MB-3128 - USA (Alaska) - Medicaid Audits Services - Deadline June 20,2019

Product (RFP/RFQ/RFI/Solicitation/Tender/Bid Etc.) ID: MB-3128

Government Authority located in Alaska; USA based organization looking for expert vendor for Medicaid audits services.

[A] Budget: Looking for Proposals

[B] Scope of Service:

(1) Vendor needs to provide Medicaid audits services.
- that the services billed by providers on claims documents were actually provided to Medicaid recipients who were eligible at the time that services were delivered;
- that the services, procedure codes, and number of units for which claims were submitted reconcile with the recipient’s medical chart record of the services rendered, and the services were medically necessary;
- that the stop and start times are documented for all time-based codes;
- that the diagnoses recorded on the claim forms reconcile with the medical charts;
- that the provider records substantiate that the services were rendered on the dates for which the claims were submitted;
- that the provider followed Medicaid rules and appropriately billed all third-party payers, applied proper co-payment and recipient cost-of-care as required;
- that no duplicate billings and payments were made or received by the provider;
- that no concurrent inpatient, nursing facility, or other residential care billings exist with other Medicaid providers;
- that the provider obtained appropriate authorization for services as applicable;
- that billings and payments did not exceed applicable service limits or 24 hours of service in one day;
- that the place of service code billed was accurate for the site at which the service was provided (inpatient hospital, office visit, etc.);
- that Medicaid-eligible medical providers were enrolled with Medicaid and had the appropriate background check at the time of service; and,
- that the providers complied with their Medicaid provider agreement to identify and quantify overpayments and to detect all possible violations of state and federal policies, regulations and criminal statutes.
(2) All questions must be submitted no later than June 3, 2019.
(3) Contract term will be three years.

[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 : Thursday, 20 June, 2019

Question Answer Deadline : Monday, 3 June, 2019

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

Country : USA

State : Alaska

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