Description
The Federal Bureau of Prisons (BOP) is conducting market research for professional analytical support services to evaluate approximately 2,000,000 historical medical claims. The analysis will be used to examine the data for fraud, waste, and abuse, as well as to identify trends within the claims data. The contractor will not perform claims adjudication, claims processing, utilization management, provider network management, or payment administration. The required services include analyzing historical medical claims data, identifying duplicate claims, and ranking providers by amount billed.
• The contractor shall furnish all personnel, management, commercial software, analytical tools, and other resources necessary to analyze the claims data.
• The analysis deliverables shall include duplicate claims, inappropriate procedure code based on included diagnostic code, outliers of specific procedure codes by specific providers and/or sites, and comparison of billed rates to Medicare rates.
• The data provided by the Government will include claim ID, patient gender, BOP internal patient ID number, authorization number, payor/institution information, diagnostic codes, service dates, procedure codes, procedure description, charge amount, billing provider information, and providing facility information.