100% Secure Payments
Tender Details
- Country: USA
- Summary: Health Benefits Claims Review Services
- KWT Ref No: 118341666
- Deadline: 30 May 2025
- Competition: ICB
- Financier: Self Financed
- Purchaser Ownership: Public
- Tender Value: Refer Document
- Notice Type: Tender
- Document Ref. No.: 005-RFP-1724-2025
- Purchaser's Detail :
- Description :
- Description ObjectivesThe State of Iowa is seeking a proposal from qualified Respondents to provide a fiscal impact analysis/reimbursement model of medical expenditures normally reimbursed by Medicaid for populations for which the State assumes financial liability not currently covered under Medicaid. Our objectives are:?Reprice medical bills on the Medicaid Fee-For-Service (FFS) fee schedule?Apply Medicaid claims edits as applicable base on what presents on the medical bill?Utilizing a managed care model that provides needed services?Fiscal impact is determined as followed ?Based on SFY 2024 pdf paid claims* (587 credit card transactions and 66 check transactions each of which could include claims for multiple patients and/or dates of service)* Bills in question are ordinarily not provided on a standard claim form but rather as employer and/or patient statement and at times refer to prior statements only.?Successful Respondent provides staff to retried PDF medical bills from the State-s Iowa Advantage accounting system and from the PDF invoice manually creates a data set of essential coding for repricing* Some invoices may be missing or do not contain adequate information for repricing. Respondent will work with agency to obtain detailed invoice or summary report from medical provider.
- Documents :
Purchaser : ADMINISTRATIVE SERVICES, DEPT
Address1 : 1305 E Walnut ST
City/State/Zip : Des Moines, IA 50319
Contact Name : Craig Trotter
Contact Title : Purchasing Agent
Contact Phone Number : (515) 322-8593
Email :craig.trotter@iowa.gov
If you are registered member, kindly login to view full details of this tender notice:
CLICK HERE TO LOGIN
