Health Care Authority

The buyer, Washington's single state Medicaid agency, is seeking a Recovery Audit Contractor (RAC) to audit payments made to Apple Health providers. The contractor will identify improper payments, including overpayments and underpayments, in Medicaid and state-funded Apple Health programs. The project involves auditing payments under Title XIX and Title XXI of the Social Security Act. The selected firm must have experience and expertise in healthcare payment auditing and recovery processes.

• 3/21/2025 - Proposal Due Date

• Audit payments made to Apple Health providers
• Identify improper payments, including overpayments and underpayments
• Review Medicaid and state-funded Apple Health program payments
• Implement recovery audit processes for Title XIX and Title XXI programs
• Develop strategies to detect and prevent improper payments
• Analyze payment data to identify patterns and anomalies
• Conduct on-site audits of healthcare providers as needed
• Prepare detailed audit reports and recommendations
• Collaborate with HCA to implement corrective actions
• Provide training to HCA staff on audit methodologies and best practices