30-2025-004-DHB Statewide Surveillance for Fraud, Waste and Abuse RFP
| Location: | North Carolina |
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| Posted: | Feb 26, 2025 |
| Due: | May 8, 2025 |
| Agency: | State Government of North Carolina |
| Type of Government: | State & Local |
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| Solicitation No: | Doc1480247003 |
| Publication URL: | To access bid details, please log in. |
| Solicitation Number: | Doc1480247003 |
| Project Title: | 30-2025-004-DHB Statewide Surveillance for Fraud, Waste and Abuse RFP |
| Description: | The North Carolina Department of Health and Human Services (“NCDHHS” or “Department”), Division of Health Benefits (“DHB” or “NC Medicaid”), through the Office of Compliance and Program Integrity (OCPI) seeks to procure an experienced and qualified partner to serve as the Fraud, Waste, and Abuse (FWA) Program Integrity Administrator. The selected Offeror shall be responsible for administering program integrity functions for (i) Prepayment Claims Reviews, (ii) Post Payment Claims Reviews, (iii) Data Analytics, (iv) Medical Necessity Reviews, (v) Investigations, (vi) Recovery Audit Contracts (RAC), and (vii) non-RAC Provider Auditing Activities. |
| Opening Date: | 5/8/2025 2:00 PM |
| Posted Date: | 2/27/2025 |
| Status: | Open |
| Department: | DEPARTMENT OF HEALTH AND HUMAN SERVICES - DHHS |
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Solicitation Number
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Doc1480247003
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Department
DEPARTMENT OF HEALTH AND HUMAN SERVICES - DHHS
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Status Reason
Open
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Opening Date
2025-05-08T14:00:00.0000000
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Posted Date
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2025-02-26T18:24:01.0000000Z
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Commodity Code
Comprehensive health services
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Mandatory Conference/Site Visit
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Special Instructions
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Description
The North Carolina Department of Health and Human Services (“NCDHHS” or “Department”), Division of Health Benefits (“DHB” or “NC Medicaid”), through the Office of Compliance and Program Integrity (OCPI) seeks to procure an experienced and qualified partner to serve as the Fraud, Waste, and Abuse (FWA) Program Integrity Administrator. The selected Offeror shall be responsible for administering program integrity functions for (i) Prepayment Claims Reviews, (ii) Post Payment Claims Reviews, (iii) Data Analytics, (iv) Medical Necessity Reviews, (v) Investigations, (vi) Recovery Audit Contracts (RAC), and (vii) non-RAC Provider Auditing Activities.
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