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MB-2867 - USA (Jefferson, Missouri) - Medical Claim Audit Administrative Services - Deadline March 15,2019

Product (RFP/RFQ/RFI/Solicitation/Tender/Bid Etc.) ID: MB-2867

Government Authority located in Jefferson, Missouri; USA based organization looking for medical claim audit administrative services.

[A] Budget: Looking for Proposal

[B] Scope of Service:

(1) Vendor needs to provide medical claim audit for self-insured population administered.
- Provides the health benefit program for employees, retirees, and their dependents covering nearly 94,000 member’s lives.
- Perform a comprehensive and objective review of claims processed for calendar year 2018. The claims auditor will determine whether claims were adjudicated according to mental health services, contractual standards, appropriate Plan benefits, and industry standards, such as those associated with cost containment and refund procedures.
- Claims payment system, including the automated process for tracking and resolving incomplete or pended claims and management reporting such as error reporting statistics.
- Override procedures and controls relating to approval of claims and exception processing.
- Automated system for detecting unbundling of charges, claims procedures and office work flow, Ability to identify duplicate claims.
- Procedure utilized for subrogation identification, investigation, and recovery, Medical necessity of specific professional services.
- Forms and communication process, Internal audit system
- Refund activity, including tests to confirm refunds from healthcare providers are forwarded, respectively or provider offsets are appropriately applied. vendor shall report how well claim overpayments are being controlled including overpayment amounts, time limitations for recovery, and the use of external vendors and their shared savings on recoveries. The report shall include an analysis of refund activity, the reasons for the refunds, breakout between solicited and unsolicited refunds and the balance of outstanding refunds.
- Include a review of cost containment procedures, quality and quantity of procedural manuals provided to claims processing, customer service, the internal audit system, mail receipt and tracking, evaluation of the security of records and data, evaluation of customer service, including communication of benefits, policies, and procedures, training programs and employee evaluations.
(2) All the questions must be submitted no later than February 28,2019.

[C] Eligibility:

- Onshore (USA Only);

[D] Work Performance:

Performance of the work will be Offsite. Vendor needs to carry work in their office location.

Expiry Date : Friday, 15 March, 2019

Question Answer Deadline : Thursday, 28 February, 2019

Category : Medical Billing and Coding, Auditing, Finance and Accounting

Country : USA

State : Missouri

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