RFI for Payment Integrity Validation and Oversight Tool
Overview
Fit Score
Settle Intelligence
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SUMMARY
DESCRIPTION
The state of New Jersey is seeking a robust payment integrity validation and oversight tool aimed at improving the detection of improper healthcare and dental payments. This solution must ensure compliance with established reimbursement policies and guidelines and should be able to support at least 100 concurrent users. Integration with existing systems is required, along with the capability to ingest and process a wide range of claims and healthcare data.
The tool should leverage advanced analytics and machine learning to enhance the identification of improper payments. Essential features include seamless integration, claims compliance verification, automation of audit processes, efficient aggregation and normalization of data, and delivery of actionable insights through comprehensive reporting. Additionally, the preferred solution will support continuous improvement through built-in feedback mechanisms.