Posted Date : February 22,2021
Product (RFP/RFQ/RFI/Solicitation/Tender/Bid Etc.) ID : MB-4953
Government Authority located in South Dakota; USA based organization looking for expert vendor for high cost claim reviews services.
[A] Budget: Looking for Proposal
[B] Scope of Service:
Vendor needs to provide cost management services related to high-cost claims for the purpose of managing costs without sacrificing quality of care.
- Requirements: Identify or help medicaid to identify claims for pre-payment and/or post-payment reviews, perform pre-payment and/or post-payment reviews based on claim data, medical records or other relevant documentation. reviews should be comprehensive and should ensure correct billing and charges, appropriate level of care, that services provided are reimbursable and consistent with medicaid reimbursement policy as well as industry standards and other applicable standards, offer utilization and case management services effective in containing costs related to high-cost claims, such as reducing inappropriate emergency department visits and avoidable readmissions and ensuring appropriate level of care and length of stay, provide expertise and consultation in the design of reimbursement methodologies and policies, internal processes, and provider contracts, offer advice and assistance in the negotiation of large claim payments, provide other expertise and consultation effective in containing costs in the above-referenced areas.
[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.
Budget :
Deadline to Submit Proposals: March 24,2021
Cost to Download This RFP/RFQ/RFI/Solicitation/Tender/Bid Document : 5 US$
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Product (RFP/RFQ/RFI/Solicitation/Tender/Bid Etc.) ID : MB-4953
Government Authority located in South Dakota; USA based organization looking for expert vendor for high cost claim reviews services.
[A] Budget: Looking for Proposal
[B] Scope of Service:
Vendor needs to provide cost management services related to high-cost claims for the purpose of managing costs without sacrificing quality of care.
- Requirements: Identify or help medicaid to identify claims for pre-payment and/or post-payment reviews, perform pre-payment and/or post-payment reviews based on claim data, medical records or other relevant documentation. reviews should be comprehensive and should ensure correct billing and charges, appropriate level of care, that services provided are reimbursable and consistent with medicaid reimbursement policy as well as industry standards and other applicable standards, offer utilization and case management services effective in containing costs related to high-cost claims, such as reducing inappropriate emergency department visits and avoidable readmissions and ensuring appropriate level of care and length of stay, provide expertise and consultation in the design of reimbursement methodologies and policies, internal processes, and provider contracts, offer advice and assistance in the negotiation of large claim payments, provide other expertise and consultation effective in containing costs in the above-referenced areas.
[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.
Budget :
Deadline to Submit Proposals: March 24,2021
Cost to Download This RFP/RFQ/RFI/Solicitation/Tender/Bid Document : 5 US$