This bid is for Medicaid hospital claims auditing for Maryland, with coordination in Baltimore, Maryland 21201 at 201 W. Preston Street. Work will primarily be performed from your location.
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What the job is
Scope: Identify overpayments and underpayments through data mining, automated reviews, and medical record reviews for in-state general, out-of-state general, and in-state psychiatric hospitals.
Annual minimum: 22 hospital audits: 15 in-state general, 6 out-of-state general, and 1 in-state psychiatric.
Technology: Provide a HIPAA-compliant records upload portal, audit tracking database, secure claims data exchange, and records retention for five years after completion.
Staffing and support: Dedicated project and quality managers, qualified clinical reviewers, certified coders, findings reports, payment prevention recommendations, and appeal support, including testimony.
Term and pricing: Three years starting August 1, 2027, plus two optional one-year extensions; all-inclusive 10% contingency fee on recovered overpayments and paid underpayments.
XL Eagle