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Independent Medical Reviewers (Physicians/Clinicians)

Active

State & Local

Response Deadline09/15/2026, 06:00:00 PM UTC

Contract Overview

Solicitation details, issuing organization, response deadlines, documents, and interested companies for this government contract opportunity.

AI Contract Overview

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This subcontract opportunity is for independent medical reviewers to provide third-party clinical evaluations for prime contractors supporting the Kentucky Department of Medicaid Services. Qualified clinicians, including MDs, DOs, or other licensed healthcare professionals, will be responsible for reviewing patient medical records and provider submissions to apply medical necessity criteria and issue formal administrative decisions on appeals. Each assigned case must result in a completed rendered decision or determination report. The solicitation is listed under NAICS code 621391 and was posted on August 7, 2026, with a response deadline of September 15, 2026. Interested parties must possess credentials appropriate to the specific medical issues being reviewed to ensure clinical accuracy in their determinations.

General Info

Independent medical reviewers needed for Kentucky Medicaid clinical evaluations and appeals decisions.

Agency

Kentucky → 275 E. Main StreetView Agency

NAICS

621391 - Offices of PodiatristsView NAICS

Place of Performance

Other, KY, USA

Set-Aside

NONE

Documents

This scope was carved out of RFP 746 2700000006.

The full solicitation package (7 documents), including the RFP, is on the prime solicitation, not on this scope.

View the prime solicitation

RFP-746-2700000006-1 | External Independent Third-Party Review (C6102)

AI Contract Breakdown

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Timeline

PostedAug 7

subcontract

Response DeadlineSep 15

Submission deadline

Response Deadline

09/15/2026, 06:00:00 PM UTCin 9 days

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Organization & Contact Information

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AgencyKentucky → 275 E. Main Street

ContactsNo contacts available

OfficeN/A

Organization / Agency

Kentucky → 275 E. Main Street

View Agency Profile

Office AddressN/A

ContactsNo contact information available

Full Description

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Performs independent third-party reviews for prime contractors on Kentucky Department of Medicaid Services (DMS) projects. Reviews patient medical records and provider submissions, applies medical necessity criteria, and renders formal administrative decisions on appeals. Requires qualified clinicians (MD, DO, or licensed healthcare professionals) with credentials appropriate for the specific medical issue. Delivers a rendered decision/determination report for each review case.

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More opportunities from Kentucky → 275 E. Main Street

Same awarding agency

RFP-746-2700000006-1 | External Independent Third-Party Review (C6102)

Solicitation # RFP 746 2700000006

The Commonwealth of Kentucky Cabinet for Health and Family Services, Department for Medicaid Services, has issued solicitation RFP-746-2700000006-1 for a Personal Service Contract to provide External Independent Third-Party Reviews (EITPR). The selected contractor will assist the Department of Medicaid Services by performing timely and accurate reviews of adverse final decisions made by Managed Care Organizations regarding Medicaid provider appeals. The scope of work includes making medical necessity, administrative, and pharmacy determinations, developing a formal process for credentialing qualified clinicians, and ensuring all reviewers are free of conflicts of interest. Key deliverables include issuing final decisions within specific timeframes—30 calendar days for administrative reviews, 3 calendar days for pharmacy reviews, and 24 hours for expedited or urgent cases—as well as providing comprehensive review summaries and regular reporting. Proposals must be submitted electronically via the Kentucky Vendor Self Service System by September 15, 2026, at 2:00 PM Eastern Time. Submissions must be divided into three distinct parts: a Technical Proposal, a Cost Proposal, and Proprietary Information, with each part limited to a single attachment not exceeding 65,000 KB. The evaluation process will rank proposals based on technical merit and cost, with the lowest-priced proposal receiving maximum points for the cost component. The contractor is required to maintain strict HIPAA compliance as a Business Associate, implement robust data security via encryption or secure FTP, and hold cyber insurance or a performance bond for the full contract amount. Additionally, the contractor must comply with various Kentucky statutes, non-discrimination laws, and federal regulations, including prohibitions on using certain specified telecommunications and surveillance equipment.

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