Prior Authorization Solution and Professional Review Services

The State of Missouri is seeking a vendor to provide a prior authorization solution and professional review services for the Missouri Department of Social Services, MO HealthNet Division. The solution must consolidate and standardize processes using automated business rules, decreasing the time, errors, confusion, and support calls for prior authorizations. The contract period will be for five years, with the effective date of the contract through acceptance of the solution implementation by the state, followed by completion of the ongoing prior authorization solution and professional review services. Key responsibilities include providing a prior authorization solution, professional review services, and ensuring compliance with state and federal regulations. • The prior authorization solution must be able to handle a high volume of transactions, with an average of 420K fee-for-service prior authorization transactions annually. • The solution must be able to integrate with existing systems, including the Medicaid Management Information System (MMIS) and the Clinical Management Services and System for Pharmacy Claims and Prior Authorization (CMSP). • The vendor must provide training and support to state staff and providers. • The vendor must ensure compliance with state and federal regulations, including the Anti-Discrimination Against Israel Act and the Federal Funding Unique Identity ID.