Tender Details

Country: USA
Summary: Health Benefits Claims Review Services
UST Ref No: 118341666
Deadline: 30 May 2025
Financier: Self Financed
Purchaser Ownership: Government
Tender Value: Refer Document
Notice Type: Tender
Document Ref. No.: 005-RFP-1724-2025
Purchaser's Detail:
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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:

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Health Benefits Claims Review Services - USA Tender

The ADMINISTRATIVE SERVICES, DEPT, a Government sector organization in USA, has announced a new tender for Health Benefits Claims Review Services. This tender is published on USARFP under UST Ref No: 118341666 and is categorized as a Tender. Interested and eligible suppliers are invited to participate by reviewing the tender documents and submitting their bids before the deadline on 2025-05-30.

The estimated tender value is Refer Document, and full details, including technical specifications and submission requirements, are provided in the official tender documents. Ensure all submissions meet the criteria outlined to be considered for evaluation.