Department For Medicaid ServicesIssuing agency·Kentucky·via a public procurement portalExternal Independent Third-Party Review (C6102)
Type: Request for Proposals (RFP). Agency: Department For Medicaid Services. Documents: No Bid Form RFP 746 26-0006 (C6102).docx; Cost Proposal Form RFP 746 2700000006.xlsx; Sample - Business Associate Agreement.pdf; Final_RFP_746_2700000006_1_SO_FORM.PDF — Assembled pdf file for document [RFP,746,2700000006,1] - Solicitation Printer; Final_RFP_746_2700000006_2_SO_FORM.PDF — Assembled pdf file for document [RFP,746,2700000006,2] - Solicitation Printer
The contractor will, at a minimum, perform accurate and timely external independent third-party reviews in compliance with 907 KAR 17:035. This includes conducting an EITPR and issuing a final decision, including a review summary, to DMS, the MCO, and the Medicaid provider within thirty (30) calendar days of receipt of the record on appeal materials. The contractor will make medical necessity determinations by a currently licensed clinician, make administrative determinations, develop a formal process for identifying qualified clinicians, develop timelines for review, ensure reviewers have no conflict of interest, be responsible for producing all regularly scheduled monthly, quarterly and annual reports, and transmit and receive all data via encryption or secure file transport protocol (FTP) site.
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Read from this solicitation’s own documents — each row shows the exact quote it was matched to. Confirm final amounts and forms with the issuing agency before you submit.
Source: Department For Medicaid Services (solicitation RFP-746-2700000006-2), retrieved via a public procurement portal. View the official posting, and always confirm requirements and deadlines with the issuing agency.
