Pharmacy Point of Sale Electronic Claims Management System

The state of Maryland is seeking information from vendors regarding pharmacy point-of-sale (POS) electronic claims management systems, with a focus on integrating Artificial Intelligence (AI) capabilities for Medicaid Pharmacy POS services. The primary objective is to understand the current marketplace of products and solutions that can enhance Medicaid pharmacy claims processes through advanced technology.

Vendors are expected to provide solutions and recommendations for leveraging AI in several critical areas, including call center facilitation and support (such as operations, monitoring, and reporting), CRM functionality and workflow automation, claims adjudication, fraud/waste/abuse detection, prior authorization automation, and drug utilization review. Additional areas of interest include clinical decision support, member and provider engagement through chatbots or virtual assistants, predictive analytics for medication adherence and outcomes, formulary and policy management, cost containment, and robust operational reporting and dashboards.

Interested parties should address how their systems and services incorporate or can be enhanced with AI-driven capabilities specific to Medicaid pharmacy operations.