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MB-6537 - USA (South Dakota) - Employee Health Plan Medical Claims Audit Service - Deadline July 18,2022

Product (RFP/RFQ/RFI/Solicitation/Tender/Bid Etc.) ID: MB-6537

Government Authority located in South Dakota; USA based organization looking for expert vendor for employee health plan medical claims audit service.

[A] Budget: Looking for Proposals

[B] Scope of Service:

(1) Vendor needs to provide employee health plan medical claims audit service.
- Conduct a performance review audit of the medical claims process.
- Electronic screening of 100.00% of paid medical claims for each audit period.
- Review of a combined financial stratified and attribute statistical sample of 200 total claims processed during fiscal year time period of July 1, 2021 to June 30, 2022 (FY 2022).
- Review of a combined financial stratified and attribute statistical sample of 200 total claims processed during the fiscal year time period of July 1, 2022 to June 30, 2023 (FY 2023).
- Review of a combined financial stratified and attribute statistical sample of 200 total claims processed during the fiscal year time period of July 1, 2023 to June 30, 2024 (FY 2024).
- Judgment claims reviews diagnosis-related group (DRG) hospital claims review of a randomly selected judgment sample of fifty (50) inpatient DRG hospital claims for each audit period will be performed to verify the accuracy of DRG claim processing.
(2) All questions must be submitted no later than June 30, 2022.
(3) Contract term will be three years.

[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 : Monday, 18 July, 2022

Question Answer Deadline : Thursday, 30 June, 2022

Category : Medical Billing and Coding

Country : USA

State : South Dakota

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