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South Dakota Medicaid Enterprise Prior Authorization, Utilization Management and Care Management Information System


Location
South Dakota
Publication Date
05/15/2019 11:04 AM EDT
Closing Date
07/09/2019 06:00 PM EDT
Issuing Organization
State of South Dakota - Office of Procurement Management
Solicitation Number
Description

Specifications include, but are not limited to: A broad category of activities focused on ensuring the provision of medically necessary services. Activities include review of individual cases i.e., prior authorization, concurrent review, discharge planning, and referrals to care management for high complexity/high cost cases. UM also includes identifying and improving utilization patterns through monitoring, analytics and reporting activities (see definition below). UM supports include alerts and notifications regarding utilization of services that are outside of set parameters and cases that warrant referrals for care management services and/or retrospective review.

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