(RFP) for Recovery Audit Contractor (RAC) - Texas Health and ...

3.15.4 Section 3 - Response to Scope of Work Requirements
The response to the Scope of Work Requirements and Deliverables must include the following
sections:
Section 1 – Summary of Approach and Understanding of Work Effort
Section 2 – Proposed Approach for Meeting General Requirements
Section 3 – Proposed Approach for Identification of Specific Providers for Audit
(Provider Based Approach)
Section 4 – Proposed Approach for Identification of Specific Claims for Audit (Claims
Based Approach)
Section 5 – Proposed Approach for Provider Communication and Support - Claims
Based Approach
Section 6 – Proposed Approach for Provider Communication and Support – Provider
Based Approach
Section 7 - Proposed Approach for Data Sharing and Security including Development
of Web-Based Application
Section 8 – Proposed Approach for Recoupment and Appeals Process
Section 9 – Proposed Approach for Reporting – Claims Based Approach
Section 10 – Value-Added Benefits
Section 11 – Assumptions for Scope of Work
3.15.4.1 Section 1 – Summary of Approach and Understanding of Work Effort
The respondent must provide a summary description to their approach to assist HHSC in
meeting the objectives of the scope of work, internal quality control processes, and project
communications methods to be implemented with HHSC over the length of the contract.
3.15.4.2 Section 2 – Proposed Approach for Meeting General Requirements
The respondent must describe how it will meet the General Requirements detailed in Section
2.3.1.
3.15.4.3 Section 3 – Proposed Approach for Identification of Specific
Providers for Audit (Provider Based Approach)
The respondent must describe how it will meet the requirements for the identification of specific
providers for audit (provider based approach) detailed in Section 2.3.2.
3.15.4.4 Section 4 – Proposed Approach for Identification of Specific Claims
for Audit (Claims Based Approach)
The respondent must describe how it will meet the requirements for the identification of specific
claims for audit (claims based approach) detailed in Section 2.3.3.
3.15.4.5 Section 5 – Proposed Approach for Provider Communication and
Support - Claims Based Approach
The respondent must describe how it will meet the requirements for provider communication
and support (claims based approach) detailed in Section 2.3.4.
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