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Dental Claims Adjudication and Prior Authorization Services

Open

State & Local

Contract Overview

Solicitation details, issuing organization, response deadlines, documents, and interested companies for this government contract opportunity.

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This subcontract for Dental Claims Adjudication and Prior Authorization Services supports prime contractors on projects for the Illinois Department of Healthcare and Family Services. The scope of work involves the technical review and processing of dental claims for reimbursement, the evaluation of prior authorization requests based on medical necessity, and the assurance of strict compliance with federal Medicaid requirements. The service provider will utilize specialized dental claims processing software and Medicaid adjudication systems to deliver processed claims and authorization determinations. The work is performed in Springfield, Illinois, under NAICS code 541219, and is managed by the Director within the state agency.

General Info

Subcontract for dental claims adjudication and prior authorization services for Illinois Medicaid.

Agency

Illinois → Director

NAICS

541219 - Other Accounting Services

Place of Performance

Springfield, IL, 62704, USA

Set-Aside

NONE

Documents

This scope was carved out of 26-478HFS-DIREC-B-51894.

The full solicitation package (3 documents), including the RFP, is on the prime solicitation, not on this scope.

View the prime solicitation

26-478HFS-DIREC-B-51894 | Sole Source: Dental Program for Fee-For-Service Customers

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Timeline

PostedApr 8

subcontract

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Organization & Contact Information

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AgencyIllinois → Director

ContactsNo contacts available

OfficeN/A

Organization / AgencyIllinois → Director

Office AddressN/A

ContactsNo contact information available

Full Description

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Performs technical review and processing of dental claims for prime contractors on Illinois Department of Healthcare and Family Services (HFS) projects. Processes dental claims for reimbursement, reviews prior authorization requests for medical necessity, and ensures compliance with federal Medicaid requirements. Utilizes dental claims processing software and Medicaid adjudication systems. Delivers processed and adjudicated claims and prior authorization determinations.

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