ICD-10 to HHS HCC Mapping Engine

The contract seeks to develop a rules-based or AI-driven engine capable of accurately mapping ICD-10 diagnostic codes to the HHS Hierarchical Condition Categories (HCCs) used for Medicare Advantage risk adjustment scoring. The solution must fully comply with federal regulations, ensuring precision and reliability in translating clinical documentation into standardized risk scores that directly impact payment determinations under Medicare Advantage and other federal health programs. The engine must handle the complexity of HCC mapping rules, including hierarchy, interaction, and demographic adjustments, while maintaining auditability and alignment with current CMS guidelines. The subcontract is issued by the Office of Acquisition and Grants Management within the Department of Health and Human Services, with a NAICS code of 541690 indicating it falls under Other Professional, Scientific, and Technical Services. The opportunity was posted on July 22, 2026, and responses are due by August 20, 2026. While specific performance location and point of contact details are not provided, the work is intended to support federal risk adjustment operations and will likely require integration with existing HHS systems and data frameworks. Proposers must demonstrate technical capability in health data analytics, deep understanding of HCC methodology, and adherence to federal compliance standards.