Product (RFP/RFQ/RFI/Solicitation/Tender/Bid Etc.) ID: MB-6668

Government Authority located in New York; USA based organization looking for expert vendor for special investigations unit services.

[A] Budget: Looking for Proposals

[B] Scope of Service:

Vendor needs to provide post payment claim review including identifying, investigating, and recovering overpayments; and recognizing and flagging billing abnormalities indicative of fraud, waste or abuse.
• Evaluate and audit claims on a line-by-line basis as they were adjudicated or as they should have been adjudicated after medical record review;
• Communicate detailed audit findings to identified aberrant providers and their representatives via print, electronic, telephonic and virtual means;
• Present options for recovery of overpayments;
• Initiate overpayment recovery actions on a case specific basis, as directed and in collaboration with agency;
• Provide, manage and update a secure case file management system with capability to store case notes and documents. Any such system must contain a customer interface with full access by designated agency personnel;
• Ensure regular meetings take place with agency in online or virtual format to discuss casework;
• Possess a robust cadre of trained coding and auditing personnel who are experienced in performing medical and clinical audits;
• Describe staffing model including the provision of dedicated investigative staff
• Ensure the appropriate expertise and necessary training of assigned investigative staff. Such staff should have access to third party investigative databases, such as LexisNexis, Accurint, etc.

[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 : Thursday, 25 August, 2022

Category : Medical Billing and Coding

Country : USA

State : New York

Cost to Download This RFP Document : $ 5

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