Views
3 years ago

Response to RFP No. MED13002 State of West Virginia ... - DHHR

Response to RFP No. MED13002 State of West Virginia ... - DHHR

Request For Proposal #

Request For Proposal # MED13002 Recovery Audit Contract – Pharmacy West Virginia Health and Human Services Our experienced Healthcare personnel, with more than 10 years of experience, have a thorough understanding of the unique regulations, policies, and applicable coding guidelines that encompass the review criteria for each audit. PRGX utilizes Our Registered Nurses and Certified Coders have valuable, practical experience in care and coverage guidelines in Acute Inpatient Hospitals, Inpatient Rehab Facilities, Skilled Nursing Facilities, Home Health and Hospice, Community and Behavioral Health, Professional Services, Outpatient Services; the list goes on. Each reviewer considers all applicable Medicaid rules and regulations to ensure all Medicaid guidelines are met in the performance of the audit. 2.4.1.6 Project Reporting § 2.4.1.6 Reporting of results; The results of pharmacy claim, clinical and coding reviews will be reported to providers/pharmacy providers by mail correspondence. Templates of letters will be provided in advance for scenario design and input needed from BMS’ stakeholders. West Virginia’s Bureau of Medical Services (BMS) will approve all provider correspondence prior to project implementation. Sample correspondence may include: Letter Type Record Request Letter Description Letter to pharmacy provider that requests the record for the claim(s) selected for audit. PROVIDER NOTIFICATION Record Request Reminder Notification Letter No Response Notification Letter to pharmacy provider that requests the record for the claim(s) selected for audit. This letter includes the same information as the initial request. Letter to pharmacy provider that indicates there was no response to the medical record requests and that the claim payment will be recouped. This letter includes the redetermination rights for the provider. 35

Request For Proposal # MED13002 Recovery Audit Contract – Pharmacy West Virginia Health and Human Services Findings Notification Letter to pharmacy provider that indicates the results for the audit and includes the redetermination rights when there is notice of overpayment. No Findings Notification Letter to pharmacy provider that indicates there were no findings and no adjustment to be made to the claim (s) audited Redetermination Findings Notification Demand Letter ( Draft/Final Demand letter) Letter to pharmacy provider that indicates the results of the rebuttal review and specifies the appeals process. Letter to pharmacy provider that indicates the demand amount 2.4.1.7 Improper Payment Prevention Plan § 2.4.1.7 Developing an Improper Payment Prevention Plan, for any RAC identified vulnerability, to help prevent similar overpayments from occurring in the future. PRGX will recommend system and process changes to prevent future improper payments. Our recommended changes will include the identification of significant deficiencies in internal control specifically legal and regulatory requirements, as well as current or emerging risks to the State of West Virginia’s systems and processes. PRGX will provide an improper payment prevention plan to the West Virginia Health and Human Resources, Bureau of Medical Services (BMS). This plan will provide BMS with details of RAC Identified vulnerabilities and associated recommendations to prevent future occurrences. PRGX will also recommend solutions/concepts to improve the West Virginia Medicaid program based on findings from audits related to fraud investigations. These findings and recommendations will be reported to BMS and other identified and approved agencies in writing. PRGX report will identify the fraud and abuse occurrences that trends continuously 36

West Virginia Family Survey - DHHR
EPI-LOG - DHHR - State of West Virginia
West Virginia Medicaid Transition Workshops - DHHR
Statement of Confidentiality - DHHR
HP Enterprise Services - DHHR
Molina Medicaid Solutions - DHHR
West Virginia State Profile - Aarp
Adam E. Klein, MD - West Virginia State Medical Association
Carnifex Ferry Battlefield - West Virginia State Parks
Energy Efficiency Efforts at the State of West Virginia
Canaan Valley Resort - West Virginia State Parks
July/August - West Virginia State Medical Association
Tu-Endie-Wei - West Virginia State Parks
West Virginia Regional Response Program - West Virginia Division ...
What is SIRN? - State of West Virginia
2008 Annual Report - West Virginia State Auditor's Office
Report - West Virginia Center on Budget & Policy
Special CME Issue - West Virginia State Medical Association
North Bend Rail Trail Brochure - West Virginia State Parks
MACV Handbook US Forces Vietnam 1967 - West Virginia State ...
west virginia state police evidence rooms - West Virginia Legislature
West Virginia - Medicaid Health Plans of America
West Virginia Ferns.indd - West Virginia State Parks
September/October - West Virginia State Medical Association
Healthcare - West Virginia State Medical Association
March/April - West Virginia State Medical Association
layout 1 - West Virginia State Auditor's Office
Moncove Lake - West Virginia State Parks
May/June - West Virginia State Medical Association