1.4.2.1. Adjudicate claims using the National Council on Prescription Drug Programs (NCPDP) D.0 format or a later release. 1.4.2.2. Adjudicate claims with coordination of benefits processing to pay at the Lessor of Methodology. 1.4.2.3. Provide technical and clinical call center services for providers. 1.4.2.4. Provide call center services for individuals receiving benefits. 1.4.2.5. Review and adjudicate prior authorization requests. 1.4.2.6. Perform Prospective Drug Utilization Review (ProDUR) and Retrospective Drug Utilization Review (RetroDUR). 1.4.2.7. Provide clinical consultation. 1.4.2.8. Manage the federal drug and supplemental rebate programs for the NH Medicaid Program, including preparing quarterly rebate invoices, tracking payments and handling of manufacturer disputes. 1.4.2.9. Manage the State’s Preferred Drug List (PDL). 1.4.2.10. Design, develop, and implement the State’s Pharmacy Benefits Management (PBM) system. The selected Vendor must provide for all of the system’s functional components and requirements, including services and deliverables.
