Dental Claims Processing & Adjudication

The contract requires the processing and adjudication of dental claims submitted by providers and members, encompassing full lifecycle management from eligibility verification and benefit determination to fraud detection and final payment processing. All tasks must be performed accurately and efficiently to ensure timely resolution of claims while maintaining compliance with applicable standards and safeguards against fraudulent activity. The scope demands robust systems and processes capable of handling high volumes of claims with precision, ensuring members receive correct benefits and providers are paid appropriately under the terms of their agreements. This is a subcontract under the City of Columbus, Ohio, with a solicitation posted on May 22, 2026, and responses due by June 24, 2026. The NAICS code 561400 indicates the work falls under administrative management and general management services. There is no set-aside designation specified, and performance location details are not provided. Interested parties must submit their proposals through the designated portal before the deadline, and the contract is open to qualified subcontractors capable of delivering reliable, secure, and scalable claims adjudication services.