4.1.1 The Respondent shall pull all medical bills from Iowa Advantage, the state’s accounting system. 4.1.2 The Respondent shall reach out to the agency when invoices cannot be found or invoice detail does not include enough claims information to reprice the claim. 4.1.3 The Respondent shall reprice all medical bills under the Medicaid Fee-For-Service (FFS) fee schedule. 4.1.4 The Respondent shall adjust pricing for services not meeting standard claims edits such as but not limited to unbundling, CCI edits, mutually exclusive procedures, provider specialty. 4.1.5 The Respondent, when applicable, shall reprice based on managed care oversight interventions. 4.1.6 The Respondent shall identify fraud, waste, and abuse. 4.1.7 The Respondent shall provide to the State the line item fiscal impact analysis/claims repricing model for review and feedback. 4.1.8 The Respondent shall provide to the State the final line item fiscal impact analysis/claims repricing model.
