Radiology Benefit Management
The State is seeking to establish service agreements with one (or more) companies that can provide Radiology benefit management. The State is now accepting proposals of Vendors who can provide to the State full radiology benefit management services for the entire Medicaid Fee-for-Service (FFS) population in Vermont, including: • Management of all prior authorization requests submitted by VT-Medicaid providers on behalf of VT-Medicaid clients including determining medical necessity and quality through application of developed, proprietary evidence-based clinical guidelines • Receipt and use of data files from HP Enterprise (HP), the Medicaid fiscal agent/claims processing agent, for prior authorization processing • Transmission of prior authorization data files to HP for uploading to the MMIS • Performance reporting • Adherence to HIPAA Privacy and Security Regulations and law • Acceptance testing
