IRO Services for Medical Claims

The State University of New York (“SUNY”) Upstate Medical University (“Upstate”) intends to make an award under our discretionary authority, which is up to $125,000.00, for the services of an Independent Review Organization (“IRO”) to conduct reviews of claims, and pursuant to New York State (“NYS”) Education Law §355(5)(a) which authorizes purchases without a formal competitive process in certain circumstances, including purchases from NYS small businesses, from business certified pursuant to Article 15-A and Article 3 of the NYS Executive Law, and if applicable, from businesses selling commodities or technology that are recycled or remanufactured. If you are interested in providing a proposal for the above commodity or service, you must contact the appropriately designated Campus contact in this advertisement within fifteen (15) business days of this Advertised Notice. A sealed bid will not be held. Scope of Work: Upstate is seeking an Independent Review Organization (“IRO”) to provide the following services: (1) Conduct an independent review of denied medical claim, taking into consideration all information provided. (2) Perform reviews addressing both medical necessity and diagnosis-related group (“DRG”) reassignment. (3) Complete the review and issue a determination within sixty (60) days after SUNY Upstate submits the claim for review. Fee Structure: The IRO may bill SUNY Upstate only for lost cases; the IRO will be required to bill the Payor for any case won by SUNY Upstate. Offerors must submit an all-inclusive fee, per lost case -- no other fee structure is permissible. No other costs or fees will be allowed under the resulting agreement. This procurement is subject to NYS Finance Law (“SFL”) §§139 –j & –k, also known as the Lobbying Law, therefore, vendors are cautioned that the only permissible contact for this procurement is the individual(s) listed below. Contacting any other individuals at Upstate in connection with this advertisement may constitute a violation of SFL. Failure to comply with this requirement can range from no contract award to debarment from sales to any NYS agency. Please refer to the Office of General Services website at https://ogs.ny.gov/acpl for more information on the Lobbying Law. The successful contractor will be required to submit applicable documents related to Vendor Responsibility, NYS SFL §§139 –j & –k and NYS Tax Law Section 5-a. The successful contractor will be required to submit valid and current NYS Workers’ Compensation and Disability forms. NYS Small Business and businesses certified pursuant to Article 3 and 15-A of the NYS Executive Law are encouraged to submit bids. Business enterprises awarded an identical or substantially similar procurement contract within the past five years: None Service-Disabled Veteran-Owned Business (SDVOB) SDVOB Goal: 0.00% Disadvantaged Business Enterprise contracting goals (DBE) DBE Goal: 0.00%