Clinical Utilization Review Services

The contract requires the provision of Clinical Utilization Review Services to evaluate non-emergent medical claims for medical necessity using evidence-based guidelines and Vermont Medicaid Rule 7103. The scope encompasses prospective, concurrent, and retrospective reviews to ensure appropriate care delivery and compliance with state regulations, with the goal of promoting cost-effective and clinically sound healthcare utilization. All reviews must be conducted in alignment with established clinical standards and regulatory requirements to support the integrity of the Vermont Medicaid program. This subcontract is issued by the Vermont Department of Economic Development and is open for response until July 10, 2027. The North American Industry Classification System code assigned to this contract is 621399, indicating it pertains to other miscellaneous ambulatory health care services. There is no specified set-aside type or designated place of performance, and no point of contact is listed in the solicitation data. The contract is accessible via the Vermont Business Registry, and interested parties must submit proposals prior to the deadline to be considered for award.