Claims Processing and Management Services Module

The State of Georgia, Department of Community Health (through DOAS), is seeking a single NASPO ValuePoint‑awarded supplier to provide a cloud‑based Claims Processing and Management Services Module for Medicaid. The core SaaS solution must adjudicate, edit, price, and reimburse Medicaid claims, and the State desires all three optional add‑ons—Financial Management & Reporting, Call Center services, and Federal Reporting—delivered as an integrated package. The award will be a six‑year base term with up to four one‑year renewal options, and the contract will be governed by a Participating Addendum to the existing Montana MMIS Claims Master Agreement. Vendors must submit a technical proposal, complete the Claims Capabilities Matrix (security and integration), provide cost worksheets, and satisfy extensive HIPAA, NIST, HITRUST, and Georgia security requirements. • Core SaaS claims adjudication platform for Georgia Medicaid. • Required optional modules: Financial Management, Call Center, Federal Reporting – all from a single supplier. • Compliance with HIPAA, NIST 800‑53 (moderate), HITRUST, ARC‑AMPE, and Georgia security/immigration statutes. • Six‑year base term (possible up to ten years with renewals); contract value expected in the tens of millions of dollars.