Utilization Review Services

The vendor is required to provide utilization of medical services in the Medicaid population, monthly reports related to retrospective review activity and interim bill review determinations are required from the contractor.
- The contractor must describe a technical approach for accomplishing the work defined in this RFP. potential contractors are encouraged to propose innovative solutions to meet or exceed the requirements
- The contractor’s plan must include the use of state-based physicians, possessing a current state license to practice, and are familiar with standards of practice.
- All reviews must be conducted in accordance with, and subject to, applicable federal and state statutes and regulations, any state medical assistance program (KMAP) policies which are contained in KMAP provider bulletins, KMAP provider manuals, and any other laws and regulations which are issued or promulgated during the term of the contract.
- Claims that are identified for review will be locked in the state Medicaid management information system (MMIS) by the contractor in a timely manner.
- Timely manner is defined as one business day.
- This is necessary to prevent these claims from being included in any other audit or adjusted by the provider.
- The contractor will attend all training that is required in order to perform this task.
- Questions/Inquires Deadline: April 29, 2025