Orthodontic Benefit Administration and Consulting Services

Agency: State Government of New Hampshire
State: New Hampshire
Type of Government: State & Local
NAICS Category:
  • 541611 - Administrative Management and General Management Consulting Services
Posted Date: Dec 2, 2021
Due Date: Jan 7, 2022
Solicitation No: RFA-2023-DMS-02-ORTHO
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Description

The New Hampshire Department of Health and Human Services (DHHS), Division of Medicaid Services (DMS), is accepting applications to provide Orthodontic Benefit Administration and Consulting Services to assist the Division of Medicaid Services with review of eligibility for orthodontic services for Medicaid recipients, ages 0 through 21, as part of the New Hampshire Medicaid Program.

Documents RFA-2023-DMS-02-ORTHO
Release Date December 2, 2021
Closing Date/Time January 7, 2022. 11:59 PM
Program Area Division of Medicaid Services
Contact Heidi Laramie
Telephone (603) 271-9405
E-mail Address Heidi.H.Laramie@dhhs.nh.gov

Attachment Preview

State of New Hampshire
Department of Health and Human Services
REQUEST FOR APPLICATION
RFA-2023-DMS-02-ORTHO
FOR
ORTHODONTIC BENEFIT ADMINISTRATION
AND CONSULTING SERVICES
DECEMBER 2, 2021
New Hampshire Department of Health and Human Services
ORTHODONTIC BENEFIT ADMINISTRATION AND CONSULTING SERVICES
Table of Contents
1. Request for Services ................................................................................................ 4
Purpose and Overview ........................................................................................ 4
Requirements...................................................................................................... 4
Scope of Services ............................................................................................... 4
Performance Measures ....................................................................................... 5
Compensation & Contract Value ......................................................................... 6
Contract Period ................................................................................................... 6
Mandatory Responses to RFA Questions ........................................................... 6
Application Evaluation ......................................................................................... 7
2. Notices (Updated 1/28/20) ........................................................................................ 7
Exceptions........................................................................................................... 7
RFA Amendment................................................................................................. 8
Application Submission ....................................................................................... 8
Compliance ......................................................................................................... 8
Non-Collusion.................................................................................................... 11
Applicant Withdrawal......................................................................................... 11
Public Disclosure............................................................................................... 11
Non-Commitment .............................................................................................. 12
Request for Additional Information or Materials ................................................ 12
Liability .............................................................................................................. 12
Oral Presentations and Discussions ................................................................. 12
Successful Applicant Notice and Contract Negotiations.................................... 12
Scope of Award and Contract Award Notice ..................................................... 13
Site Visits .......................................................................................................... 13
Protest of Intended Award................................................................................. 13
Contingency ...................................................................................................... 13
Ethical Requirements ........................................................................................ 13
3. Application Process ................................................................................................ 14
Overview ........................................................................................................... 14
Application Content ........................................................................................... 14
Procurement Timetable and Contact Information.............................................. 15
Applicant’s Questions and Answers .................................................................. 16
RFA-2023-DMS-02-ORTHO
Page 2 of 17
New Hampshire Department of Health and Human Services
ORTHODONTIC BENEFIT ADMINISTRATION AND CONSULTING SERVICES
Validity of Application ........................................................................................ 17
4. Appendices ............................................................................................................. 17
Appendix A – P-37 General Provisions and Standard Exhibits (for reference
only-do not return) ..................................................................................................... 17
RFA-2023-DMS-02-ORTHO
Page 3 of 17
New Hampshire Department of Health and Human Services
ORTHODONTIC BENEFIT ADMINISTRATION AND CONSULTING SERVICES
REQUEST FOR APPLICATIONS
1. Request for Services
Purpose and Overview
Purpose
This Request for Applications (RFA) is published to solicit applications for
the provision of Orthodontic Benefit Administration and Consulting Services
to assist the Division of Medicaid Services (DMS) with review of eligibility
for orthodontic services for Medicaid recipients, ages 0 through 21, as part
of the New Hampshire Medicaid Program.
The Department of Health and Human Services (Department) anticipates
awarding one (1) contract for the services in this RFA.
Overview
Children suffering from severe handicapping malocclusions who are eligible
recipients of Medicaid services are entitled to receive uninterrupted access
to orthodontic services as required under Title XIX. In order to ensure
continuity of services, orthodontic cases submitted for approval of Medicaid
coverage are evaluated by a licensed, fully credentialed orthodontist to
ensure they meet the medical necessity criteria set forth in the current New
Hampshire Administrative Rule He-W 566. This evaluation also ensures
fiscal responsibility by avoiding overpayment for services, and appropriately
denying coverage of cases that do not meet the medical necessity criteria.
Requirements
To apply for this RFA, an Applicant must be a dentist licensed as an
orthodontic specialist by the New Hampshire Board of Dental Examiners
and must be a graduate of a dental school accredited by the American
Dental Association.
Scope of Services
The selected Applicant must:
Review requests for prior authorization for orthodontic services
submitted by New Hampshire Medicaid providers on behalf of
eligible Medicaid recipients to ensure completeness.
Analyze requests for prior authorization to determine if the
recipient meets the criteria for approval in accordance with New
Hampshire Administrative Rules He-W 566, Dental Services, and
He-W 546, Early and Periodic Screening, Diagnosis and
Treatment Services.
Complete orthodontic prior authorization worksheets as
documentation of the decision-making process undertaken.
RFA-2023-DMS-02-ORTHO
Page 4 of 17
New Hampshire Department of Health and Human Services
ORTHODONTIC BENEFIT ADMINISTRATION AND CONSULTING SERVICES
Provide sufficient information for the preparation of denial letters
in accordance with requirements outlined by the Division of
Medicaid Services.
Respond to requests for information from providers, Department
staff and Medicaid members within seven (7) calendar days
Participate as the Department’s expert on orthodontia at fair
hearings before the Department’s Administrative Appeals Unit as
required.
Participate in administrative meetings as requested by the DMS
Dental Director for the purpose of providing subject matter
expertise for the development of a comprehensive oral health
program for Medicaid recipients.
Provide services under the administrative leadership of and
collaborate with the DMS Dental Director.
Communicate with community orthodontists, general dentists,
DMS personnel and other State agencies concerning the
Medicaid dental program and its operation, policies, practices
and protocols.
Exercise continuous initiative, judgment, and creativity in the
planning and execution of the New Hampshire Medicaid Program
dental services.
Use the Department’s equipment and computer system to access
records and submit determinations. The selected Applicant must
comply with the terms of the Department’s Computer Use Policy.
Be available two days a week (8 hours per day), 52 weeks per
year, to be scheduled in consultation with the Department.
Performance Measures
The selected Applicant will:
Complete reviews and corrections of 85% of claims within forty-
five (45) days of receipt of claim;
Complete 85% of prior authorization requests within forty-five
(45) days of receipt of cases with complete documentation, as
required; and
Ensure 95% of eligibility determinations appealed to the
Department’s Administrative Appeals Unit are upheld.
Applicants must demonstrate the capacity and performance experience to
meet the Scope of Services outlined in this RFA.
RFA-2023-DMS-02-ORTHO
Page 5 of 17

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