Government Contract | Alabama
Medical and Quality Review

Bid Information

Bid Alert No: 00000562000

Bid Title: Medical and Quality Review

Agency Bid No. Title: 2016-MQR-01

Received Date: 05/03/2016

Close Date: 06/21/2016

Purchase Type: Term:

Delivery Point: Various Locations, Alabama

Delivery Date: Not Stated

Special Notices: Questions Due By Optional 05/10/2016


Specifications include, but are not limited to: The Scope of Work section is separated into four areas. Vendors must address the requirements in each area. 1.IP Hospital Quality Assurance Program 42 CFR 456.121-456.137 requires hospitals to perform admission and continued stay reviews on all inpatient hospital admissions. The Agency solicits bids for the services of a qualified Quality Improvement Organization (QIO) who shall be responsible for meeting the requirement of 42 CFR 456 et.seq, Utilization Control requirements for inpatient hospital services. The Vendor shall conduct retrospective reviews on a random sample of paid hospital inpatient claims on all inpatient admissions April-September 2016 and then only on non-RCO recipients October 1, 2016 forward to ensure that criteria were correctly applied, to assess the necessity, appropriateness and quality of services that were rendered. For dates of service October 1, 2016 forward, the review will also include validation of hospital diagnosis and procedure coding information for services reimbursed by APR-DRG to ensure that critical elements necessary to assign an APR-DRG are present in the medical record and procedures are sequenced correctly. The Vendor shall request, review and document medical record findings of hospital providers. The Vendors professional staff shall review the documentation to ensure compliance with state and federal requirements governing the Hospital Program and to ensure that services meet Agency Adult and Pediatric Inpatient Care Criteria.

Bid Related Documents

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Bid Related Attachments

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Product Codes: 91878, 94807, 95327, 94874

Agency Information

Issuing Agency: Alabama Medicaid

State: Alabama

Agency Type: State and Local

Contact: Theresa Carlos 501 Dexter Avenue, Montgomery, Alabama, 36103




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