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 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 vendor must have at least five years of experience providing prior authorization solutions for state Medicaid programs and meet other requirements outlined in the RFP. Key features of the solution include: • Prior authorization call centers • Clinical prior authorization • Automated business rules • Integration with existing systems • Security and compliance with federal and state regulations The contract period is expected to be five years, with the option for renewal. The vendor must be registered in MissouriBUYS and achieve "Approved" registration status to be considered for a contract award.