To: Board of Supervisors
From: Dr. Grant Colfax, Health Services Director
Report Title: Contract #23-915 with Optum Insight, Inc.
Recommendation: Recommendation of the County Administrator
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RECOMMENDATIONS:
APPROVE and AUTHORIZE the Health Services Director, or designee, to execute on behalf of the County a Pharmacy Services Agreement (County Contract #23-915) with Optum Insight, Inc., a Delaware corporation, in an amount not to exceed $6,000, to provide its pharmaceutical drug claims regulatory compliance software and services to Contra Costa Health Information Systems Unit for the period from November 3, 2026 through November 2, 2029, and for successive one (1) year terms thereafter until terminated pursuant to the terms of the agreement.
FISCAL IMPACT:
Approval of this Contract will result in contractual service expenditures of up to $6,000 over a three-year period and will be funded 100% by Hospital Enterprise Fund I revenues.
BACKGROUND:
This Contract meets Contra Costa Health (CCH)’s needs by enabling the submission of complete, accurate, and timely encounter data for services provided to CCH Detention Health’s Medi-Cal-enrolled beneficiaries by causing its transmission of prescription (Rx) claims for payment and reimbursement of covered drugs, specific medical supplies, and enteral nutrition products to be in accordance with the California Department of Health Care Services (DHCS) Medi-Cal Managed Care Encounter Data Reporting of procedures, data element standards, formats, codes, protocols and edits in accordance with National Council Prescription Drug Programs (NCPDP) standards and services specifications. Under federal regulations, DHCS contractually requires Medi-Cal Managed Care Plans to process encounter data using national standard transactions and NCPDP standards to meet state and federal Medicaid monitoring and reporting requirements and to accommodate receipt of ICD-10 diagnosis codes in accordance with Health Insurance Portability and Accou...
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