SW-30424 - USA (Massachusetts) - Medicaid Reimbursement Processing Systems - Deadline February 7,2020

Product (RFP/RFQ/RFI/Solicitation/Tender/Bid Etc.) ID: SW-30424

Government Authority located in Massachusetts; USA based organization looking for expert vendor for Medicaid reimbursement processing systems.

[A] Budget: Looking for proposal

[B] Scope of Service:

(1) Vendor needs to provide design, implementation and administration of Medicaid revenue maximization system for students in city public schools. The primary goal of the city to maximize recovery of funds from MassHealth, Medicaid, and private third-party payers for health-related services provided to Worcester school children. These include but are not limited to:
● Identifying and enrolling MassHealth eligible students not receiving services
● Maximizing administrative case reimbursement, including transportation, capital, and indirect costs
● Reviewing or negotiating state's division of medical assistance calculation of rates
● Reviewing status of retroactive claims beyond 90 day and two-year limit
● Maximizing reimbursement for MassHealth eligible students for eligible services under any enrollment initiative by the Commonwealth or the Public Schools
● Provide for automated collection, maintenance, processing, management, and reporting of all data necessary to produce and file claims with the state's division of medical assistance.
● Must accommodate changing requirements resulting from legislative or regulatory changes, or changes in the city's strategy for seeking reimbursement.
● Must track additions, deletions, and eligibility changes in the Medicaid-eligible student population as they occur in order to ensure the accuracy and completeness of individual claims, and to maximize reimbursement recognition within service delivery programs, claim processing, and billing.
● Must make all information, it maintains under the terms of this agreement, available to the public schools.
● Must agree to return all information it maintains under the terms of this agreement, within 30 days of notification of termination of agreement.
● Must identify MassHealth enrolled or eligible students. This population includes all students who are registered for services with public schools.
● Must work with public schools to do the Medicaid quarterly eligibility matching, including the file creation, upload, matching, download and Medicaid percent calculations
(2) A vendor conference will be held on January 31, 2020.
(3) Contract period will be for three years.
- For more information download this RFP Document.

[C] Eligibility:

- Onshore (USA Only);

[D] Work Performance:

Performance of the work will be Offsite. Vendor needs to carry work in their office location.

Expiry Date : Friday, 7 February, 2020

Pre-proposal Conference Date : Friday, 31 January, 2020

Category : Software, System and Application, Medical Billing and Coding

Country : USA

State : Massachusetts

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