Health Benefits Claims Review Services
| Location: | Iowa |
|---|---|
| Posted: | Apr 28, 2025 |
| Due: | May 30, 2025 |
| Agency: | State Government of Iowa |
| Type of Government: | State & Local |
| Category: |
|
| Solicitation No: | 005-RFP-1724-2025 |
| Publication URL: | To access bid details, please log in. |
Bid Information
Bid Number
005-RFP-1724-2025
Solicitation
Health Benefits Claims Review Services
Solicitation Type
Request for Proposals
County
Description
Description
Objectives
The 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.
Agency Information
Number
005
Name
Administrative Services, Dept
Address 1
1305 E Walnut ST
Address 2
City/State/Zip
Des Moines, IA 50319
Contact Information
Contact Name
Craig Trotter
Contact Title
Purchasing Agent
Contact Email
Contact Phone Number
(515) 322-8593
Contact Phone Extension
Contact Other Number
Contact Fax Number
Valid Dates
From
4/28/2025 8:00:00 AM
Until
5/30/2025 12:00:00 PM
Documents/Attachments
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