What the buyer needs
AI summaryA government authority located in NH seeks a vendor to provide dental orthodontic consultant services for its Medicaid and Children’s Health Insurance Program (CHIP) orthodontic benefit programs. The contractor must be a licensed DMD or DDS orthodontic specialist in good standing with the state board of dental examiners and maintain active licensure throughout the contract. The consultant will conduct clinical reviews for children with severe handicapping malocclusions, process orthodontic dental claims to prevent overpayment or wrongful denial, and maintain documentation consistent with Medicaid orthodontia standards. Additional duties include using the Medicaid Management Information System (MMIS) to gather data for research and program planning, working with Medicaid providers, and assisting with provider recruitment strategies. Only onshore USA organizations are eligible to bid, and all work will be performed offsite. Vendors must submit all questions no later than November 20, 2026, and the buyer is currently looking for proposals without a specified budget.
Scope of work
- Provide orthodontic benefit administration and consulting services for NH Medicaid and CHIP.
- Conduct clinical reviews and prior authorization analyses for severe handicapping malocclusions.
- Appear as the Department’s orthodontia expert at Administrative Appeals Unit and fair hearings.
- Review and process orthodontic dental claims, including pricing adjustments and suspended MMIS claims.
- Respond to provider, vendor, member, and staff inquiries within seven calendar days.
- Conduct annual fee and utilization reviews and report CDT code revisions.
- Assist in implementing provider recruitment strategies and developing DMS orthodontic policies.
- Use Department-provided equipment and MMIS to gather data and complete system review reports.
Minimum qualifications
- Licensed Doctor of Dental Medicine (DMD) or Doctor of Dental Surgery (DDS).
- Orthodontic specialist in good standing with the New Hampshire Board of Dental Examiners.
- Must maintain active licensure for the duration of the contract.
- Available at least four (4) days per week, approximately fifty (50) hours per month.
- Immediately available for urgent or emergency clinical matters when DMS Dental Director is unavailable.
- Available to travel to Concord, NH State Offices as requested.
- Must pass criminal background check, BAAS State Registry, and DCYF Central Registry checks.
- Onshore (USA Organization Only).