The Washington State Health Care Authority, hereafter called “HCA,” is initiating this Request for Proposals (RFP) to solicit Proposals from firms interested in providing the services of a Recovery Audit Contractor (RAC). This RFP document sets forth the requirements for the HCA RAC program. The resulting Contract will govern how the Contractor will perform audits on payments made to providers and identify Improper Payments. In the HCA RAC program, one (1) provider’s claims universe and/or sample of selected claims is considered one (1) audit. HCA will provide all appropriate data and data sets pertaining to the audit work performed by the Contractor. A full extract of Apple Health data, or access to all Apple Health data, for the purpose of data mining and data analysis is not included in the scope of this RFP. The awarded Contractor’s compensation will be in the form of a contingency fee percentage of the amount recovered from Contractor-identified overpayments and Contractor-identified underpayments to providers that are more than $250. Currently the audit scope is limited to fee-for-service (FFS) but may expand scope to Managed Care Organization (MCO) claims during the term of the Contract.
