This is a 5-year contract award in support of the Department of Veterans Affairs. Performant Healthcare Solutions® technology-enabled audit, eligibility, recovery and data analytics solutions are designed to help health plans identify improper payments and recoup or save capital lost due to errant billing practices. Our holistic approach to solving waste in the healthcare industry leverages experienced healthcare experts and sophisticated analytics technology to offer health plans a suite of payment integrity solutions to control costs.
Solicitation Number: VHA-OF-RAS-36C10X26C0003 | 36C10X25R0021
Department/Ind. Agency: VETERANS AFFAIRS, DEPARTMENT OF | SAC FREDERICK (36C10X)
Contract Award Number: 36C10X26C0003
Number of Offers Received: 7
Named Awardees
36C10X26C0002 MQL5DMJGJJL5 COTIVITI GOV SERVICES LLC
36C10X26C0003 HFAJCUH5UU53 PERFORMANT RECOVERY, INC.
Key objectives of the RA Contract (RAC) 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 the contractor; verify overpayments through a defined dispute process by qualified individuals employed by contractor; and report results to VA. The contractor shall also identify root causes or trends for potential reduction of improper payments. Another key objective of the RAC 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 contractor; receiving documentation from providers (e.g., via RAC’s provider portal); notifying providers of audit findings; communicating findings according to the defined dispute process; and establishing and operating a Customer Service Center (CSC) for addressing questions from
providers.
The auditing of various VA Community Care Programs has been organized into mandatory and optional tasks with any exclusions noted in the task descriptions. Each of the auditing tasks has criteria for the specific data set for that scenario. The contractor shall review 100% of the supplied paid claims data in accordance with their approved audit plan, unless otherwise directed by VA, and report results to OF, who will validate findings and perform collection processes once the RAC’s contractor-managed dispute process is exhausted. The contractor shall be paid a percentage of the recovered funds. VA may elect to name another VA organization, another government entity, or a separate contractor to perform the collections on its behalf.
