Federal and Postal Employee Health Benefit Independent Medical Review

The contract entails providing medical and dental health benefits reviews for disputed claims and preservice requests, such as prior approval, authorization, or precertification. The Office of Personnel Management (OPM) will assign the appropriate medical specialist category to each disputed claim, and the contractor will match these claims with specialists including Coding Specialists, M.D.s, D.O.s, D.D.S.s, or D.M.D.s. These specialists will thoroughly evaluate each case file, reviewing documentation across various categories of disputed medical services. The output will consist of detailed, typewritten review analyses along with paper or electronic copies of all cited references to support their conclusions. This opportunity is listed as a presolicitation with a tentative release date of June 9, 2025, and is unrestricted in terms of small business set-asides. The contract fits under the NAICS code 541611, relating to administrative management and general management consulting services, and will be managed by the Office of Personnel Management based in Washington, DC. The scope focuses on federal and postal employee health benefit independent medical reviews, crucial for ensuring accurate assessment and processing of health benefit claims disputes.