Specifications include, but are not limited to: The California Victim Compensation Board (CalVCB) issued this Request for Proposal (RFP) for a Contractor to provide Bill Review Services (BRS). Contractor is responsible for providing a project director, technology and staff with the skills, knowledge, abilities and experience to professionally and expertly execute the services and activities associated with the identified service areas in Scope of Work (SOW), Exhibit A in the Sample Standard Agreement, Attachment 15. BRS includes but is not limited to: manual data entry of bills, bill review and adjudication, and bill audit services. For each bill manually keyed, BRS performs a series of validations and then determination (often called adjudication) of the allowed amount for each service by applying CalVCB’s rate billing guidelines for medical, dental, and mental health services. These guidelines include applying the Medicare Fee Schedule for medical services, a twenty-five percent (25%) reduction for dental services, or CalVCB’s own schedule for mental health services. BRS performs adjudication by bill line item. Each bill line item is determined individually to be valid or not. An adjudication code is assigned to each bill line item. See BRS Interface Design Document in the Sample Standard Agreement, Attachment 15, for additional information including process details, system and data exchange requirements. CalVCB is a State program dedicated to providing reimbursement for many crime-related expenses to eligible victims who suffer physical injury or the threat of physical injury as a direct result of a violent crime. CalVCB funding comes from restitution paid by criminal offenders through fines, orders, penalty assessments and federal funds. Victims may apply for compensation by filing an application with CalVCB. To be eligible for compensation, a person must be a victim of a qualifying crime involving physical injury, threat of physical injury or death. CalVCB received nearly 40,640 applications during fiscal year 2020/2021 and paid $52.7 million in compensation.
