BILLING-3171 - USA (Alameda, California) - Pre-Payment Claim Review, Post Payment Audit and Recovery Services - Deadline August 25,2026

(1) Vendor needs to provide pre–payment claim review, post payment audit and recovery services to the government authority located in Alameda, CA.– PPCR (Pre–Payment Claim Review) only: The Contractor must demonstrate the ability to review claims prior to payment within specified timeframes to ensure accurate billing practices including clinical reviews (Diagnosis–Related Group [DRG]), industry guidelines, level of care, etc.) – provider billing practices, contract compliance, accurate documentation, and patient eligibility.– PPAR only: The Contractor must demonstrate previous experience using health care industry standard Recovery Audit Contractor methodologies, tools, expertise and technology in compliance with applicable state and federal requirements, accepted medical, clinical, coding, and audit standards.– The Contractor shall:a. Coordinate with the current Contractor, during a transitional period until October31, 2026, for any open claims and to transfer intellectual property, if applicable.b. Ensure a compliant resolution process by responding to questions and/orconcerns from agency within three (3) business days.c. Ensure all requests from agency flagged as “high importance” or“priority” receive a response within two (2) calendar days.d. Have the ability to receive claims data electronically through file types such asComma Separated Value (CSV) and through agency databases andcontracted system databases such as through TPA, within 30 calendar days.e. Provide a secure web portal and HIPAA–compliant email exchange processcompatible with agency systems and contracted healthcare entities withtechnical support by live person via telephone and email, which includes training,within 30 calendar days. These systems should support uninterruptedcommunication and access to reports and to view and exchange documentsrelated to PPCR and PPAR services.(2) The contract period will be for one year.(3) All the questions must be submitted no later than August 14, 2026.