Gold Coast Health Plan

Buyer seeks an Eligibility and Enrollment Software solution for their Medi-Cal managed care program. The software must support integrated Medicare & Medi-Cal D-SNP eligibility rules, automate enrollment processing, and integrate with CMS and DHCS systems. Buyer requires the solution to manage dual-eligible beneficiaries, ensure compliance with regulations, and provide robust reporting capabilities. The implementation must be completed within 6 months to support the launch of their D-SNP Medicare program.

• 3/13/2025 - Proposal Due Date
• 1/1/2026 - D-SNP Medicare Program Implementation

• Support integrated Medicare & Medi-Cal D-SNP Eligibility Rules
• Integrate with CMS MARx and DHCS MEDS/AEVS systems
• Integrate with Salesforce
• Comply with HIPAA & Security Standards
• Implement software within 6-month period

• Implement integrated Medicare & Medi-Cal D-SNP Eligibility Rules
• Integrate with CMS and DHCS Enrollment Systems
• Automate eligibility checks and enrollment processing
• Generate member communications and integrate with fulfillment vendor
• Manage members during 'deeming period'
• Enable data reconciliation between CMS, DHCS, and internal data
• Comply with HIPAA & Security Standards
• Collaborate with GHCP System Implementation partner
• Process 834 Enrollment Files and other CMS/DHCS files
• Provide dashboard for enrollment insights and error resolution