RFI for Supplemental Medical Review Services

The government authority located in Baltimore, Maryland is seeking supplemental medical review services to support its program integrity and fraud detection efforts. The agency needs to protect the integrity of trust funds and safeguard taxpayer resources by detecting, investigating, and responding to potential fraud in Medicare, Medicaid, and related programs. To solve this problem, the agency requires a contractor to perform post-payment medical reviews and related activities offsite. The scope of work covers performing non-medical record reviews to make payment recommendations without reviewing medical records, as well as conducting claim re-reviews to adjust recommendations that resulted in overpayments or underpayments. The contractor must also conduct evidence-based research of literature, regulations, and billing guidelines to establish facts and develop recommendations. Additionally, the contractor must perform data analysis to inspect, cleanse, transform, and model data to support decision-making. To support providers and suppliers, the contractor must develop and maintain a public website and a secure web-based public portal that allows users to view up-to-date review statuses. The contractor must also provide customer service support, including a toll-free telephone number staffed from 8:30 a.m. to 6:00 p.m. Eastern Standard Time during normal business hours. Eligibility is restricted to onshore organizations based in the United States, and all work must be performed offsite. The agency is looking for proposals to establish the budget for this project. Bidders must submit their responses digitally via email or through an online portal.