Description
The Mississippi Division of Medicaid is seeking a contractor to provide external medical review services for State Fair Hearings and/or State Administrative Hearings. The contractor will be responsible for conducting reviews of medical records, providing written clinical rationales, and attending telephonic hearings. The contract term is expected to be 36 months, with one optional two-year renewal. The contractor must have at least five years of experience providing independent external medical review services and must ensure that all medical providers are licensed and board-certified.
Key requirements include:
• Conducting reviews of medical records and providing written clinical rationales
• Attending telephonic hearings and providing knowledgeable testimony
• Ensuring that all medical providers are licensed and board-certified
• Providing a certified biller/coder's review and recommendation for certain cases
• Submitting all recommendations in accordance with the contract requirements