WTCHP Comprehensive Cost Avoidance, Coordination of Benefits, and Recovery Program

The World Trade Center (WTC) Health Program intends to improve efficiency and control health care costs. Our purpose is to establish a comprehensive cost avoidance, coordination of benefit, and recovery program by implementing a comprehensive cost avoidance and recovery platform from pre- to post-payment processes. This requirement includes the deployment of a robust and near real-time primary insurance identification system and database, validation and facilitation of the Coordination of Benefit (COB), recovery of incorrectly or inappropriately paid claims from private insurance, participation in New York State (NYS) Workers’ Compensation Board (WCB)’s Health Insurance Matching Program (HIMP) to identify individuals who are eligible for WC benefits and to seek reimbursement from WC’s insurers, identification of deceased members, and providing performance metrics, quality assurance and payment integrity services. See Request for Proposal (RFP) and attachments. Amended February 17, 2020, to add attachments and amend RFP. For the SOO, Objective 5 is no longer optional.