Primary Support Services 2.1 Claims Clearinghouse- The awarded Bidder shall act as a central point of contact for the claims process by standing up a Claims Clearinghouse that supports the submission of claims or claims data by participating facilities and providers. The awarded Bidder shall receive, review, and process claims data for services related to CBHS, turning claims data into submittable claims or encounters, and ensure that this process is compliant with all Medicaid billing requirements. The awarded Bidder shall prioritize the implementation of a Claims Clearinghouse and satisfy the contractual requirements of operating the Claims Clearinghouse by January 1, 2026, as well as successfully complete any state required security reviews by no later than February 2, 2026. Specifically, the awarded Bidder shall be responsible for: A. Claims/Encounter Processing and Provider Support- The awarded Bidder shall have the ability to create an Apple Health claim or encounter from data submitted by participating facilities and providers through billing modules from electronic medical record platforms, other electronic methods, or paper-based claims. The awarded Bidder must have the ability to check eligibility and be compliant with HIPAA data sharing. The awarded Bidder shall also provide TA to participating facilities and providers submitting claims data or submitting claims with service that meets the needs of each participating facility or provider...
