The vendor is required 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.
- Pull all medical bills from state advantage, the state’s accounting system.
- Reach out to the agency when invoices cannot be found or invoice detail does not include enough claims information to reprice the claim.
- Reprice all medical bills under the medicaid fee-for-service (FFS) fee schedule.
- Adjust pricing for services not meeting standard claims edits such as but not limited to unbundling, cci edits, mutually exclusive procedures, provider specialty.
- Reprice based on managed care oversight interventions.
- Identify fraud, waste, and abuse.
- Provide to the state the line item fiscal impact analysis/claims repricing model for review and feedback.
- Provide to the state the line item fiscal impact analysis/claims repricing model for review and feedback.
- Contract Period/Term: 1 year
- Questions/Inquires Deadline: May 9, 2025