In its performance of the requirements of this RFP, the Contractor must meet and fulfill all federally mandated and state required actions regarding TPL Contractors, including, but not limited to, the Code of Federal Regulations 42 CFR Part 433, the Social Security Act Title XIX Section 1902 (a) (25), Health Insurance Portability and Accountability Act of 1996, the Deficit Reduction Act of 2005, State Social Services Law Section 367-a, New York Insurance Law Section 3212 and New York Codes Rules and Regulations Title 18 NYCRR Section 540.6. Federal laws and regulations require that states take all reasonable measures to ascertain the legal liability of third parties to pay for medical services provided to Medicaid Enrollees. To comply with these requirements, OMIG is seeking proposals from Offerors to assist and supplement OMIG's mission to identify, verify, and recover Medicaid overpayments from liable third parties for cost savings and recovery purposes. The goal is to ensure that Medicaid is the payor of last resort for health care services and supports, that liable third parties cover their appropriate share of the costs and that the State recover on paid Medicaid claims for which TPL was not known or available at the time of Medicaid payment.
Additionally, the Offeror must provide and manage staff that are able to handle the volume of work required to successfully manage this project. Such staff must be assigned solely to this contract. An insufficient number of dedicated staff, or excessive staff vacancies, will result in customer service and processing delays which could negatively impact performance.
Service-Disabled Veteran-Owned Set Aside: No
Total MWBE Participation Goals: 0%
Service-Disabled Veteran-Owned Business Contracting Goal: 0%
Disadvantaged Owned Sub-Contracting Goal: 0%
Due date:06/19/2024 2:30 PM
Questions due 5/8/24 by 2:30 PM EST
Contract term: Three (3) years with two(2), optional 1-year extensions
County(ies): All NYS counties
Location: 800 North Pearl St., Albany, NY 12204
Business entities awarded an identical or substantially similar procurement contract within the past five years:
N/A
Background
The New York State Office of the Medicaid Inspector General (OMIG) is responsible for the requirements specified in this RFP and for evaluating all proposals. OMIG was established to improve and preserve the integrity of the New York State Medicaid Program by conducting and coordinating fraud, waste, and abuse control activities for all State agencies responsible for services funded by Medicaid. The goal is to ensure that Medicaid is the payor of last resort for health care services and supports, that liable third parties cover their appropriate share of the costs, and that the State recovers on paid Medicaid claims for which Third-Party Liability (TPL) was not known or available at the time of Medicaid payment.
Work Details
The scope of work includes two project modules: Prepayment Insurance Verification (PPIV) services and Third-Party retroactive recovery projects. The Offeror must identify and verify new commercial and terminated insurance coverage, load updated TPL information to the MMIS, perform reverifications on transmitted cost avoidance files at OMIG’s request, and conduct a data match of insurance segments identified with the Child Support Eligibility file.
Additionally, the Offeror must develop a recovery process that utilizes known overpayments by implementing and administering a Medicaid recoveries process established and directed by OMIG.
Period of Performance
The contract term is three years with two optional one-year extensions. The closing date for receipt of proposals is 06/19/2024 at 2:30 PM EST.
The period of performance will begin on 12/04/2024.
Place of Performance
The contract will be performed in all NYS counties with headquarters in Albany, New York.
