Description
The State of South Carolina, through its Department of Health and Human Services, is seeking a single vendor to replace and operate its Third‑Party Liability (TPL) system. The contract will deliver a modern, automated, CMS‑certifiable solution that captures third‑party insurance data, performs ongoing data‑matching with external sources, automates case‑management workflows, supports estate‑recovery, casualty, HIPP, and other Medicaid cost‑avoidance functions, and provides full operational support for the life of the agreement.
• Design, build, and integrate a new TPL platform with the Medicaid Enterprise System (MES) and external data feeds (DMV, workers’ comp, courts, etc.).
• Provide comprehensive case‑management, document‑management, reporting, and analytics capabilities, including real‑time alerts and dashboards.
• Deliver 24/7 help‑desk, training, system maintenance, and incident‑response services; meet strict SLAs (e.g., 30‑minute critical‑incident notification).
• Manage OHI verification, retro‑health collections, estate‑recovery, and HIPP premium‑payment processes, with monthly, quarterly, and daily reporting requirements.
• Maintain a physical presence within 10 mi of the SCDHHS main office in Columbia, SC, and hold required cybersecurity insurance and certifications.