This Solicitation opportunity from Massachusetts was posted on October 27, 2025. The submission period has ended. Browse the details below for market research, or find similar active opportunities.
26EHSKWTPLIIRFR: RFR for Third Party Liability Health Insurance Investigations and Recovery Claims
Contract Overview
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The Massachusetts Executive Office of Health and Human Services is soliciting proposals under bid number BD-26-1039-EHS01-ASHWA-122275 for qualified vendors to provide third party liability health insurance investigations and claims recovery services. The scope of work is divided into three primary parts: health insurance investigations, premium assistance health insurance investigations, and claims recovery for both MassHealth and the Health Safety Net. The selected contractor will be responsible for developing work plans, processing TPL referrals, performing data matches, and managing inpatient claims recovery. The contract also requires the provision of a management information system capable of handling various file formats, including XML. The contract has an initial duration of three years with four optional one-year renewals, for a maximum total duration of seven years. Performance is governed by detailed Service Level Agreements across all three parts of the contract, with benchmarks for call center metrics, investigation completion rates, and quarterly recovery targets. Payment is performance-based and contingent on the savings generated for MassHealth. Bidders must designate key personnel, including a full-time project manager, a program lead for identification and verification, a quality assurance lead, and a compliance manager. Award decisions will be based on best value overall, evaluating both programmatic and cost responses. Bidders must comply with strict submission guidelines via COMMBUYS and provide mandatory certifications, including a Supplier Diversity Program plan with a minimum 1% commitment to certified diverse businesses. Additionally, the contract includes specific provisions regarding the use of artificial intelligence, requiring non-discriminatory deployment and annual compliance certifications. The procurement is governed by the World Trade Organization Government Procurement Agreement and standard Commonwealth of Massachusetts terms and conditions.
General Info
Place of Performance
Fl Boston, MA, 02108, USASet-Aside
Timeline
Submission Closed
Organization & Contact Information
Full Description
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