Government Contract | New Mexico
Workers Compensation Claims Administration Medical Bill Review Services

Bid Information

Bid Alert No: 00000507375

Bid Title: Workers Compensation Claims Administration Medical Bill Review Services

Agency Bid No. Title: 16-031MG-AM

Received Date: 03/11/2016

Close Date: 04/12/2016

Purchase Type: Not Stated

Delivery Point:

Delivery Date: Not Stated

Special Notices: Questions Due By 03/21/2016 05:00 PM


Specifications include, but are not limited to:Albuquerque Public Schools (APS) is seeking a professional risk management claims administration and related services firm, in accordance with the specifications in the Request for Proposal (RFP). The services requested areWorkersCompensation Medical Bill Review Services. Medical Bill Review Services Requirements: 1. Contractor shall act as a representative of APS in reviewing Workers Compensation claims for which APS is financially responsible for possible billing and accounting errors and overcharges. Further, the Contractor must meet all the requirements of state and federal laws applicable to proper medical bill review practices. Minimum services to be performed are outlined hereafter. Any additional service must be outlined in the Proposal. APS seeks to define the obligations of both parties and to ensure timely and efficient medical bill review for all claims. 2. Contractor shall review the Workers Compensation claims, for which APS is financially responsible, for possible errors and overcharges in full compliance with all applicable federal and state statutes, rules, and regulations. The work shall involve comparing detailed invoices with medical records to identify erroneous charges and reviewing detailed invoices for duplicate charges and charges that do not match indicated reasons for treatment. Contractor shall review the CPT, HCPCS, and ICD-9 codes used in the invoices to ensure they a r e a p p r o p r i a t e , b a s e d o n t h e c l a i m a n t s c o n d i t i o n a n d t r e a t m e n t . 3. Contractor shall adjust charges made by health care providers in excess of the maximum allowable under t h e N e w M e x i c o W o r k e r s Compensation Administration (NMWCA) regulations to reflect the Maximum Allowable pay. Contractor shall adjust the Preferred Provider discounts for those charges made by health care providers who are entered into their Preferred Provider network. 4. Contractor shall provide APS with an explanation of benefits report reflecting the suggested payment for each bill after it is reviewed and adjusted. Contractor shall safeguard access to all information obtained by, created by, or utilized by Contractor for medical bill review. 5. Various ad hoc reports are required on an as-needed basis; the costs to produce any such report(s) is part of the Contractors basic services and may not be separately charged to APS. APS reserves the right to assign medical bill review to an independent adjusting firm when, for example, a potential conflict of interest may exist

Product Codes: 95861, 95327, 94620

Agency Information

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Issuing Agency: Albuquerque Public Schools/IPT

State: New Mexico

Agency Type: State and Local

Contact: Procurement Division, 6400 Uptown Blvd. NE, Ste. 500 East, Albuquerque, New Mexico, 87110



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