VHA OFFICE OF FINANCE (OF) – RECOVERY AUDIT SERVICES Tender, USA - 121591660

Procurement Summary

Country : USA

Summary : VHA OFFICE OF FINANCE (OF) – RECOVERY AUDIT SERVICES

Deadline : 07 Jul 2025

Other Information

Notice Type : Tender

TOT Ref.No.: 121591660

Document Ref. No. : 36C10x25R0021

Financier : Self Financed

Purchaser Ownership : Public

Tender Value : Refer Document

Purchaser's Detail

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Tender Details

Description

THIS IS NOT A REQUEST FOR COMPETITIVE OFFERS Recovery Audit (RA) Services This is a Pre-Solicitation Notice for The Department of Veterans Affairs (VA), VHA Office of Finance (OF) has a requirement for up to 3 highly skilled contractor(s) to conduct Recovery Audit (RA) activities of healthcare claim payments made for a variety of VHA Community Care programs, as described below. Automated reviews occur at the system level while complex reviews require a qualified individual to review the medical record. Each program has specific payment methodologies as defined by VA regulations. In general, the audit will review various types of paid healthcare claim data with specific dates and criteria included in the description of each auditing scenario.OBJECTIVESKey objectives of the RA contract are to receive access to paid Community Care healthcare claims data; audit that data for potential overpayments to providers based on laws, regulations, policies and industry standard practices (e.g., medical coding) using RAC s technology solutions and validated by qualified individuals employed by RAC; verify overpayments through a defined dispute process by qualified individuals employed by RAC; and report results to VA. The contractor shall also identify FboNotice causes or trends for potential reduction of improper payments. Another key objective of the contract is to manage and perform all provider communications and interactions through the entire lifecycle of each claim s audit and recovery process, which includes announcements of RAs for new audit topics (e.g., claim types, programs) on a provider portal established and operated by the RAC; receiving ml documentation from providers (e.g., via RAC s provider portal); notifying providers of audit findings; communicating findings from the defined dispute process; establishing and operating a Customer Service Center (CSC) for addressing questions from providers.The auditing of various VA Community Care Programs has ...
Active Contract Opportunity
Notice ID : 36C10x25R0021
Related Notice
Department/Ind. Agency : VETERANS AFFAIRS, DEPARTMENT OF
Sub-tier : VETERANS AFFAIRS, DEPARTMENT OF
Office: SAC FREDERICK (36C10x)
General Information
Contract Opportunity Type: Presolicitation (Original)
Original Published Date: Jun 25, 2025 02:42 pm EDT
Original Response Date: Jul 07, 2025 03:00 pm EDT
Inactive Policy: Manual
Original Inactive Date: Jul 07, 2025
Initiative: None

Classification
Original Set Aside:
Product Service Code: R704 - SUPPORT- MANAGEMENT: AUDITING
NAICS Code: 541219 - Other Accounting Services

Place of Performance: The contractor’s facilities,

Documents

 Tender Notice

36C10X25R0021_1.docx