Automated Appeals & Denials Management System Development

The contract is for the design and implementation of an AI-driven system aimed at automating the management of insurance claim denials within the healthcare sector. The system must identify the root causes of claim rejections, generate accurate and clinically supported appeal letters using evidence from patient records, and electronically submit these appeals to third-party payers. The primary goals are to accelerate revenue recovery, decrease the volume of aged receivables, and improve the efficiency of billing operations through intelligent automation. The project requires deep integration with clinical and financial data sources to ensure appeals are both compliant and medically grounded, leveraging natural language processing and machine learning models tailored to healthcare reimbursement workflows. This is a subcontract under the Defense Health Agency of the Department of Defense, with the North American Industry Classification System code 541512, indicating it pertains to custom computer programming services. The solicitation was posted on August 5, 2026, with a response deadline of August 19, 2026. The place of performance is not specified beyond a placeholder location, and no set-aside provisions or point of contact details are provided. The system must be fully operational upon delivery, with the contractor responsible for end-to-end development, testing, and deployment to meet the agency’s requirements for scalability, security, and interoperability with existing healthcare IT infrastructure.