South Dakota Department of Social Services

Buyer seeks a contractor to provide dental and orthodontic claims adjudication and administrative services for South Dakota Medicaid. The contractor will process claims, operate customer service lines, implement outreach and education programs, and provide reporting and advisory services. The contractor must also develop provider networks, conduct quality assurance, and assist with program integrity activities. The contract term is three years with option to renew for two additional one-year periods.

• 1/2/2025 - Letter of Intent Due
• 1/16/2025 - Offeror Questions Due
• 1/30/2025 - Responses to Offeror Questions
• 3/13/2025 - Proposal Due Date
• 4/10/2025 - Anticipated Award Decision

• Adjudicate and pay South Dakota Medicaid dental and orthodontic claims
• Operate toll-free telephone service for providers and recipients
• Implement care coordination, outreach, and education plan
• Provide monthly executive summary reports and quarterly data dashboards
• Conduct provider surveys and training annually
• Perform quality assurance and utilization reviews
• Advise on dental benefit policy matters
• Develop and implement network development plan
• Perform program integrity activities and reporting
• Assist with design and implementation of quality initiatives