County of Marin Department of Health and Human Services

Buyer is seeking a Third-Party Administrator (TPA) for billing, collection, and revenue cycle management services related to the CalAIM Justice Involved Reentry Initiative. The TPA will bill the California Department of Health Care Services for healthcare services and medications provided to eligible individuals in adult correctional facilities and juvenile hall. Services include eligibility verification, claim submission, payment posting, denial management, and reporting. This is an RFI to gather information for a potential future RFP.

• 3/28/2025 - RFI Released
• 4/10/2025 - Questions Due
• 4/15/2025 - County Response to Questions
• 4/30/2025 - Proposal Due Date
• 9/29/2026 - CalAIM Go-Live Date

• Experience providing TPA services
• Expertise in Medi-Cal billing for justice-involved populations
• Experience with California MMIS for fee-for-service claims
• Experience with Medi-Cal Rx for billing pharmacy claims

• Verify real-time eligibility for justice-involved individuals with active JI Aid codes
• Submit electronic claims to Medi-Cal for pre-release healthcare services
• Bill Medi-Cal Rx for pharmaceutical reimbursement
• Manage eligibility changes and retroactive adjustments
• Process correctional healthcare claims with JI-specific billing codes and modifiers
• Reconcile Medi-Cal payments and manage denied claims
• Integrate with County's electronic health record systems
• Ensure HIPAA compliance and data security for sensitive patient information
• Generate comprehensive revenue cycle management reports
• Provide dedicated account management and technical support