RFQ 2025-03 Second Pass Data Mining Services

RFQ 2025-03 Second Pass Data Mining Services

REQUEST FOR QUOTES (RFQ) #2025-03 SECOND PASS DATA MINING SERVICES

315 SW Fifth Ave, Portland, OR 97204 | 800-224-4840 | TTY 711 | careoregon.org
George Marlton
Procurement Director

Procurement Department
503-488-7646
vendorservices@careoregon.org

REQUEST FOR QUOTES #2025-03
Second Pass Data Mining Services
RESPONSE TO CLARIFYING QUESTIONS #1
November 13, 2025

Note that these are questions submitted by interested firms to the above referenced solicitation.
The below answers are for clarification purposes only and in no way alter or amend the RFQ as
published.

1. The RFQ states that “CareOregon may award to more than one Quoter for second pass
data mining services.” In the case that multiple Quoters are selected for second pass data
mining services, is it CareOregon’s intention to deploy each vendor in sequence with
appropriate lag times between vendors/review? (i.e. 1st pass, 2nd pass, 3rd pass). Or, will
care CareOregon deploy multiple vendors in a head-to-head review in 2nd pass?

Answer: In the event CareOregon selects more than one vendor, it would be in sequence
with the appropriate lag time.

2. Can you share which external supplier CareOregon is using for 1st pass Data Mining?

Answer: CareOregon chooses not to answer this question.

3. For FWA investigations, is CareOregon interested in investigative services from the
supplier to support investigation of leads? Or, is the intent to generate leads and
CareOregon’s FWA team will support the investigative work?

Answer: RFQ Section 2. Services states, “Support for Fraud, Waste, and Abuse (“FWA”)
Investigations: Data mining outputs should assist CareOregon in its internal FWA
investigations.”

4. What is your current vendor DM analytic/concept approval process?

Answer: The current vendor proposes analytics with anticipated claim volume and value
add which is evaluated with an internal CareOregon payment integrity team before
implementing new data mining analytics.

5. How long does the analytic/concept approval process take?

Answer: Typically within 30 days.

6. Are there any provider exclusions that would be out of scope?

Answer: CareOregon chooses not to answer this question.

7. How long has Optum/Equian been working DM audits?

Answer: CareOregon chooses not to answer this question.

315 SW Fifth Ave, Portland, OR 97204 | 800-224-4840 | TTY 711 | careoregon.org


8. What is the size of your PI department?

Answer: CareOregon chooses not to answer this question.

9. How many internal staff are currently performing internal data mining audits?

Answer: CareOregon chooses not to answer this question.

10. What is the percent of total recoveries that your internal team is bringing in?

Answer: Not currently measured by percentage points.

11. How do you develop new internal DM analytics/concepts?

Answer: Through coding and compliance research.

12. How many analytics/concepts do you have in place currently for internal audit functions?

Answer: CareOregon currently houses a robust payment integrity program.

13. Is the internal DM audit function being performed before Optum at zero pass?

Answer: Yes.

14. How long is our internal pass prior to sending to Optum?

Answer: Case by case in terms of length of time.

15. Is Optum performing both DM audits and COB verification?

Answer: CareOregon chooses not to answer this question.

16. What would the DM audit overlap process look like with internal, 1st and 2nd pass?

Answer: There will be a 60 day delay between first pass and second pass. Internal data
mining activities can happen at any point.

17. As this is for 2nd pass data mining, who is currently in 1st pass for data mining?

Answer: CareOregon chooses not to answer this question.

18. Is your go forward strategy is to bring more of the Data Mining auditing function
internally with her current team and or expand her internal team to bring even more in
house to reduce vendor contingency spend?

315 SW Fifth Ave, Portland, OR 97204 | 800-224-4840 | TTY 711 | careoregon.org
Answer: We have had discussions about expanding internally in addition to bringing on a
second pass external vendor.

19. Is CareOregon open to considering a longer look-back period? Medicaid allows a 6-year
look back and most Medicaid payers allow a minimum of three.

Answer: Not at this time. Initiatives that require a longer look-back are currently
performed internally.


20. We understand that chart review is out of scope but can we request itemized bills in
support of our data mining queries?

Answer: Itemized bill review is already being performed as a separate Payment Integrity
activity.


End of Clarifying Questions