MB-5875 - USA (Colorado) - RFI for TRICARE Claims Review Service - Deadline January 7,2022

Product (RFP/RFQ/RFI/Solicitation/Tender/Bid Etc.) ID: MB-5875

Government authority located in Colorado, USA; based organization looking for expert vendor for TRICARE claims review service.

[A] Budget: Looking for Proposal

[B] Scope of Service:

(1) Vendor needs to provide TRICARE claims review service for impartial reviews of claims to include timely and accurate evaluations of each purchased care contractor’s healthcare claims processing and payment record coding procedures.
- Maintain effective management solutions to provide the necessary claims review services
- identifying and reporting improper payments and discrepancies in payment record coding
- impartial review of claims processing procedures and reimbursement methodologies utilized by purchased-care contractors, assesses purchased-care contractor compliance with TRICARE
policies and directives, and monitors the claims processing performance of DHA TRICARE purchased-care support contractors
- evaluate the accuracy of claims payment and payment record coding for the six purchased-care contractors.
- to track and monitor the claims processing performance of TRICARE purchased care contractors
- Allows for the retention of a compliance review trail with the appropriate error codes and error amounts
- Identify duplicate claim submissions
- Query patient or sponsor healthcare medical and pharmacy claims history
- operating and maintaining systems of records, including the collection, use, and dissemination of Government records
- capability to store, organize and categorize documentation based on contract type, review cycle, submission type (i.e. initial, rebuttal, second rebuttal), and shall facilitate the preservation, retrieval, use and disposition of compliance review documentation
- coding review includes reading the medical record documentation and applying applicable coding guidelines to assure that the code billed and paid is the most appropriate code and level of code for the services rendered and that multiple codes were not assigned when only one code is appropriate.
(2) This bid is set aside for total small business.

[C] Eligibility:

- Onshore (USA Organization Only);

[D] Work Performance:

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

Expiry Date : Friday, 7 January, 2022

Category : Medical Billing and Coding

Country : USA

State : Colorado

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