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MB-2984 - USA (Mississippi) - Workers Compensation Claims and Performance Audit Services - Deadline May 15,2019

Product (RFP/RFQ/RFI/Solicitation/Tender/Bid Etc.) ID: MB-2984

Government Authority located in Mississippi; USA based organization looking for expert vendor for workers compensation claims and performance audit services.

[A] Budget: Looking for Proposals

[B] Scope of Service:

(1) Vendor needs to provide workers compensation claims and performance audit services to perform a comprehensive and objective audit of the claims processed by the trust third-party claims administrator to determine if the claims were adjudicated according to the contractual standards, audit must be based on a statistically valid random sample, should include open and closed indemnity claims and medical-only claims for which there has been activity during the 12-month audit period, and must include an audit and determination of the compliance with the contractual standards.
- Three-point contact
- Reserve calculations and updates
- Payment of medical bills and indemnity benefits
- Supervisory and managerial review
- Compliance with contract fee schedule for medical management services and other defined claims expenses
- Claims payment system
- Claims investigation and adjudication procedures
- Reserving procedures
- Bill payment and review
- Security and override procedures relating to approval of claims and access to records
- Evaluation of the disaster recovery plan
- Evaluation of the security of records and data
- For any claims and performance audit performed, the selected auditor will provide a comprehensive, detailed written report to include the methodology used by the consultant, the claims and performance audit findings, recommendations to the board regarding such findings, and may provide an oral presentation of the findings, if deemed necessary by the board.
(2) All question must be submitted no later than April 16, 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 : Wednesday, 15 May, 2019

Question Answer Deadline : Tuesday, 16 April, 2019

Category : Medical Billing and Coding

Country : USA

State : Mississippi

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