New York State Contract Reporter #2140006

New York OMIG seeks statewide Medicare maximization services for home health claims

New York OMIG is seeking one contractor to operate its statewide Home Health Care Medicare Maximization program and pursue Medicare coverage and recoveries for eligible home health claims. - Government buyer: New York State Office of the Medicaid Inspector General (OMIG), Division of Medicaid Audit, Bureau of Provider Audit. - Opportunity: RFP OMIG 26-23 for Home Health Care Medicare Maximization Services (HHC MMX). - Requested services: - Analyze claims data, identify cases, and pursue Medicare appeals through available administrative levels for Medicaid-paid home health claims. - Coordinate with providers and Medicare contractors; support audits, recovery, reconciliation, demand-billing compliance, and return of Medicare overpayments. - Maintain case tracking and reporting systems, provide technology support, and educate providers. - Support coverage determinations for skilled nursing, home health aide, physical therapy, occupational therapy, speech-language pathology, and medical social services. - Estimated workload: Approximately 1,700 fee-for-service recipient cases selected annually and capacity for claim volumes exceeding 100,000 per year; the program may expand to Medicaid Managed Care. - Notable requirements: Work under OMIG direction, support provider compliance and coordination, and adapt operations as program requirements change. Services are statewide. - OEMs, vendors, products, and quantities: No OEMs or vendors are named, and no physical products or product quantities are requested. The procurement is for services. - Contract term: Anticipated to begin in 2027 or upon Office of the State Comptroller approval, whichever is later; three-year initial term with two optional one-year extensions.

Description

The New York State Office of the Medicaid Inspector General seeks a qualified contractor to perform Home Health Care Medicare Maximization Services (HHC MMX). The work supports pursuing Medicare coverage for home health services provided to dual-eligible recipients, including data analysis and case selection, Medicare appeals processing, provider coordination, audits and recoveries, reporting, and provider education. The contractor will operate under the direction of OMIG’s Bureau of Provider Audit and must adapt processes as federal and state healthcare regulations and program requirements change. The contract term is three years, with two optional one-year extensions.

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