Case Management and Bill Auditing Services

This is a non-personal service(s) contract to perform client case management services and audits of hospital and physician invoices for services rendered to clients enrolled in the Tuskegee Health Benefit Program (THBP). The Contractor shall review claims and conduct audits to ensure the THBP clients have received healthcare that is clinically appropriate and medically necessary. The resulting contract from this solicitation will be a Firm Fixed Price, Single Award Purchase Order. No work shall begin prior to a Purchase Order being issued. Dates and Location of Contract Performance: Period of Performance includes a one-year base period with two 12-month option periods. See table below: Base Period September 30, 2024 to September 29, 2025 Option Period 1 September 30, 2025 to September 29, 2026 Option Period 2 September 30, 2026 to September 29, 2027 Location of Performance will occur at multiple locations in accordance with the Statement of Work Tasks and Subtasks. Performance for Tasks 1, 2, 4: Subtasks 3.1, 3.2.2, 3.3, and 3.4 will occur at the Contractor’s facility. Performance for Subtask 3.2.1 will occur at the THBP client’s residence. Performance for Subtask 3.5 will occur at the inpatient treatment facility. The Government will award a contract resulting from this solicitation to the reponsible offeror whose offer conforms to the solicitation and will be the most advantageous to the Government, price and other factors considered. The following factors shall be used to evaluate the offers: Technical Requirements – Offeror shall meet the following:  Certified Case Manager (CCM). CCM certification is through The Commission for Case Manager Certification  Certified Medical and/or Provider Bill Review Services. Certification through Certified Clinical Financial Auditor (CCFA)  Shall be a member with the Case Management Society of America (CMSA) 75D301-24-Q-78141 Page 4 of 27  Shall be a current member of the American Association of Medical Audit Specialists (AAMAS) Past Performace – Provide a description of any and all projects performed within the past three years that clearly demonstrates the offeror’s experience in performing projects of similar scope, size, and complexity to the requirements described in the RFQ. Price: Quote shall be inclusive of all costs, base year and all options, to perfom the tasks specified in the Statement of Work.