2.2.1 Contractor shall be able to provide a Secured Portal with User Access & Authentication tool to include but not limited to the following: Secure Login: DOM Staff, Contractors, or authorized Reviewers log in using secure credentials (username/password, two-factor authentication). Role-Based Access: Different access levels for users. HIPAA-Compliant Security: Encryption of all data transmissions and storage to protect PHI (protected health information). 2.2.2 Contractor shall be able to provide a Secured Portal with a Dashboard / Homepage to include but not limited to: Summary of Cases: Displays a list or summary of pending, in-process, on hold, and completed external review requests. Quick Actions: Buttons to start a new review, search cases, or view detailed case statuses. 2.2.3 Contractor shall be able to provide a Secured Portal with a Case Intake & Management tool to include but not limited to: Case Submission: DOM can submit requests for external review of medically necessary appeals. Submission includes attaching all relevant documentation such as denial notices, medical records, clinical notes, and treatment plans. Ability to submit voluminous medical records for one appeal. Automated Case Numbering & Tracking: Each case is assigned a unique identifier for easy tracking. 2.2.4 Contractor shall be able to provide a Secured Portal with a Medical Review Interface to include but not limited to: Review Assignment: Cases are assigned to qualified external medical reviewers based on specialty and availability. Ability to schedule Reviewer for virtual hearing, if needed. Case Details Display: Reviewers to review all documentation, to include summary of the denial, clinical information, state policy citations, and relevant medical necessity criteria. Reviewer Tools: Ability to enter detailed recommendations, findings, and conclusions. Access to guidelines or medical necessity criteria embedded or linked in the portal. Option to request additional information from DOM. 2.2.5 Contractor shall be able to provide a Secured Portal with Communication & Notifications tool to include but not limited to: Automated Notifications: Alerts sent to DOM when Reviewers are assigned, completed, or if additional info is requested. Messaging System: Secure internal messaging for communication between Reviewers, Contractors, and DOM. Status Updates: Real-time updates on case status accessible to authorized users.
