Government Contract | Alabama
Medical and Quality Review

Bid Information

Bid Alert No: 00000577208

Bid Title: Medical and Quality Review

Agency Bid No. Title: 2016-MQR-02

Received Date: 05/24/2016

Close Date: 06/22/2016

Purchase Type: 1 year term

Delivery Point:

Delivery Date: Not Stated


Specifications include, but are not limited to:The Scope of Work section is separated into three areas. Vendors must address the requirements in each area. 1.Institutional Record Reviews The primary goal of the Institutional record review process is to ensure the appropriate utilization of services for admissions to the Institutional programs by performing reviews of medical record documentation for admissions, re-admissions, and transfers to the facilities. Institutional providers include nursing facilities, PEC, swing bed, ICF/IIDs, inpatient psychiatric hospitals, including RTFs for recipients under age 21, inpatient psychiatric facilities for recipients over the age of 65 and potentially inpatient psychiatric facilities participating in the CMS MEPD for adults between the ages of 21-64. Inpatient psychiatric admissions are otherwise only covered in acute care hospitals for adults ages 21-64. Criteria for these facilities are documented in the following resources: Alabama Medicaid Administrative Codes Chapter 10, Long Term Care (LTC), for nursing facilities; Chapter 7, Hospitals, for PEC admissions and continued stays; Chapter 46, for Swing Beds; Chapter 5, for Psychiatric Facilities for Individuals 65 or Over; Chapter 41, for Psychiatric Facilities for Individuals Under Age 21; and Provider Manual Chapter 102, for ICF/IID. Policies and procedures for MEPD are documented in the MEPD Operational Manual. The Vendor will utilize the monthly report, LTC-0007-M, generatedb y M e d i c a i d s fiscal agent, Hewlett-Packard Enterprise (HPE) for the nursing facilities and ICF/IIDs reviews. A query is utilized for the inpatient psychiatric reviews. All MEPD admissions, re-admissions and continued stays shall be reviewed. A five percent random sample of admissions and re-admissions in inpatient psychiatric facilities, including RTFs shall be reviewed. For inpatient psychiatric requests, including the MEPD, the Vendor shall review cases for which the Medicaid eligibility is pending. For all other Institutional record reviews (nursing home, PEC and swing-bed), the recipient must be Medicaid eligible

Product Codes: 94872, 95327, 94876, 94874

Agency Information

Issuing Agency: Alabama Medicaid

State: Alabama

Agency Type: State and Local

Contact: Theresa Carlos 100 N. Union Street, Suite 192, Montgomery, Alabama, 36104




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