medicaid dental and orthodontic claims using an automated processing system. Utilize the most updated dental claim form. 3.3 South Dakota prefers a system that is certified by the Centers for Medicare and Medicaid Services. If certified in South Dakota, the offeror should include a verification of certification. If not yet certified in South Dakota, offerors should include a description of the states the system has been certified in and a plan to achieve certification within 18 months of implementation of the contract. 3.4 Adjudicate and pay South Dakota Medicaid dental and orthodontic claims in accordance with Federal and State regulations and according to the South Dakota Medicaid State Plan. 3.5 The offeror must adjudicate and pay claims, on average, within seven (7) business days of receipt.
