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MB-4261 - USA (South Carolina) - Medicaid Recovery Audit Services - Deadline June 30,2020

Product (RFP/RFQ/RFI/Solicitation/Tender/Bid Etc.) ID: MB-4261

Government Authority located in South Carolina; USA based organization looking for expert vendor for Medicaid recovery audit services.

[A] Budget: Looking For Proposal

[B] Scope of Service:

(1) Vendor needs to provide Medicaid recovery audit services for Approving all audit protocols, methodologies, procedures, and Provider communications to be used for overpayment recovery activities as well for the identification of underpayments,
- Collections and financial reporting of any overpayments identified by Contractor as well as giving Providers credit for any underpayments,
- In conducting audits for all Providers, will identify improper payments which include, but is not limited to:
- Non-covered services,
- Inadequate supporting documentation for services,
- Non-medically necessary services,
- Hospital and nursing home billing and medical records to identify improper payments related to non-covered and/or non-verified services; improper coding including Diagnosis Related Groups, level of care assignments, medical necessity determinations, length of stay, and outlier payments,
- Billing and record review to identify non-covered or non-verified services and all other potential payment sources for the claims, when applicable,
- Provider medical, financial, and billing records request procedures, including contact with Providers both in writing and in person, if needed, as well as an electronic record intake option, etc. 
(2) A pre-proposal conference will be held on June 17, 2020.

[C] Eligibility:

Onshore (USA Only);

[D] Work Performance:

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

[E] Proposal Submission:

Response can be submitted digitally via Email or Online.

Expiry Date : Tuesday, 30 June, 2020

Pre-proposal Conference Date : Wednesday, 17 June, 2020

Category : Medical Billing and Coding

Country : USA

State : South Carolina

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