The Alabama Medicaid Agency on October 7, 2013 issued a Request for Proposals (RFP) seeking vendors to develop, implement, and maintain an Advanced Fraud Detection and 100 percent web-based Case Management System. The system will need to be able to use the newest technology along with fraud and abuse detection services available in the marketplace.
The system must:
- Support fraud detection and case management for both fee-for-service and managed care related claims and payments
- Provide detection and trending tools that will alert the agency to providers that are exhibiting fraud or abuse indicator
- Incorporate improved trending capabilities for complaints, case management, and audit resolutions
The advance detection tools will also have to incorporate predictive analytics and neural networking to allow users to query data in a way that reveals patterns and relationships between people, places, events, times, and things. The system also needs to allow queries based on groups and other clustered or networked behavior. These varied analytic techniques will offer users choices on how to uncover connections in seemingly unrelated data.
The data obtained will also improve the ability of the Medicaid agency to target provider and recipient investigations, provide for reviews and audits, ensure a higher return on the agency’s resource investment, and help the agency identify high risk areas.
Vendors may propose a cloud-based solution where the vendor has the responsibility to install, host, and maintain the system which can be a Software as a Service (SaaS) model. If a hosted solution is proposed, the vendor’s production application and hardware will need to be available 24/7. In addition, vendors may propose a solution where the agency purchases the software and is responsible for hosting the system within their own data center.
Go to http://medicaid.alabama.gov/CONTENT/2.0_newsroom/2.4 _Procurement.aspx to view the RFP (2013-cmFD-01). The RFP due date in January 3, 2014. For more information, go to www.medicaid.alabama.gov or email Jacqueline G. Thomas Project Director at Jacqueline.thomas@medicaid.alabama.gov or call (334)-242-5318.