Procurement for Medical Management and Utilization Review Services

Pursuant to the State Purchasing Act (Official Code of Georgia Annotated (O.C.G.A) §§50-5-50 et seq.), this electronic Request for Proposals (“eRFP”) is being issued to establish a contract with a single qualified supplier who will provide Medical Management and Utilization Review (UR) services to the Georgia Department of Community Health (hereinafter, “DCH” or “the State Entity”) as further described in this eRFP. This procurement will also serve children in the CHIP program who are awaiting an assignment to a Care Management Organization (CMO).

For the procurement announcement, please visit the following link:

All questions regarding the RFP must be directed to the DCH Issuing Officer, Mr. Percival Griffiths at

The following Resource Library is provided to assist Bidders in preparing responses to the RFP:

1. Copy of Offeror’s Transaction Numbers in Excel Format

1a. Copy of Offeror's Transaction Numbers in .pdf format

2. DMA6 Nursing Facility ICFID - Posted 09/21/15

3. DMA6A Pediatric Form - Posted 09/21/15

4. DMA 80 Prior Authorization Request - Posted 09/21/15

5. DMA 81 Prior Approval for Medical Service - Posted 09/21/15

6. Prior Authorizationfor Hospital Admissions Form - Posted 09/21/15

7. PASSR Form Redacted rev - Posted 09/21/15

8. DCH Medicaid Data Management Strategy - Posted 09/21/15

9.  Appendix 1, Hospital/Healthcare Acquired Conditions/Never Events - Posted 09/25/15

10. Appendix 2, Deeming/Katie Beckett Optional Eligibility Category and HCBS Waivers - Posted 09/25/15

11. SOURCE Manual, Appendix F, Level of Care Placement - Posted 09/25/15

12. SOURCE Manual, Appendix I, Level of Care Justification for Intermediate Nursing Facility Care - Posted 09/25/15

13. SOURCE Manual, Appendix S, MDS-HC Form - Posted 09/25/15

14. SOURCE Manual, Appendix C, SOURCE Assessment Addendum - Posted 09/25/15