Posted Date : May 07,2019
Product (RFP/RFQ/RFI/Solicitation/Tender/Bid Etc.) ID : MB-3092
Government Authority located in Kansas; USA based organization looking for expert vendor for denied Medicaid claims third party review service.
[A] Budget: Looking for Proposals
[B] Scope of Service:
(1) Vendor needs to provide denied Medicaid claims third party review service.
- Maintain a signed statement for each external independent third-party review stating the reviewer has no conflict of interest regarding the review.
- Transmit and receive all data via encryption or secure file transport protocol (FTP) site.
- Use a specially-matched clinician to review the submitted information.
- Complete each review within thirty (30) calendar days of the receipt of the managed care organization appeal material and produce a summary and final decision, the managed care organization, the recipient, and the provider.
- Have a formal process for the identification of appropriate clinicians to respond to specific medical issues and timeframes associated with the review and submissions of medical determinations or opinions.
- Submit a summary of each case with an analysis of the information and rationale for the determination. Each summary shall identify the discipline of the individuals reviewing the case.
- Bill the external independent third-party reviews at the rates specified in the vendor’s cost proposal per case to include specialty matched clinician review, indirect costs, administrative fees and incidental expenses related to the reviews.
- Place a stay on any payment order directed to the losing party of the review pending an appeal of the review to the office of administrative hearings. In the event the independent review decision is reversed by the administrative hearing decision, the losing party will then be responsible for paying the cost of the review. If the losing party of the review has already paid the vendor for the review, the vendor will be responsible for refunding the review charge and recovering the cost of the review from the losing party of the hearing decision.
- Complete and submit by the 15th of each month, a monthly report regarding reviews conducted during the previous month.
- Complete and submit by March 31 of each year, an annual report regarding reviews conducted during the previous calendar year.
(2) All questions must be submitted no later than May 14, 2019.
(3) Contract term will be four years.
[C] Eligibility:
- Onshore (USA 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: June 06,2019
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-3092
Government Authority located in Kansas; USA based organization looking for expert vendor for denied Medicaid claims third party review service.
[A] Budget: Looking for Proposals
[B] Scope of Service:
(1) Vendor needs to provide denied Medicaid claims third party review service.
- Maintain a signed statement for each external independent third-party review stating the reviewer has no conflict of interest regarding the review.
- Transmit and receive all data via encryption or secure file transport protocol (FTP) site.
- Use a specially-matched clinician to review the submitted information.
- Complete each review within thirty (30) calendar days of the receipt of the managed care organization appeal material and produce a summary and final decision, the managed care organization, the recipient, and the provider.
- Have a formal process for the identification of appropriate clinicians to respond to specific medical issues and timeframes associated with the review and submissions of medical determinations or opinions.
- Submit a summary of each case with an analysis of the information and rationale for the determination. Each summary shall identify the discipline of the individuals reviewing the case.
- Bill the external independent third-party reviews at the rates specified in the vendor’s cost proposal per case to include specialty matched clinician review, indirect costs, administrative fees and incidental expenses related to the reviews.
- Place a stay on any payment order directed to the losing party of the review pending an appeal of the review to the office of administrative hearings. In the event the independent review decision is reversed by the administrative hearing decision, the losing party will then be responsible for paying the cost of the review. If the losing party of the review has already paid the vendor for the review, the vendor will be responsible for refunding the review charge and recovering the cost of the review from the losing party of the hearing decision.
- Complete and submit by the 15th of each month, a monthly report regarding reviews conducted during the previous month.
- Complete and submit by March 31 of each year, an annual report regarding reviews conducted during the previous calendar year.
(2) All questions must be submitted no later than May 14, 2019.
(3) Contract term will be four years.
[C] Eligibility:
- Onshore (USA 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: June 06,2019
Cost to Download This RFP/RFQ/RFI/Solicitation/Tender/Bid Document : 5 US$