INTEGRATED PROVIDER DATA MANAGEMENT/CREDENTIALING SYSTEM

Bid #ERFP-PRC-FY22-0113 - INTEGRATED PROVIDER DATA MANAGEMENT/CREDENTIALING SYSTEM




Bid contact:Please log in to view Bid contact informationIssuing agency:County of Santa Clara, CASee other Bids by this agencyIssuing department:PROCUREMENT DEPARTMENTSee other Bids by this departmentBid Comments:
The County of Santa Clara (County) dba Valley Health Plan (VHP) is seeking proposals from qualified vendors to provide an integrated Provider Data Management/Credentialing system solution that conforms to the  National Committee for Quality Assurance (NCQA) and Accreditation Association for Ambulatory Healthcare (AAAHC) standards, other regulatory requirements, and the service level agreements between VHP and Santa Clara Valley Medical Center and the Behavioral Health Services Department.


The County requires that the Integrated Provider Data Management/Credentialing System Solution meet the following

mandatory requirements:  
1.VHP must have a NCQA-accredited Credentialing system that is integrated with a Provider Data Management database to warehouse credentialing and provider profile data for all product lines of business (Commercial, Marketplace, and Medi-Cal), with an ability to capture multiple group/network/location data for provider, while maintaining the link between the entities.
 
 

2.Solution provides the ability to generate standard provider roster reports with a variety of information (i.e. age, specialty, status, board certification, individual provider, network affiliation, pay-to affiliation, etc.), and should allow for customized reports using all data elements.
 

3.The solution supports the efficient processes and workflows of a credentialing department to complete the following tasks/functions:
 
Verification of current DEA certificate
 

Verification of relevant training
 

Verification of current professional liability insurance
 

Provides alerts when signatures are not completed within appropriate timeframe(s)
 

Following signature, automatically produces a letter that is sent to the provider electronically.
 

Integrates with an automated workflow to support the credentialing committee processes and includes an electronic document signature system (e.g., DocuSign)
 

Integrates data through an interface with other core operating systems
 

Produces reminders to inform the credentialing process
 

Edits manual entry of data as compared to criteria
 

4.Solution performs file reconciliation, an automated pull-down of provider application data (i.e., CAQH, etc.) and verifications (via web crawler), and returns key provider data elements on a periodic basis (See examples below)
 
Verification of licensure
 

National Practitioner Data Bank (NPDB) report
 

Verification of Board certification and/or Board eligibility (ABMS)

The proposed solution must be a proven core system accredited by NCQA. The County is not interested in beta systems or purchasing professional services to design and develop a system. The solution must meet the technical, and functional requirements as defined in this RFP.
This RFP will result in a single award.  If an award is made, it is the County’s intent to award a contract with a term of up to three (3) years with the option by County to renew for an additional two (2) year terms unless terminated earlier or otherwise amended.
Added on Dec 2, 2021:Addendum #1 makes changes to Appendix A. It also extends the Question and Answer time period until December 6th, @ 3pm PST. Description:
Clinician Credentialing Delivery location:Please log in to see the delivery locationClassification codes: View classification codesContract duration:5 yearsContract renewal:1 annual renewalPrices good for:30 daysRegions:California, Santa Clara

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