MB-10469 - USA (Oregon) - Third Party Administrator and Related Services - Deadline October 23,2026

(1) Vendor needs to provide third party administrator and related services.– Program administration and eligibility:– Maintain covered–entity, child–site, location, department, prescriber, pharmacy, payer, NPI, medicaid billing number, and contract–pharmacy configuration with effective dating and approval workflows.– Apply –approved patient, encounter, prescriber, referral, location, drug, payer, and discharge–status rules consistently and retain the evidence supporting each qualification decision.– Split billing, purchasing, and inventory:– Reconcile purchase orders, wholesaler invoices, receipts, returns, credits, reversals, changes, package–size differences, shortages, allocations, and substitutions.– Support multiple wholesalers and direct manufacturers, including account mapping, duplicate order protection, configurable order approval, and transmission status monitoring.– Contract pharmacy and owned–pharmacy administration:– Support claims qualification, reversals, replenishment, financial settlement, dispense–fee calculation, and pharmacy/network reconciliation for owned and contract pharmacies.– Medicaid and duplicate–discount controls:– Support Medicaid fee–for–service and managed–care carve–in/carve–out configurations by entity, site, pharmacy, state, payer, and claim type.– Compliance, audit, and monitoring:– Deliver a traceable audit trail for source data, rules, configuration changes, qualification outcomes, accumulator activity, orders, user activity, overrides, and financial settlement.(2) All the questions must be submitted no later than September 28, 2026.