Awarded vendors
- Pinnacle Claims Management, Inc.
Description
The California Health Benefit Exchange contracted a vendor to administer the Small Business Health Options Program (SHOP), covering sales support, agent management, eligibility and enrollment processing, financial management, customer service, and the supporting IT infrastructure. The work includes an implementation phase (Jan‑Jun 2013) followed by a two‑year operations period (Jul 2013‑Dec 2015) with the possibility of two additional one‑year extensions. The vendor must meet stringent performance metrics (call‑answer times, system availability, enrollment accuracy) and comply with HIPAA, HITECH, FISMA, and state security standards. The contract is firm‑fixed‑price and was awarded through a full and open competition.
• Scope: sales & fulfillment, agent & GA management, eligibility/enrollment, premium billing, call‑center, and IT/security services (using CalHEERS platform or an optional vendor‑owned solution).
• Key dates: proposal deadline 9 Nov 2012, award decision by 4 Jan 2013, vendor start 14 Jan 2013.
• Optional extension: up to two additional one‑year terms, extending potential performance through Dec 2017.