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26EHSKWTPLIIRFR: RFR for Third Party Liability Health Insurance Investigations and Recovery Claims

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BD-26-1039-EHS01-ASHWA-122275State & Local

Contract Overview

Solicitation details, issuing organization, response deadlines, documents, and interested companies for this government contract opportunity.

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The Executive Office of Health and Human Services (EOHHS) in Massachusetts is soliciting proposals for third party liability health insurance investigations and claims recovery services. The selected vendor will be responsible for claims recovery, data management, and reporting, with a specific focus on achieving service level agreement targets such as billing 14 million dollars in claims per month. Performance is measured through monthly and quarterly reports, including BARS and Claims Lifecycle data, and must adhere to strict privacy and security standards including HIPAA, NIST 800-53, and M.G.L. c. 66A. The contract utilizes a best-value award methodology, evaluating programmatic responses based on comprehensiveness, feasibility, and effectiveness alongside cost reasonableness. Compensation is structured as a combination of fixed monthly fees for investigations and a percentage of estimated savings for recoveries. Key personnel requirements include a Project Manager, Program Lead, Quality Assurance lead, Fair Hearing Coordinator, and Compliance Manager, all of whom must possess at least three years of relevant experience. Proposals must be submitted electronically via COMMBUYS by September 17, 2026, and must strictly follow specified formatting and tabbed organizational requirements.

General Info

Vendors sought to investigate and recover third-party insurance payments for Massachusetts health programs by September 17, 2026, in Boston.

Agency

Massachusetts → EHS01 - EHSView Agency

NAICS

561440 - Collection AgenciesView NAICS

Place of Performance

Fl Boston, MA, 02108, USA

Set-Aside

NONE

Documents

(30)

Attachment A-Statistics Health Insurance and MassHealth Data

DOCX6 pagesstatistics

EOHHS Required Bidder Certifications Form

DOCcertifications

BD-26-1039-EHS01-ASHWA-122275 RFR Third Party Liability Health Insurance Investigations

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Contractor Authorized Signatory Listing Form CASL for Sole Proprietors

PDF1 pageother

Commonwealth Terms and Conditions - Massachusetts State Contract

PDF2 pagescontract-terms-and-conditions

BD-26-1039-EHS01-ASHWA-122275 RFR for Third Party Liability Health Insurance Investigations

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BD-26-1039-EHS01-ASHWA-122275 RFR for Third Party Liability Health Insurance Investigations

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Massachusetts Substitute Form W-9 (Rev 4-2022)

PDF6 pagestax-form

Supplier Diversity Program SDP Plan Form

XLSX5 pagessupplier-diversity-plan

MassHealth Third Party Health Insurance Investigations RFR BD-26-1039-EHS01-ASHWA-122275

DOCX57 pagesrfr

Appendix B - Service Level Agreements for Premium Assistance Investigations

DOCX7 pagessow

BD-26-1039-EHS01-ASHWA-122275 RFR for Third Party Liability Health Insurance Investigations

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Massachusetts Standard Contract Form Instructions and Contractor Certifications

PDF11 pagesinstructions

Prompt Pay Discount Form for Commonwealth Contracts

PDF1 pageother

Appendix C - Service Level Agreements for Claims Recoveries

DOCX2 pagessow

Attachment C Cost Response and Methodology

XLSX9 pagescost-response

BD-26-1039-EHS01-ASHWA-122275 RFR for Third Party Liability Health Insurance Investigations

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Attachment B - Model Contract for Third Party Health Insurance Investigations

DOCX105 pagescontract-document

BD-26-1039-EHS01-ASHWA-122275 RFR for Third Party Liability Health Insurance Investigations

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Appendix G - Artificial Intelligence Provisions

DOCX3 pagescontract-document

BD-26-1039-EHS01-ASHWA-122275 RFR for Third Party Liability Health Insurance Investigations

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Massachusetts EOHHS Request for Responses for Third Party Liability Health Insurance Investigations

PDF1 pagepresolicitation

Evaluation Criteria for RFR Third Party Health Insurance Investigations

DOCX1 pageevaluation-criteria

BD-26-1039-EHS01-ASHWA-122275 RFR for Third Party Liability Health Insurance

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Appendix D Third Party Agreements - Interdepartmental Service Agreement ISA

PDFinterdepartmental-service-agreement

Commonwealth of Massachusetts Standard Contract Form

PDF2 pagescontract-document

Appendix A - Service Level Agreements for Health Insurance Investigations

DOCX4 pagessow

BD-26-1039-EHS01-ASHWA-122275 RFR for Third Party Liability Health Insurance Investigations

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BD-26-1039-EHS01-ASHWA-122275 RFR: Third Party Liability Health Insurance Investigations

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Contractor Authorized Signatory Listing Form CASL for Corporations

PDF1 pageother

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Timeline

PhaseSolicitation
Posted

Solicitation

Response Deadline

Submission deadline

Response Deadline

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Organization & Contact Information

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AgencyMassachusetts → EHS01 - EHS
Contacts1 person available
OfficeFl Boston, MA, 02108, USA
Organization / Agency
Massachusetts → EHS01 - EHS
View Agency Profile
Office AddressFl Boston, MA, 02108, USA
Contacts
Karla WallacePurchaser

Full Description

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The Executive Office of Health and Human Services (EOHHS) is issuing this RFR to solicit proposals from qualified vendors to perform third party liability health insurance investigations and to provide claims recovery services.

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