Medicaid Hospital Claims Audit Services
Maryland > Department of Health & Mental Hygiene
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Description
The Maryland Department of Health is soliciting a single contractor to perform recovery audits of Medicaid hospital claims for in-state general hospitals, out-of-state general hospitals, and in-state psychiatric hospitals. The scope includes data mining, algorithmic sampling, automated and complex claim reviews, identification of overpayments and underpayments, fraud referrals, prevention recommendations, provider notifications, reporting, and support for provider appeals and external audits. The contractor must audit hospitals at least once every two years, create and maintain a secure provider web portal and hospital audit claims database, securely exchange Medicaid claims and medical records, maintain audit documentation, provide qualified clinical and coding personnel, and support Maryland's Medicaid program throughout the audit and recovery process. Compensation will be based primarily on contingency percentages of amounts recovered or accepted as valid underpayments. The contract is structured as a three-year base term beginning August 1, 2027, with two one-year option periods, although completion of audits and appeal-related obligations may extend beyond the stated term.
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Join Google MeetRequirements
- Commercial General Liability — $1,000,000.00
- Errors and Omissions/Professional Liability — $1,000,000.00
- Crime Insurance/Employee Theft Insurance — $1,000,000.00
- Cyber Security / Data Breach Insurance — $5,000,000.00
- Worker's Compensation — $1,000,000.00
- Automobile or Commercial Truck Insurance
- Within the last 5 years
- Client point of contact required for each reference
Documents
| Title | Date Posted |
|---|---|
| rfp10052616 | Oct 05, 2026 02:16 PM |
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