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MB-3994 - USA (Maryland) - Maximization of Third Party Liability Recoveries Service - Deadline March 31,2020

Product (RFP/RFQ/RFI/Solicitation/Tender/Bid Etc.) ID: MB-3994

Government Authority located in Maryland; USA based organization looking for expert vendor for maximization of third party liability recoveries service.

[A] Budget: Looking for proposal

[B] Scope of Service:

(1) Vendor needs to provide maximization of third party liability recoveries service including automated data processing to identify liable third parties; audits; third party liability payments recovery; identifying new third-party resources to offset Medicaid expenditures; and conducting third party recoveries based on newly identified resources.
- The Contractor shall identify self-insured health plans, Workers’ Compensation Carriers, commercial health insurance, Medicare or private Health Maintenance Organization coverage, TRICARE fiscal intermediaries, and other government insurance to identify any claims paid.
- The Contractor shall identify member match records as well as eligibility and third-party coverage matches.
- The Contractor shall perform the matching process with health insurance coverage files provided by payers monthly, at a minimum.
- The Contractor shall develop an appropriate exact matching protocol, acceptable to MDH, that explains how information from the files will be matched with files from the entities and other payers. The Contractor shall include a proposed exact matching protocol that identifies data elements and the process to be used.
- The contractor shall use paid claims - Medicaid file to match against each program’s paid claims history file to identify claims which were paid by each program but for which coverage may exist.
- Once assigned, Mass Tort Resolution firms will send entitlement list to the Contractor.
- The Contractor’s Business Analyst shall match names on entitlement lists to MDH’S eligibility files.
- Matches shall be reviewed by the Contractor for quality assurance.
- If recipient eligibility issues are identified, they are resolved by the Contractor and the Contractor will process a new match; otherwise the entitlement list consisting of positive matches shall be transmitted by the contractor to the Mass Tort Law Firm.
- The Contractor shall create a recipient case for each positive recipient match in its Maestro database for tracking purposes.
(2) The contract period will be for three year.
(3) Pre-bid conference will be held on March 16, 2020  

[C] Eligibility:

Onshore (USA Only)

[D] Work Performance:

Performance of the work will be Onsite.

Expiry Date : Tuesday, 31 March, 2020

Pre-proposal Conference Date : Monday, 16 March, 2020

Category : Medical Billing and Coding

Country : USA

State : Maryland

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