Pharmacy Benefit Claims Monitoring

The Commonwealth of Kentucky is seeking a qualified vendor to provide full‑scale, near‑real‑time monitoring and analysis of all pharmacy benefit claims submitted under the Kentucky Employees’ Health Plan (KEHP). The vendor will validate claim accuracy, identify over‑ and under‑payments, negotiate corrections with contracted pharmacy benefit managers, and deliver quarterly savings reports to the Personnel Cabinet and Legislative Research Commission. The work requires 100 % claim coverage (no sampling), HIPAA‑compliant data handling, and a staffing model that includes a dedicated account manager. The contract’s compensation is capped at 30 % of any verified savings the vendor generates. • Analyze every pharmacy claim/invoice submitted to KEHP (post‑July 1 2026) • Identify and correct billing errors, over‑payments, under‑payments, and inappropriate fees • Provide quarterly reports detailing findings, resolutions, and realized savings • Negotiate with CVS Caremark, Anthem, or any future PBM to recover over‑payments • Maintain HIPAA compliance and execute Business Associate Agreements • Supply a designated account manager and necessary reporting infrastructure