Community Behavioral Health Support (CBHS) Services Clearinghouse

Background
The Washington State Health Care Authority (HCA) is seeking qualified bidders to serve as the Third-Party Administrator (TPA) for the Community Behavioral Health Support (CBHS) Claims Administrator.
The goal of this contract is to partner with HCA, Adult Family Homes (AFH), Assisted Living Facilities (ALF), and other approved Residential Care Services providers to provide technical assistance to CBHS Providers in implementing CBHS services.
This initiative aims to enhance support for individuals with mental health needs in long-term care settings, following the approval of a new Medicaid benefit under the 1915(i) State Plan by the Centers for Medicare and Medicaid Services (CMS).

Work Details
The awarded Bidder will manage a Claims Clearinghouse and provide technical assistance to support Adult Family Homes and other approved Residential Care Facilities with billing processes.
Key responsibilities include:
1. Establishing a Claims Clearinghouse that supports claims submission from participating facilities and providers, ensuring compliance with Medicaid billing requirements.
2. Providing daily coordination of CBHS services delivery and payment for approved Apple Health Enrollees.
3. Onboarding providers and offering training on provider enrollment, costs, and claiming processes.
4. Assisting facilities in developing strategies for proper billing and claims processing to ensure timely payments.
5. Engaging collaboratively with HCA and relevant stakeholders to ensure effective communication and training.
6. Sending completed claims to HCA’s claim payment system and managing relationships with Managed Care Organizations (MCOs).
7. Providing ongoing technical assistance including a virtual help desk for claim submission issues, monitoring compliance with billing guidelines, and reporting on performance metrics.

Period of Performance
The contract period is scheduled from November 13, 2025, to June 30, 2027, with the possibility of extending for up to three additional one-year periods at HCA's discretion.

Place of Performance
The services will be performed primarily in Washington State.

Bidder Requirements
Bidders must be licensed to do business in Washington State, have five years of experience working with Medicaid programs, establish a regional office in Washington if not already located there, comply with all relevant regulations regarding individual complaints and appeals processes, adhere to HIPAA privacy standards, have program integrity policies addressing fraud prevention, and maintain a Quality Management Plan.
Bidders must also meet an AM Best financial rating score of A- or better.