South Carolina Sfaa Sfaa #5400029282

South Carolina Solicits Medical Bill Review Services for State Accident Fund

• The State of South Carolina, through its State Accident Fund (SAF) and Division of Procurement Services, is seeking proposals for Medical Bill Review Services related to workers' compensation claims.
• Key requirements include:
  • Processing and reviewing approximately 120-150 medical bills daily, ensuring compliance with the South Carolina Workers Compensation Fee Schedule and network discounts.
  • Clinical review by qualified medical professionals (RNs or MDs) for complex or high-cost bills.
  • Provision of compatible scanner hardware for SAF staff and conducting multiple training sessions during implementation, with at least two annual trainings thereafter.
  • Secure electronic data interchange (EDI) for bills and invoices, maintenance of an online portal for SAF review, and regular provider communication and dispute resolution.
  • Generation of monthly and quarterly reports in Excel format, and adherence to confidentiality and HIPAA requirements.
  • Average bill review turnaround time must not exceed seven calendar days.
• Pricing proposals may be based on a percentage of savings or per bill processed.
• No specific OEMs or vendors are named in the solicitation; the opportunity is open to qualified service providers with relevant experience.

Description

This solicitation is for Medical Bill Review Services to be provided to the State Accident Fund. The scope includes processing and reviewing medical bills, ensuring compliance with applicable guidelines, and providing clinical review when necessary. The contract involves handling electronic data interchange (EDI) file layouts for bills and invoices, and requires interaction with State Accident Fund adjusters. The solicitation includes detailed instructions for submission, amendments, and award posting.

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