Pharmacy Claims Switching and Benefit Eligibility Verification Services

The Indian Health Service is seeking information from vendors to assess their capabilities in providing pharmacy claims switching and benefit eligibility verification services. The services must be integrated with the Resource and Patient Management System (RPMS) and support electronic claims submission, adjudication, and reimbursement from third-party payers. The required capabilities include pharmacy claims switching, benefit eligibility verification, and technical and compliance requirements. • Electronic routing of pharmacy claims in compliance with NCPDP D.0 standards • Support for Medicare Part D, Medicaid, commercial insurance, and other third-party payers • Secure, internet-based connectivity • Pre- and post-edit functionality to improve claim acceptance rates • Ability to provide bundled, per-transaction pricing consistent with GSA Schedule pricing • Advance notification and coordination of system updates, testing, and implementation • Real-time eligibility verification integrated with RPMS pharmacy POS • Support for PBM onboarding and eligibility database maintenance • Audit logging, dispute resolution support, and eligibility accuracy controls • No additional cost to IHS for portal access or eligibility interfaces