Management Services Organization / Administrative Services Organization

The Sacramento County Department of Health Services, Primary Health Services is seeking Letters of Interest from Medi-Cal Managed Care Health Plans, Independent Provider Associations, or Management Services Organizations to operate and manage the Healthy Partners Program care delivery network. The program provides comprehensive primary and preventive care services for eligible undocumented Sacramento County residents. The selected organization will be responsible for managing and administering the program, including developing and managing a network of participating providers, healthcare claims administration, and specialist claim adjudication and payment. The organization must meet minimum requirements, including having at least 10 years of experience operating as a licensed health plan, Independent Practice Association, or Managed Services Organization, and demonstrating compliance with HIPAA and other applicable state and federal managed care regulations. • The program delivers integrated primary care, behavioral health, and basic diagnostic services through the Sacramento County Health Center. • The selected organization will be responsible for providing subject matter expertise and consultation for healthcare services for low-income adults. • The organization must have the ability to administer provider contracts under risk-based, capitated, or delegated arrangements. • The organization must have a minimum of 10 years of experience administering Medi-Cal managed care benefits. • The organization must have a current operation of a HIPAA compliant claims adjudication system.