Medicaid Claims Processing & Adjudication Services

The contract titled Medicaid Claims Processing & Adjudication Services encompasses full-cycle handling of Medicaid 1115 waiver claims, requiring comprehensive services such as real-time eligibility verification, accurate coding validation, precise payment calculation, and systematic denial management. The performance scope demands a robust technical infrastructure capable of integrating with state systems to ensure timely, compliant, and error-free claim adjudication throughout the entire lifecycle. The work must be completed with strict adherence to federal and state Medicaid regulations governing the 1115 waiver program, ensuring fiscal integrity and service continuity for beneficiaries. This subcontract opportunity, posted on July 6, 2026, with a response deadline of July 28, 2026, is classified under NAICS code 621399 and is issued by the state of Utah. The place of performance and agency office details are unspecified, but the work is intended to support Utah’s Medicaid program. Interested parties must submit proposals through the designated BonfireHub portal prior to the deadline, and no set-aside provisions have been indicated. The contract seeks a capable subcontractor with proven experience in large-scale public healthcare claims processing and demonstrated ability to manage complex waiver-related workflows under tight regulatory constraints.