RFI: Enhanced Prior Authorization System
KHPA intends to issue a contract for the processing of enhanced prior authorization services for publicly funded programs (Medicaid, the Childrens Health Insurance Program (CHIP), and other optional health care programs). The contractor will develop and update call center program and prior authorization guides detailing the requirements of the Kansas publicly funded programs including Medicaid and CHIP. The contractor must be able to provide an automated system to support a PA process that utilizes automation to the fullest extent while still providing the necessary prior authorization services.
As additional projects and federal requirements are implemented, the burden to the PA unit becomes greater. KHPA is looking to enhance the current Kansas Medicaid AutoPA process [which includes automated Drug Utilization Review (DUR) capabilities] to include additional panel criteria as well as the ability to AutoPA professional services. This would create a more robust, cost effective program through the placement of more drugs and professional services on prior authorization without increased administrative staff
