The Health and Human Services Commission (HHSC) is gathering information from vendors with experience providing claims review management and tracking software solutions.
In a request for information (RFI) released by the agency on behalf of the Office of Inspector General (OIG), HHSC detailed the office’s need to replace multiple applications with a centralized surveillance utilization review (SUR) platform.
According to the RFI, OIG’s SUR unit reviewed 23,457 hospital claims and 264 acute-care cases and performed 412 nursing home reviews, bringing in $18,012,570 in recoveries in Fiscal Year 2023.
The desired system must be capable of pulling samples of provider claim data based on customizable criteria, sorting and categorizing samples, timekeeping, reporting detailed real-time individual review progress, calculating overpayment amounts, automatically generating provider notices and more.
More detailed information about RFI No. HHS0015278, including all submission requirements and requests, can be found online. HHSC is not accepting questions regarding the request. The deadline for proposals is 10:30 a.m. Aug. 28. Fernando Garcia is the point of contact for this RFI.
Inspector General to Consolidate Surveillance Utilization Review Platform
According to a request for information, the office’s current unit reviewed 23,457 hospital claims and 264 acute-care cases and performed 412 nursing home reviews, bringing in $18,012,570 in recoveries in Fiscal Year 2023.
