SLED Opportunity · NORTH CAROLINA · NORTH CAROLINA
AI Summary
The North Carolina Department of Health and Human Services is seeking a qualified partner to administer its Fraud, Waste, and Abuse program. Responsibilities include claims reviews, data analytics, medical necessity reviews, investigations, and auditing activities. The RFP is open for bids starting May 8, 2025, with publication on February 26, 2025.
The North Carolina Department of Health and Human Services (“NCDHHS” or “Department”), Division of Health Benefits (“DHB” or “NC Medicaid”), through the Office of Compliance and Program Integrity (OCPI) seeks to procure an experienced and qualified partner to serve as the Fraud, Waste, and Abuse (FWA) Program Integrity Administrator. The selected Offeror shall be responsible for administering program integrity functions for (i) Prepayment Claims Reviews, (ii) Post Payment Claims Reviews, (iii) Data Analytics, (iv) Medical Necessity Reviews, (v) Investigations, (vi) Recovery Audit Contracts (RAC), and (vii) non-RAC Provider Auditing Activities.
SLED stands for State, Local, and Education. These are solicitations issued by state governments, counties, cities, school districts, utilities, and higher education institutions — as opposed to federal agencies.
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