Specifications include, but are not limited to: 1. An analysis of one hundred percent (100%) of medical invoices or claims submitted for payment to the KEHP by Anthem or any TPA with which Personnel Cabinet may contract in the future while the contract awarded pursuant to this TPA is in effect. The Vendor shall not utilize statistical sampling methods in lieu of analyzing all pertinent medical invoices and claims; 2. Identification and correction of errors in Medical Benefit Claims in order to avoid or reduce erroneous overpayments by KEHP through the KEHP Contracted Entities, including a check for any duplicate claim reporting (such as duplicate claims resulting from prepayment, or claims incorrectly applied to a KEHP member due to faulty identification); 3. Identification of underpayments made by the KEHP Contracted Entities; 4. Identification of inappropriate or erroneous fees imposed by a KEHP Contracted Entity; 5. Submission of a report to the Personnel Cabinet and the Legislative Research Commission beginning April 30, 2024, and quarterly thereafter, which shall include the following: a. A summary of the analysis conducted; b. A statement of the errors identified pursuant to the Vendor’s responsibilities outlined herein; c. A statement of the resolutions of the errors identified pursuant to the Vendor’s responsibilities outlined herein; and d. Savings realized by KEHP as a result of the Vendor’s analysis, validation, and resolutions of the Errors. 6. Negotiation with KEHP Contracted Entities when Errors are identified to resolve the Error; 7. Analysis that takes the following into consideration: a. Compliance with all state and federal laws relating to or applicable to the KEHP; b. Compliance with any contract between the Personnel Cabinet and KEHP Contracted Entities; and c. The market competitiveness of medical benefit payments, including the adequacy of payments to medical providers; and 8. Demonstration of the Vendor’s capability of performing the analysis of Medical Benefit Claims to validate Accuracy of the Claims and identify errors in Near Real Time.
