Describe your mental health/substance abuse case management service from structural and functional perspectives and how these lend to long-term stability of a member. PLAN ADMINISTRATION - ELIGIBILITY The State of Maryland would like direct access to the Offeror's eligibility systems for review and input purposes. Describe your ability to provide the State with direct access to the eligibility system only. Describe your eligibility system used to keep track of SLEOLA’s eligibility files, including: System "trade name" System organization Date system was put in place Number of system upgrades since inception Is eligibility processing real-time with the claim system? If no, what is the time? Briefly describe your process for correcting data in the event of a data tape which contains "bad data.” REPORTING What limitations do you have with customizing standard reports? Please explain. The State requires online access to standard reports; describe how you will make your reports available online. Describe your organization’s ability to provide the following at a minimum in your reports, including your ability to report member detail to the State. Billed amount Paid amount Network savings Non-Medicare COB savings Medicare COB savings Negotiated savings
Describe your mental health/substance abuse case management service from structural and functional perspectives and how these lend to long-term stability of a member. PLAN ADMINISTRATION - ELIGIBILITY The State of Maryland would like direct access to the Offeror's eligibility systems for review and input purposes. Describe your ability to provide the State with direct access to the eligibility system only. Describe your eligibility system used to keep track of SLEOLA’s eligibility files, including: System "trade name" System organization Date system was put in place Number of system upgrades since inception Is eligibility processing real-time with the claim system? If no, what is the time? Briefly describe your process for correcting data in the event of a data tape which contains "bad data.” REPORTING What limitations do you have with customizing standard reports? Please explain. The State requires online access to standard reports; describe how you will make your reports available online. Describe your organization’s ability to provide the following at a minimum in your reports, including your ability to report member detail to the State. Billed amount Paid amount Network savings Non-Medicare COB savings Medicare COB savings Negotiated savings
SLEOLAMedical_FA2_EPO-SF.docx