MB-6658 - USA (Massachusetts) - Utilization Review Services - Deadline August 8,2022

Product (RFP/RFQ/RFI/Solicitation/Tender/Bid Etc.) ID: MB-6658

Government Authority located in Massachusetts; USA based organization looking for expert vendor for utilization review services.

[A] Budget: Looking for Proposals

[B] Scope of Service:

Vendor needs to provide utilization review services for the Commonwealth’s self-insured workers’ compensation program. HRD-WC administers the workers’ compensation benefit program for the Commonwealth’s workforce of approximately 85,000 employees.
- Communicate with HRD claims adjusters, medical providers, and employees as necessary to obtain relevant information to complete the determination.
- Comply with the billing practices set forth in this finalized in any contract agreement.
- Medical Bill Audit: - The vendor will help ensure that duplicate coding is not being submitted for reimbursement and that the self-insurer is not paying for unnecessary and/or unauthorized services.
a. Review large dollar physician and hospital medical bills submitted by providers for audit review.
b. Request missing documentation from providers as indicated.
c. Verifying all billing CPT codes comply with actual treatment provided.
d. Repricing of bills in accordance with State fee schedule and PPO contracts if applicable.
e. Identifying treatment that may not appropriate under the agency or other nationally recognized evidence- based treatment guidelines, as well as local treatment guidelines.
f. Assist with testimony and other professional services that may be required on all medical bill review audit issues on litigated cases including justification of payment as requested by agency.

[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, 8 August, 2022

Category : Medical Billing and Coding

Country : USA

State : Massachusetts

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