Inland Empire Health Plan Bonfire #RFI-26-07123

RFI for Payment Integrity Solutions – Pre-Pay & Post-Pay Capabilities for IEHP

This opportunity seeks vendor input on Payment Integrity solutions for the Inland Empire Health Plan (IEHP) Finance – Provider Resolution & Recovery Department. - Government Buyer: - Inland Empire Health Plan (IEHP), Finance – Provider Resolution & Recovery Department - OEMs and Vendors: - No specific OEMs or vendors are named in the solicitation - Products/Services Requested: - Payment Integrity solutions covering both Pre-Pay and Post-Pay capabilities - Reduce improper payments before adjudication - Recover overpayments retrospectively - Detect and prevent fraud - Improve payment accuracy for Medi-Cal, Medicare Advantage (D-SNP), and Covered California claims - Vendors may respond to one or more solution areas - Unique or Notable Requirements: - Submission of a Certification of Non-Debarment - Completion of a questionnaire using the provided response template - Focus on both pre-payment and post-payment integrity, including fraud detection and claims accuracy improvement

Description

IEHP's Finance – Provider Resolution & Recovery Department is seeking information from qualified vendors regarding Payment Integrity capabilities in both Pre-Pay and Post-Pay domains. The goal is to find solutions that reduce improper payments before adjudication, recover overpayments retrospectively, detect fraud, and improve payment accuracy across Medi-Cal, Medicare Advantage (D-SNP), and Covered California claims operations. Vendors may provide capabilities in one or more of these areas as part of this Request for Information (RFI).

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