Provide post payment claims review services for members participating in the State Employees Group Insurance Program (SEGIP), Teachers’ Retirement Insurance Program (TRIP), College Insurance Program (CIP), and Local Government Health Plan (LGHP) self-insured benefit programs. The four Programs, which will hereinafter be referred to collectively as the “Programs”, provide members with the following services: medical/behavioral health, prescription, dental, vision, employee assistance plan, life insurance, flexible spending accounts (FSA), and a commuter savings plan (CSP). CMS is seeking a vendor to conduct post payment claims review and audit services of self-insured medical, prescription, and dental claims to identify anomalies indicating fraud, waste, and abuse within the Program’s claims data. Claims review and audits will be performed on retrospective (up to 60 months) claims and real-time claims.
