Specifications include, but are not limited to: • Furnish all necessary personnel, materials, facilities and other services to accomplish delivery of Services, except as otherwise expressly provided in this RFP. • Maintain and expand upon cost-effective provider contracts with a statewide PPO network for Off-site medical care for AICs. The network must include providers on the borders of Idaho and Washington near those ODOC Institutions identified above. The successful Provider shall work to enhance the provider network upon execution of the Contract. • Be a good steward of plan funds in addition to processing and paying medical claims timely and accurately. Innovative solutions to help the plan save money and manage risk are a high priority. • Establish reimbursement rates with aggressive provider discounts that are comparable with those in the commercial marketplace. • Provide internet based electronic access to claims data analysis and information. • Ensure all claims and administrative charges are billed as agreed. • Provide concurrent claims review, cost management and utilization management. • Accept weekly enrollment data regarding eligibility of AICs. • Disclose all existing and future subcontracting in furtherance of this Contract to ODOC. • Provide monthly or quarterly utilization reports as requested by ODOC. • Provide training to ODOC staff regarding claims software.
