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MB-6023 - USA (California) - High Dollar Claim and Code Review Services - Deadline February 21,2022

Product (RFP/RFQ/RFI/Solicitation/Tender/Bid Etc.) ID: MB-6023

Government Authority located in California; USA based organization looking for expert vendor for high dollar claim and code review services.

[A] Budget: Looking for Proposal

[B] Scope of Service:

 Vendor needs to provide high dollar claim and code review services.
- Hospitals and or providers necessary documents to complete the review of claims. The claims reviewed based on high dollar, random sample, or other industry standard methodology.
- Payment is per stay
- Mother and newborn billed on separate claims.
- Interim bill types 112, 113, and discharge status 30 only accepted for stays exceeding 29 days.
- Validate split billing hospital stays for paper claims.
- Administrative days billed on a separate claim identified by revenue codes.
- Clinical document supports appropriate APR-DRG coding
- Perform the review and provide feedback and supporting documentation for the decisions.
- Suggest which claims to review based on billed charges, contract rates, or coding methodology.
- Proposal should clearly indicate how all services will be fulfilled by the Proposer, including timelines, and Gantt chart.
- Explain how software and or system works as well as what types and data will be required in claim data file.
- Provide details on turnaround times, which includes access of records.
- Provider details on claim dispute resolution statistics and handling.
- Ability to identify potential fraud waste abuse (FWA) billing issues or patterns.

[C] Eligibility:

- Onshore (USA Organization Only);

[D] Work Performance:

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

Expiry Date : Monday, 21 February, 2022

Category : Medical Billing and Coding

Country : USA

State : California

RFP Expired

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