Medical Claims Services

The agency is seeking a vendor to provide independent medical claims services. The project requires the selected vendor to conduct independent reviews of denied medical claims by taking into consideration all information provided. These reviews must address both medical necessity and diagnosis-related group reassignment. The selected vendor must complete each review and issue a final determination within sixty days after the upstate agency submits the claim for review. All performance of the work must take place onsite. Eligible bidders must be located onshore within the United States. Bidders must submit their responses digitally via email or through the online portal. The agency is looking for proposals to determine the budget for these services. No specific evaluation criteria or key dates are provided in the solicitation.