RFP 2024-13 Clarifying Questions #1 - final.pdf
PDF 136 KB Posted
- Attached to
- RFP 2024-13 IBR & DRG Billing Services
- Solicitation number
- S-X26083-00011233
- Issued by
- Multnomah County, Oregon
About this file
This document contains responses to clarifying questions submitted by interested firms regarding Request for Proposals (RFP) #2024-13 for IBR & DRG Billing Services issued by CareOregon, a managed Medicare and Medicaid plan in Oregon. The RFP is seeking services to perform Itemized Bill Reviews (IBR) and Diagnosis Related Grouping (DRG) claim reviews for high dollar inpatient hospital claims prior to payment to meet regulatory requirements and minimize claim overpayments. The expected DRG claim volume is about 500 per month, with 150-200 DRG claims and 50-70 IBR claims reviewed per month. CareOregon has approximately 500,000 total members covered under this program.
CareOregon will be issuing a separate RFP for post-pay claims data mining and recovery services. The contract term and pricing details were not provided in this document. There were no details on any set-asides, incumbents, funding sources, or other salient information.
View the file
Other files
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
Text version
315 SW Fifth Ave, Portland, OR 97204 | 800-224-4840 | TTY 711 | careoregon.org
REQUEST FOR PROPOSALS #2024-13
IBR & DRG BILLING SERVICES
RESPONSE TO CLARIFYING QUESTIONS #1
August 19, 2024
Note that these are questions submitted by interested firms to the above referenced solicitation.
The below answers are for clarification purposes only and in no way alter or amend the RFP as published.
1. Would the claim reviews be done before the claims are paid?
Answer: CareOregon shall provide Proposer an extract claim file containing paid claims on a monthly basis, unless parties agree to an alternate schedule.
2. How many claims do you estimate will be reviewed per month by the vendor?
Answer: Section 3.2.3. states, “Expected DRG claim volume is about 500 for the first year of the Contract.”
3. How many providers do you estimate would be referred for review each month?
Answer: It wouldn’t be number of providers, but number of claims. Between 150 to 200 claims for DRG per month. For IBR, 50 to 70 claims per month.
4. How many total members are covered in this program?
Answer: About 500k total members.
5. Is CareOregon planning a separate RFP for post pay claims data mining and recovery?
Answer: Yes, there will be a separate RFP for post pay claims data mining and recovery.
End of Clarifying Questions http://careoregon.org/
File details come from the government source that posted it. Updated .