RFI for Supplemental Medical Review Services

The government authority located in Baltimore, Maryland is seeking supplemental medical review services to support program integrity and safeguard taxpayer resources. The agency needs to detect, investigate, and respond to potential fraud in Medicare, Medicaid, and related programs through post-payment medical reviews and related activities. The selected provider will perform non-medical record reviews to make payment recommendations without medical records, conduct claim re-reviews to remedy past payment decisions, and perform evidence-based research of literature and policies to establish facts and recommendations. The scope of work also requires data analysis to inspect, cleanse, transform, and model data for decision-making support. Additionally, the agency requires the development of a public website to assist Medicare providers and suppliers, alongside a secure web-based public portal that allows providers to view the status of their reviews. To ensure quality customer service, the agency requires a toll-free customer service 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. The agency requires all work to be performed offsite. Bidders must submit their responses digitally via email or through an online portal, and the agency is currently looking for proposals to determine the budget.