MEDI-8187 - USA (Washington, DC) - Medical Review and Consultative Services - Deadline November 13,2026

(1) Vendor needs to provide medical review and consultative services to the government authority located in Washington, DC.– The Government is assessing the market’s capability to provide comprehensive support under thefollowing disciplines:• Audits for Medicare Parts A, B, D, and Medicaid medical record review and consultative services• Audits for Medicare Part C medical record review and consultative services• Evaluations and Inspections medical record review and consultative services• Expert consultant and witness services in support of the agency to the Inspector General• Medical Records and Data. The Contractor will work with the agency to establish a means for intake (i.e., transfer, receipt, and compliant storage) of medical records, other documentation, and claims data provided by the agency.• The Contractor will conduct a review of claims data and a full review of medical records (completeness review) to identify core deficiencies (e.g., missing documents) that could hinder a thorough and complete review.• Medical Review. The Contractor will perform post–payment reviews of claims and supporting medical records to identify improper payments, medical necessity, medical appropriateness, incorrect coding, documentation discrepancies, quality of care issues, and adverse events.• Document a detailed step–by–step approach for evaluating whether coverage requirements are met and to assist reviewers in making logical decisions based on the information in the supporting documentation.• Be firmly grounded in correct and applicable Medicare and Medicaid criteria.• Clearly describe the required qualifications for personnel conducting the review and those overseeing the review for final approval of determination.(2) The contract period will be for one year.