SLED Opportunity · IOWA · IOWA
AI Summary
The State of Iowa is seeking proposals for Health Benefits Claims Review Services to analyze Medicaid medical expenditures for populations not currently covered. The project involves repricing medical bills, applying Medicaid claims edits, and utilizing a managed care model. Interested bidders must submit proposals by May 30, 2025. Contact Craig Trotter for more information.
Objectives The State of Iowa is seeking a proposal from qualified Respondents to provide a fiscal impact analysis/reimbursement model of medical expenditures normally reimbursed by Medicaid for populations for which the State assumes financial liability not currently covered under Medicaid. Our objectives are: ? Reprice medical bills on the Medicaid Fee-For-Service (FFS) fee schedule ? Apply Medicaid claims edits as applicable base on what presents on the medical bill ? Utilizing a managed care model that provides needed services ? Fiscal impact is determined as followed ? Based on SFY 2024 pdf paid claims* (587 credit card transactions and 66 check transactions each of which could include claims for multiple patients and/or dates of service) * Bills in question are ordinarily not provided on a standard claim form but rather as employer and/or patient statement and at times refer to prior statements only. ? Successful Respondent provides staff to retried PDF medical bills from the State’s Iowa Advantage accounting system and from the PDF invoice manually creates a data set of essential coding for repricing * Some invoices may be missing or do not contain adequate information for repricing. Respondent will work with agency to obtain detailed invoice or summary report from medical provider.
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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