Description
The State of Maine is seeking a qualified vendor to design, implement, and operate a comprehensive Workers’ Compensation Medical Bill Review Program. The contractor will provide an end‑to‑end solution that receives medical bills, down‑codes them according to the state fee schedule, negotiates out‑of‑network fees, and returns audited bills to the Department. The scope includes a secure web‑based software platform, integration with the Department’s Risk Management Information System (RMIS), quarterly training for staff, and detailed reporting on savings, claim activity, and compliance. The contract runs from November 1 2026 through October 31 2031 (up to five years with optional renewals) and requires adherence to HIPAA, state privacy statutes, annual SOC 2 Type 2 audits, and vulnerability scanning.
• Provide a secure electronic clearinghouse for providers to submit claims and for the vendor to process them.
• Perform bill down‑coding, fee‑schedule compliance checks, and out‑of‑network fee negotiations.
• Deliver a web‑based application with import/export capabilities, searchable dashboards, and automated quarterly and annual reports.
• Conduct quarterly training for Department staff and onboarding for medical providers on the electronic system.
• Maintain compliance with all state IT security policies, HIPAA, and provide annual SOC 2 Type 2 audit reports.