January 12, 2011
The purpose of this RFP is to solicit proposals from qualified proposers to perform the following activities as primary for the fee-for-service Medicaid recipient population and as secondary for Medicaid recipients enrolled in Coordinated Care Network (CCN)s after time has expired for the CCNs to bill and collect from responsible third parties: 1) develop and implement a cost avoidance process in conjunction with maintenance of the Medicaid resource file; 2) develop and implement a collection process for seeking reimbursement from liable third party health insurers for medical services provided under Title XIX and Title XXI; 3) perform annual hospital and long- term care provider reviews; 4) augment the fiscal intermediary (FI)’s Medicare Parts A, B, and D recovery efforts; 5) administer the Louisiana Health Insurance Premium Payment program (LaHIPP), and 6) submit optional innovative concepts such as asset verification services, special needs trust services, CMS RAC (Recovery Audit Contractor) activities, Express Lane eligibility assistance (data matches with the La. Department of Education, the La. Department of Revenue, etc.) as well as other concepts for consideration and evaluation based on usefulness, practicality, and likelihood of successful implementation.