Supplemental Medical Review Services
Overview
Fit Score
Settle Intelligence
Settle helps teams find, evaluate, and respond to public RFPs. We continuously surface new opportunities, score them against your company strengths, and draft proposal responses so you can focus on the work that wins business.
SUMMARY
DESCRIPTION
The selected vendor will provide supplemental medical review services, which include conducting thorough medical record reviews and adjudicating insurance claims. The scope of work encompasses discussion and education sessions with healthcare providers and suppliers to ensure compliance and understanding of claim outcomes.
Additional responsibilities involve performing statistical extrapolation of overpayments and supporting Administrative Law Judge (ALJ) hearings with appropriate participation and expertise. The provider will be expected to deliver comprehensive monthly and annual reports, establish and maintain a dedicated website, and implement robust quality control and performance monitoring frameworks.
Work also includes IT systems setup and ongoing maintenance, effective record management, and diligent tracking of all assigned tasks to support transparency and accountability throughout the project lifecycle.
Source attribution
This Settle analysis is based on the issuing organization’s public RFP listing.