The SEBC desires to contract with an independent organization(s) specializing in auditing contract compliance for medical and prescription drug plans for clients of similar size as the State of Delaware’s GHIP. Vendors may bid on either audit service or both (i.e., medical insurance contract compliance audits and/or prescription drug insurance contract compliance audits, or both). As noted above, proposals for medical insurance contract compliance audits that include proposed audit services for the SurgeryPlus program should provide pricing for that program separate from the pricing provided for audits of Aetna and Highmark Delaware. The SEBC is interested in receiving proposals from organizations whose medical and prescription drug claim audit services focus on retrospective reviews of plan experience, which is consistent with the audit services that the SEBC is receiving from its incumbent contract compliance auditor. Additionally, the SEBC is also interested in receiving proposals from organizations that have contract compliance review services that can support ongoing and real-time reviews of administrative claims and fees for the GHIP medical and pharmacy benefit programs.
