ALPS Services, Inc. Capability Statement

Controlling health care cost. Ensuring quality of care. Identifying medical fraud, waste and abuse.

Core Competencies

ALPS Services, Inc. is a member in the growing field of Medical Quality and Cost Control Consulting. Three principles help define our mission:
• Controlling health care cost
• Ensuring quality of care
• Identifying medical fraud, waste and abuse
Based on these principles, our mission is to ensure that beneficiaries/plan members are provided with health services that meet the highest professionally recognized standards of care; that this is provided in the most appropriate setting; that treatment is medically necessary and is provided at the lowest possible cost.


  • Certified as a Service-Disabled Veteran-Owned Small Business by the U. S. Department of Veterans Affairs
  • Certified as a Minority Business Enterprise (MBE) in the states of Ohio, Pennsylvania, Missouri, and Massachusetts
  • Certified by the U.S. Department of Health and Human Services, Centers for Medicare and Medicaid Services as a Quality Improvement-like Entity


  • 75% of our workforce are Registered Nurses averaging more than 10 years clinical experience
  • All staff have college degrees from an accredited college or university or have a state certification such as Certified Coders and Registered Health Information Technicians
  • Our reviewers are trained by ALPS and other professional organizations
  • Our problem-solving team, in most cases, will also offer Value Added Services that will effectively enhance the goals and objectives of the project at no additional cost

Company Snapshot

DUNS Number: 783567274
Cage Code: 1QTT5
NAICS: 524114, 524291, 524292, 524298, 525120,524219, 541611, 541612, 541618, 541990, 561110, 561320, 561410, 561422, 561440, 561499, 561611, 621399, 621999, 624310, 813920

Past and Present Performance

Prime – Medical Record Review, Medical Quality Review for the U.S. Department of Justice
Prime – Medical Record Abstraction, Data Collection and Cardiac Data Monitoring for Pennsylvania hospitals
Prime – Workers’ Compensation Management services for the Natural Resources Conservation Service (NRCS), an agency of the U.S. Department of Agriculture
Prime – Workers’ Compensation Administrator for more than 150 private companies
Subcontractor – Department of Veterans Affairs Quality Assurance Assessment /Medical Record Abstraction for 21 states
Subcontractor – Medicaid Medical Record Review and Coding Validation, Recovery Audit Contractor (RAC)
Subcontractor – Validation of Performance Measures, Medical Record Abstraction, Physician Quality Reporting System (PQRS) for the Centers for Medicare & Medicaid Services (CMS)
Subcontractor – Coding Validation, Fraud & Abuse Review of Skilled Nursing Facilities (SNFs), Resource Utilization Group (RUG) for Medicare claims
Subcontractor – Coding Validation and Quality Review for the States of Ohio and Pennsylvania for Medicaid claims
Subcontractor – Medical Record Abstraction to validate the quality of care and develop quality measures for pediatric sickle cell disease patients, University of Michigan C. S. Mott Children’s Hospital Child Health and Evaluation Recearch (CHEAR) unit
Subcontractor – CMS Medical Record Review and Coding Validation, Zone Program Integrity Contractor (ZPIC) in Zones 1, 3, 6, and 7
Subcontractor – Northeast Unified Program Integrity Contractor (NE UPIC)
Subcontractor – Military Health Systems medical case reviewing in support of the Institute for Healthcare Improvement
Subcontractor – Medicaid Preadmission Screening and Resident Review (PASRR) to help ensure that individuals are not inappropriately placed in nursing homes for long term care
Subcontractor – Ohio Medicaid Third Party Liability requesting recovery of millions of dollars.