Federal and Postal Employee Health Benefit Independent Medical Review   3

Background
The Office of Personnel Management (OPM) is issuing this contract to provide independent medical review services for the Federal and Postal Employee Health Benefits Program. The goal of this contract is to ensure accurate and thorough reviews of disputed medical claims and preservice requests, thereby supporting OPM's mission to manage the health benefits program effectively.

Work Details
The contractor will perform the following tasks:

1. Provide medical and dental health benefits reviews of disputed claims and preservice requests, including prior approval, prior authorization, or precertification.

2. Assign a qualified medical specialist (Coding Specialist, M.D., D.O., D.D.S., or D.M.D.) to each disputed claim as determined by OPM.

3. Review case documentation for various categories of disputed medical services and produce typewritten review analyses.

4. Provide a paper or electronic copy of all references cited in support of the analyses.

5. Ensure that the Medical Director is available as an expert witness for legal discussions regarding cases reviewed under the contract.

6. Complete Quality Control Reports reflecting the Quality Review Team's efforts for each case and consultation service, including statistics on cases reviewed, rejected cases, and corrective actions taken.

7. Conduct monthly meetings to discuss quality reports and ongoing performance with key personnel such as the Contractor’s Program Manager and Medical Director.

Place of Performance
The geographic location(s) for performance are not explicitly provided in the solicitation.