California eProcure #SD25-00049

California Correctional Health Care Services seeks Pre-Payment Claim Review and Post Payment Audit and Recovery Services

This opportunity is for contractors to provide Pre-Payment Claim Review (PPCR) and Post Payment Audit and Recovery (PPAR) services for the California Department of Corrections and Rehabilitation (CDCR) and its California Correctional Health Care Services (CCHCS) division. - Government Buyer: - California Department of Corrections and Rehabilitation (CDCR) - California Correctional Health Care Services (CCHCS) - Acquisitions Management Section and Health Care Contracts and Claims Management Branch - Services Requested: - Pre-Payment Claim Review (PPCR): - Review healthcare claims prior to payment for accuracy, compliance, and fraud detection - Includes clinical and billing reviews, provider education, reporting, and coordination - Estimated claim volumes: 300, 500, and 200 claims for various periods - Post Payment Audit and Recovery (PPAR): - Audit paid claims to identify and recover overpayments, errors, or fraud - Includes provider notification, appeals processing, refund handling, and detailed reporting - Estimated recovery amounts: $7,000,000 and $10,000,000 for various periods - Contractor paid a percentage of recovered funds (not to exceed 20%) - Unique Requirements: - Bidders may submit proposals for either or both services; contracts may be awarded separately or together - Services must be performed at the contractor's U.S. business location during standard business hours - Coordination between PPCR and PPAR to avoid duplicative reviews - Minimum qualifications: experience in medical audits, fraud detection, secure web portal capabilities - HIPAA compliance, secure data handling, and qualified medical personnel required - Provider education and detailed reporting are integral to both services - No specific OEMs or technology vendors are named; this is a service-based solicitation - Contract term is three years with options for up to five additional one-year extensions - Estimated contract value ranges from several million to tens of millions of dollars, based on claim volumes and recovery amounts

Description

The California Department of Corrections and Rehabilitation (CDCR) and California Correctional Health Care Services (CCHCS) are soliciting bids for Pre-Payment Claim Review (PPCR) and Post Payment Audit and Recovery Services (PPAR). The contractor will provide all labor, materials, transportation, equipment, and other necessary expenses to perform these services. PPCR and PPAR services will operate independently but in coordination to avoid duplicative reviews. Bidders may submit bids for both services or independently for one service.

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