Pharmacy Benefit Claims Monitoring

The Commonwealth of Kentucky is seeking a vendor to perform pharmacy benefit claims monitoring services for the Public Employee Health Insurance Program. The vendor will be responsible for analyzing 100% of pharmacy invoices and claims submitted for payment, identifying errors, and negotiating with contracted entities to resolve discrepancies. The vendor must have at least 5 years of experience in providing similar services and comply with all applicable federal and state laws, including HIPAA. The contract term is anticipated to be from July 1, 2026, to June 30, 2028, with the option to renew for up to two additional two-year periods. Key aspects of the job include: * Analyzing pharmacy benefit claims to validate accuracy and identify errors * Negotiating with contracted entities to resolve discrepancies * Providing quarterly reports to the Personnel Cabinet and Legislative Research Commission * Complying with all applicable federal and state laws, including HIPAA * Meeting minimum mandatory requirements, including 5 years of experience and HIPAA compliance * Providing sufficient staffing resources, including a designated account manager