Core Claims Adjudication Engine Development and Integration

The contract seeks the development and integration of a claims adjudication engine tailored for Medicaid claims processing in Georgia, requiring full compliance with both Centers for Medicare & Medicaid Services standards and state-specific regulations. The engine must encompass core functionalities including automated rules engines for claim evaluation, real-time eligibility verification, accurate payment calculations, and robust denial logic that accounts for intricate Medicaid program rules. The solution must be designed for seamless integration with existing state systems and ensure data integrity, auditability, and scalability to handle high volumes of claims processing. This is a subcontract opportunity under NAICS code 518210, with a response deadline of August 17, 2026, and the work will be performed under the oversight of the Georgia Department of Community Health. Though specific performance locations and points of contact are not provided, the system must meet Georgia’s operational and regulatory requirements without relying on external state infrastructure assumptions. Proposals must demonstrate technical feasibility, regulatory adherence, and experience in healthcare claims automation, with emphasis on accuracy, timeliness, and system reliability to support Medicaid beneficiaries across the state.