Coding Review Services

The Vendor is required to provide perform charge master coding audit review for CDM (charge description master) containing approximately 23,000-line items
- Using Medicare and state Medicaid billing guidance, provide recommendations for any changes required to assure accurate reporting on claims.
- Interview CDM staff to identify current processes and procedures related to processing. 
- Identify weaknesses in controls and make recommendations to strengthen structure around charge master maintenance and processing.
- Review current CDM pricing for all procedures and services to provide comparison to industry best practices and market benchmarks.
- Provide pricing strategy recommendations to help ensure pricing is competitive, compliant, and aligned with cost and reimbursement trends.
- Provide services pursuant to standards and regulations for both technical and professional service components, as well as special rules for commission federal and state filing.
- Must have experience in coding audit reviews of inpatient and outpatient services including: kidney acquisition, trauma, burn, nursing, radiology, laboratory, cardiology, surgical services, family planning, obstetrics, supplies, pharmacy, provider-based clinic visits.

- Contract Period/Term: 1 year
- Questions/Inquires Deadline: September 30, 2025