Second Pass Data Mining Services
Location:
Oregon, USA
Posted on:
Nov 11, 2025
Deadline:
Dec 4, 2025
Summary:
Oregon seeks a vendor to provide second pass data mining services for claims processing, focusing on identifying high-risk and suspect claims.
(1) Vendor needs to provide second pass data mining services to the government authority located in Oregon.– Provide a second pass data mining system.– Handle second pass for all claims submitted to payment. – Integrate seamlessly into the existing claims processing system with minimal effort, time, and cost, and assure no disruption in the regulatory processing of claims. – Integrate into multiple points in the claim processing flow from submission through adjudication for the identification of high–risk and suspect claims. – Provide a rapid solution with the ability to assess the risk of providers and target specific. – Utilize statistically sound, empirically derived data mining technologies including link analytics, geospatial capabilities including but not limited to analysis of third–party sources designed to identify high–risk and suspect claims and identify suspect relationships, patterns, trends, utilization, and billing behavior. – Process historical transaction data and information from external databases. – Be linked to third party systems and data sources, such as the Investigation Database, List of Excluded Individuals/Entities (LEIE), vital statistics, land records, and criminal history data. – Identify improper payments on medical and possibly pharmacy claims. – Provide detailed analysis and auditing, including claim details, the error source, and the reason for the overpayment. (2) All the questions must be submitted no later than November 20, 2025.
