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Managed Health Care Services

Publication Date
06/14/2018 05:10 AM EDT
Closing Date
07/20/2018 04:00 PM EDT
Issuing Organization
Northern Neck Regional Jail Authority
Solicitation Number

Specifications include, but are not limited to: A. Develop and maintain one or more networks of institutional and professional providers who, by contract, agree to accept discounted charges as payment in full for covered services. The credentialing of providers, maintenance of the network and communications with providers shall be a responsibility of the contractor. The Contractor shall ensure that 1. Providers continue to meet selection and screening criteria. 2. Providers maintain sufficient liability insurance. 3. Provider contracts remain in force. 4. Referral patterns and utilization of services are monitored continually for providers. 5. Provider discounts are secured to reduce costs. 6. State-wide provider access to all Regional Jail inmates. B. The contractor shall provide health claims processing including, but not limited to, the following: 1. Process all claims incurred during the life of the contract. 2. Check that pre-authorization, if required, was obtained. 3. Determine if the services provided were medically necessary.

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