World Trade Center Health Program - Comprehensive Cost Avoidance, Coordination of Benefits, and Recovery Program

The World Trade Center Health Program is seeking a contractor to provide a comprehensive cost avoidance, coordination of benefits, and recovery program. The program aims to improve operational efficiency and control healthcare costs by identifying primary health insurance coverage, validating and facilitating coordination of benefits, recovering incorrectly paid claims, and identifying deceased members. The contractor will be responsible for designing, implementing, and operating an off-site program that meets these objectives. Key tasks include deploying a robust primary insurance identification system, validating and facilitating coordination of benefits, recovering claims from other health insurance and workers' compensation insurers, and providing performance metrics and quality assurance services. The contract is expected to be a firm-fixed-price contract with a base period of 12 months and four 12-month option periods. * The contractor will identify primary health insurance coverage for program members * The contractor will validate and facilitate coordination of benefits among program stakeholders * The contractor will recover incorrectly paid claims from other health insurance and workers' compensation insurers * The contractor will identify deceased members through cross-matching with the Death Master File and other data sources * The contractor will provide performance metrics and quality assurance services, including clinical claims review and fraud, waste, and abuse detection