SLCo SHE130921-1 Medicaid 1115 Waiver - RFC

Salt Lake County Contracts and Procurement, on behalf of Salt Lake County Sheriff’s Office Jail Health Services Division, is seeking a qualified and experienced contractor to provide Medicaid claim submission and management services under the 1115 Medicaid Waiver. The selected vendor will be responsible for preparing, submitting, and managing all eligible Medicaid claims for incarcerated individuals who received Medicaid-covered services or medications during the final 90 days of their incarceration. This initiative supports the County’s efforts to improve continuity of care, enhance reimbursement accuracy, and ensure compliance with State and Federal Medicaid requirements.
Initial implementation will focus exclusively on Medication-Assisted Treatment (MAT) participants (approximately 90 inmates) and will eventually expand to include all inmates receiving Medicaid-eligible medical care as the program matures.
The contractor must be able to Interface seamlessly with the County’s Saphire Health EHR system to enable secure data exchange, eligibility verification, and claim submission. Comply with all County IT standards, security, and privacy policies governing inmate health data. Provide training to County staff on identifying and validating Medicaid-eligible claims.
The contractor will be required to provide a dedicated Account Manager to oversee all billing operations. and add billing specialists as needed based on claim volume. The Contractor will be required to submit monthly reports detailing claim submissions, reimbursements, denials, and resolution timelines. Attend quarterly performance review meetings with Health Services representatives and provide an annual compliance audit summary and recommendations for process improvement.
The Sheriff’s Office and Jail Health Services shall • Provide inmate demographic, booking, custody, and release data necessary for eligibility verification and claims processing. • Facilitate secure access to jail medical records and EHR documentation for Medicaid-eligible encounters. • Approve and support technical integrations between County/jail systems and the Contractor’s billing platform. • Coordinate among internal departments and healthcare providers to ensure timely and complete transmission of encounter and billing data. • Establish service-level expectations for response times, issue resolution, and data exchange. Collaborate with Contractor to address compliance issues and implement corrective actions. • Review and approve vendor invoices per County financial policies.
A virtual pre-bid meeting will be held on July 15th at 9:00am. To request a seat at this conference, please send an invitation request via email to Aaron Stone at AStone@saltlakecounty.gov. Attendance is not mandatory, but it shall be the sole responsibility of the bidder to attend this conference. Bidders not attending do so at their own risk.