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Government in New York issued “Medical Bill Review Services” (RFP (Request for Proposal)). Solicitation TPA-0729 closes on October 19, 2026. Eligibility: USA Organization. Submissions via Email.
Medical bill review/repricing and utilization review services for Workers’ Compensation claims
a. Audit all workers’ compensation bills including verification of Current Procedural Terminology billing codes to comply with actual treatment provided; reprice bills in accordance with State fee schedule and/or Preferred Provider Organization (“PPO”) contracts; request needed documents for incomplete bills; and identify treatment that is not appropriate under New York State Workers’ Compensation medical treatment guidelines and/or American Medical Association (“AMA”) guidelines.
b. Transfer all applicable reviewed/audited bills to the County contracted PPO on a daily basis. Bills will be returned and the Explanation of Benefits (“EOB”) adjusted.
c. Prepare an “explanation of payment” letter to be used for all bills that includes the amount claimed on the invoice, the amount of the claim that is deemed permissible and the valid reason, according to the Workers’ Compensation Board fee schedule and MTG, for the amount of the bill that is disputed.
d. Accept bills electronically and in paper format; and scan all paper medical bills and reports into digital format on a daily basis.
e. Provide a secure, encrypted, browser-based interface, which shall enable online review of medical bills, records and explanations of payment including ability to file objections (e.g., C8.1, C8.4) and process variances electronically in full compliance with New York State Workers’ Compensation law and regulations.
f. Develop and implement a continuing education program for workers’ compensation staff and remain abreast of all workers compensation legal developments and treatment/billing issues and trends.
g. Attend, when necessary or as directed by the Department, meetings and New York State Workers’ Compensation Board hearings.
h. Develop and assist the County with implementing guidelines for medical case management.
i. Conduct case review for pre-authorizations of diagnostic testing and surgical intervention.
j. Negotiate fees for non-fee schedule situations and out-of-state providers to maximize savings for the County.
k. Provide phone/e-mail availability for consultation five days per week during normal business hours.
l. Identify excessive/unnecessary treatment protocols by medical practitioners.
m. Identify abusive/fraudulent billing practices by medical providers.
Proposals for TPA-0729 are due by October 19, 2026.
Government, New York.
USA Organization.
Submissions are accepted via Email. Follow the instructions in the solicitation documents.
Contract term: 2 Years.
Questions and inquiries must be submitted by October 2, 2026.
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