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Medicaid Claims Processing Services

Closed

RFP #F1052A-23State & Local

Submission Closed06/16/2026, 08:00:00 PM UTC

Contract Overview

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

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NAICS: 524292

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State of South Dakota Account Based Plans (HRA, HSA and FSA)

Solicitation # 26RFP19879

The State of South Dakota Bureau of Human Resources and Administration is seeking a qualified vendor under solicitation 26RFP19879 to provide comprehensive administration services for its Account Based Plans. The scope of work includes the management of Health Savings Accounts (HSA), Health Reimbursement Arrangements (HRA), and Medical and Dependent Care Flexible Spending Accounts (FSA). The state aims to secure a partnership that leverages innovative technology and exceptional service to ensure a positive participant experience while supporting the long-term Tidal Rewards strategy. Proposals must be submitted electronically in MS Word or PDF format to Peggy Carter by October 28, 2026, at 5:00 PM CDT, with a total email size limit of 20MB. All submissions must be signed by an authorized representative and reference the solicitation number. The state will not award contracts to entities in arrears on obligations to South Dakota or those deemed irresponsible. Additionally, all IT-related purchases associated with the contract require approval from the Bureau of Information and Technology. An award decision and contract negotiation are anticipated by December 14, 2026.

South Dakota State Government

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TPA Workers' Compensation

Solicitation # 127-2026

The Southwest Ohio Regional Transit Authority (SORTA), operating as Cincinnati Metro, is soliciting proposals for a Third-Party Administrator (TPA) to manage its self-insured Workers' Compensation program. The scope of work includes comprehensive claims administration from intake to closure, medical management, cost containment, legal support, and regulatory compliance in accordance with Ohio Workers' Compensation laws and the Ohio Industrial Commission. Additionally, the TPA will provide safety consulting, OSHA/VSSR review services, and bi-weekly payment forecasts. Proposals must be submitted electronically by November 4, 2026, and must be divided into a Technical Proposal and a Business Proposal, with pricing submitted separately via a firm-fixed price proposal and a Vendor Questionnaire. Award selection will be based on the most advantageous proposal, with evaluation heavily weighted toward the project approach (45 percent) and firm and staffing qualifications (35 percent). The selected contractor must comply with strict federal and state regulations, including the Americans with Disabilities Act, Title VII of the Civil Rights Act, and Equal Employment Opportunity requirements. Contractual terms include NET 30 payment schedules, a requirement for designated project managers from both parties, and a three-year record retention policy. Funding is contingent upon annual appropriations, and the contractor must maintain comprehensive insurance coverage, including Professional Liability and Errors and Omissions.

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Request for Proposal - Third Party Administrative and Actuarial Services

Solicitation # 2025-RFP-127

The City of Cleveland Department of Finance, Division of Risk Management, is soliciting competitive bids for Third-Party Administrative and Actuarial Services under solicitation 2025-RFP-127. The selected Third-Party Administrator will be responsible for managing Ohio Bureau of Workers' Compensation claims and conducting detailed liability claim reviews to reduce premium costs and minimize organizational exposure. Key deliverables include administrative claims handling, the provision of online communication tools, and the delivery of annual unmodified SOC 1 Type II and SOC 2 Type II reports to validate data security and processing controls. Technical requirements mandate that data be encrypted at rest using AES-256 and in transit via TLS 1.3, with strict adherence to PII and data breach notification laws. Proposals are due by October 29, 2026, and will be evaluated through a phased, points-based process. Phase 1 assesses the quality of the proposal, demonstrated ability, OEO compliance, technical components, key personnel credentials, and the proposed schedule, while Phase 2 may involve presentations for shortlisted teams. Compensation will be based on a simple time-based method or a mutually agreed-upon fee schedule. Contractors must maintain comprehensive general liability insurance of at least 2 million dollars and business automobile liability of 1 million dollars. Additionally, successful bidders must comply with the Cleveland Area Business Code, including good-faith efforts to involve certified Minority, Female, and Cleveland Small Business Enterprises, and must file a written affirmative action program within 60 days of contract execution.

Finance - Division of Risk Management

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Vehicle Assistance and Claims AdministratorThe Vehicle Assistance and Claims Administrator subcontract, issued by the US Embassy Paris for the Department of State, involves providing roadside assistance and third-party insurance claims management for prime contractors in France. The selected provider will manage assistance for 112 vehicles, settle third-party claims, and recover expenses related to personnel and equipment. Key deliverables include the resolution of claims, the recovery of funds, and detailed documentation of all roadside assistance events. To be eligible, the contractor must possess a Kbis registration and appoint a Project Manager who is fluent in both English and French. The work will be performed in Paris, France, under NAICS code 524292. Responses for this opportunity are due by November 6, 2026.

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Announcement of RFP for Retirement Plan Administration and Record Keeping Services

Solicitation # LC26028

Lane County is seeking proposals from qualified firms to provide comprehensive administration, record keeping, education, and investment-related services for its 457 Deferred Compensation Plans and 401(a) Defined Contribution Plan. The primary objectives of this solicitation are to enhance participant retirement outcomes, improve education and communication, and implement robust online transaction capabilities. Additionally, the County aims to reduce expenses, evaluate competitive pricing structures, and streamline administrative functions through automation and integrated reporting. Interested parties must request solicitation documents from the designated consultants by November 12, 2026, at 5:00 PM. The final deadline for proposal submissions is November 20, 2026. The selected firm will be expected to ensure an orderly transition of assets and services while maintaining a strong working relationship with the Deferred Compensation Advisory Committee.

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Nevada State Pharmacy Benefit Manager

Solicitation # 41NHA-S3992

The Nevada Health Authority Director's Office is seeking proposals for a Nevada State Pharmacy Benefit Manager under solicitation number 41NHA-S3992. This state-level procurement opportunity is managed by the Nevada Health Authority in Carson City and is open for responses until December 29, 2026. Interested parties should coordinate with the primary purchaser, Heather Moon, or the designated administration contact for further inquiries. All detailed requirements and submission guidelines are contained within the official solicitation attachments provided through the Nevada ePro portal.

410 - Nevada Health Authority Director's Office

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Solicitation # 2611-KP

The Sacramento Housing and Redevelopment Agency (SHRA) is soliciting proposals under RFP 2611-KP for a qualified actuarial services firm to manage its Other Post-Employment Benefits (OPEB) program. The primary objective is to obtain professional services for measuring liabilities, supporting funding decisions, and ensuring compliance with GASB 75 financial reporting standards. The scope of work includes performing full actuarial valuations, developing Actuarially Determined Contributions (ADCs), and providing advisory services for prefunding strategies and long-term planning. The selected contractor will be required to handle complex plan designs, including various contribution structures based on hire dates and PEMHCA vesting-based subsidies, while coordinating with independent auditors. The contract is envisioned as an initial one-year term with options to extend for up to four additional periods, not to exceed five years in total. Key deliverables include actuarial valuation reports for the years 2026 through 2030, kickoff and review meetings, and presentations to executive management or the governing board. Proposals must be submitted via the Agency's Electronic Bid Portal by October 29, 2026, with an anticipated start date of December 7, 2026. Selection is based on a two-stage process evaluating technical qualifications, past performance, and cost, with a minimum technical score of 70 percent required for responsiveness. Contractors must adhere to strict compliance requirements, including maintaining acceptable insurance coverage, complying with the Federal Privacy Act of 1974, and certifying no conflicts of interest. Subcontracting is generally prohibited. Payment will be made based on an agreed-upon method such as invoice, task, or monthly billing, provided that all invoices include a valid SHRA Purchase Order number and itemized details of work performed. The Agency encourages participation from small, minority, and women-owned business enterprises.

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Medicaid Medication Risk Reduction Initiative

Solicitation # RFP-2027-DMS-01-MEDIC

The New Hampshire Department of Health and Human Services, Division of Medicaid Services, is soliciting proposals for a statewide Medicaid Medication Risk Reduction Initiative (MMRRI). This program will be led by New Hampshire licensed clinical pharmacists to reduce medication-related problems, adverse drug events, polypharmacy, over-prescribing, and risks associated with opioids and behavioral health medications. The selected vendor will implement a technology solution to analyze pharmacy claims and encounter data to identify high-risk beneficiaries, conduct comprehensive medication reviews, and generate actionable medication safety reports for patients and providers. The contract has an anticipated total funding value of approximately 33,553,391 dollars, distributed across five budget periods through September 2031, and is supported by federal funds under the Rural Health Transformation Program. Key performance requirements include a guaranteed positive return on investment by the end of the third contract year, measured by a reduction in total cost of care on a per member per month basis. Vendors must possess at least three years of experience in pharmacy data analysis and medication review. Award decisions will be based on a point system evaluating technical and cost responses, with a minimum technical score of 1,600 points required to avoid disqualification. The contractor must adhere to strict data security standards, including maintaining an Information Security Management System and ensuring all data processing occurs within the United States. Compliance with Title VI of the Civil Rights Act, the Americans with Disabilities Act, and 2 CFR Part 200 is mandatory. Proposals are due by October 28, 2026, and must be submitted as separate technical and cost documents.

Dhhs-Department Of Health & Human Services

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Pharmacy Drug Benefits

Solicitation # HHS0017240

The Texas Department of State Health Services (DSHS) is soliciting proposals under solicitation number HHS0017240 for a Pharmacy Benefits Manager (PBM) to support the Texas HIV Medications Program (THMP). The selected PBM will act as a secondary payor to manage prescription drug benefits, premium payments, and copayments through three primary programs: the State Pharmacy Assistance Program (SPAP) for Medicare Part D costs, the Texas Insurance Assistance Program (TIAP) for medication copayments and COBRA premiums, and the Texas Insurance Assistance Program-PLUS (TIAP-PLUS) for private and federal marketplace plan assistance. The scope of work involves processing medication claims and monthly invoice premium payments, with historical data indicating the management of over 15,000 claims for approximately 2,764 participants. The contract features an initial one-year term with the possibility of four additional one-year extensions and one final option period at the discretion of DSHS. Award selection is based on best value, evaluated through a weighted scoring system consisting of the Project Workplan (45%), Cost Proposal (35%), and Qualifications and Experience (20%). Proposals must be submitted by November 19, 2026, via either USB drive or an online bid room. Requirements include a narrative proposal limited to 40 pages, a separate Excel-based cost proposal, and a VetHUB Subcontracting Plan. The contract is governed by Texas Government Code Section 2155.144 and incorporates various HHS uniform terms, additional provisions, and a Data Use Agreement.

Department of State Health Services

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DAS Behavioral Health Third-Party Administrator RFP

Solicitation # SRC0000040548

The State of Ohio, through the Department of Administrative Services, is soliciting proposals for a Third-Party Administrator to manage its self-insured Behavioral Health Benefit Plan. Starting July 1, 2027, the selected contractor will provide administrative services for approximately 43,800 employees and 104,600 total lives. Key responsibilities include managing eligibility, claims history, prior authorizations, utilization management, and data integration with the State's data warehouse. The contract runs from the date of signature through June 30, 2030, with the possibility of a one-month discretionary renewal and further mutual renewals for up to four additional years. To be eligible, offerors must be NCQA accredited and comply with the Mental Health Parity and Addiction Equity Act. The evaluation process is based on a total score derived from technical requirements, cost, and presentations, with the highest-ranking responsible offeror recommended for award. Financial terms utilize a not-to-exceed unit cost fee structure, and the contractor must provide a Benefits Fund of at least 150,000 dollars. Strict compliance is required regarding HIPAA through a Business Associate Agreement, State IT policies, and secure data transfer protocols via SFTP. Proposals must be submitted electronically through the OhioBuys portal, consisting of separate technical and cost volumes.

Administrative Services

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Employee Benefits- Life/STD/FSA/HSA/COBRA

Solicitation # 27-011CH-32RFP

The Tempe Union High School District is soliciting proposals under solicitation number 27-011CH-32RFP to secure a provider for the administration of employee benefits, including Basic and Voluntary Life and Accidental Death and Dismemberment, Short-Term Disability, Flexible Spending Account, Health Spending Account, and COBRA administration. The intended contract period runs from July 1, 2027, through June 30, 2032. Key requirements include the waiver of pre-existing condition limitations for initially enrolled employees and dependents, the elimination of active-at-work restrictions, and a guarantee that no employee suffers a loss of benefits during a carrier change. The selected vendor must provide a designated account management team, bilingual educational materials, and attendance at four days of annual open enrollment meetings in Tempe, Arizona. The award process utilizes a point formula system across three phases: initial evaluation, vendor interviews, and a best and final offer. Evaluation factors include responsiveness, cost, and past performance, with a minimum of 500 technical points required to proceed to price evaluation. The District intends to award the least number of vendors necessary, with contracts potentially awarded by individual product lines. Proposals must be submitted via the OpenGov portal by November 19, 2026. The contract is subject to Arizona Revised Statutes and School District Procurement Rules, featuring a zero-tolerance gift policy and net 30-day payment terms. Implementation must be completed 60 days prior to open enrollment, with a required 45-day support period following the July 1 effective date.

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COBRA Administration, Retiree Billing & FSA Administration

Solicitation # RFP 2435

The Township of Wayne, New Jersey, issued Request for Proposal RFP 2435 to secure a qualified organization for comprehensive COBRA Administration, Retiree Billing, and Flexible Spending Account (FSA) Administration services. With an effective start date of January 1, 2027, the selected vendor will manage notice generation, election tracking, premium administration, and direct billing for retirees, as well as provide regulatory compliance support and vendor integration. The contract duration is up to two years, with the possibility of two additional one-year extensions. Proposals must be submitted electronically via the ProcureNow portal by October 29, 2026, at 11:00 am. Award selection may be based on the lowest responsive bid or a points-based evaluation focusing on qualifications, method statement, history and experience, resource availability, and references. Mandatory submission requirements include a Statement of Ownership Disclosure, a notarized Non-Collusion Affidavit, and certifications regarding affirmative action and prohibited activities in Russia, Belarus, and Iran. The successful contractor must maintain specific insurance coverages, including a minimum of 1,000,000 dollars for Business Automobile and Umbrella liability, and at least 2,000,000 dollars per occurrence for certain data losses. Additionally, the vendor must ensure strict adherence to HIPAA regulations and New Jersey state statutory requirements.

Purchasing Division

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7 days ago

DEADLINE

in 1 day

AI Contract Overview

Lewisville Independent School District (LISD) is seeking proposals for Medicaid Claims Processing Services under RFP #F1052A-23. The contract involves processing School Health and Related Services (SHARS) Medicaid claims, providing annual training for all Medicaid providers, and ongoing technical consultation on Medicaid regulations and submission requirements. The scope may expand to include other departments or functionalities as needed. Vendors, including sole source providers, must submit complete proposals with all required attachments to be considered, as incomplete submissions may negatively affect evaluations. The District reserves the right to award the contract to multiple vendors supplying comparable services or to a single vendor, based on what provides the best value. The initial contract term runs from August 2026 through August 2027, with four possible one-year renewals through August 2031, for a total of five terms if all renewals are exercised. If vendors do not notify LISD at least 90 days before a renewal date, the contract will automatically renew under existing terms. In some cases, LISD may extend the current term for up to 90 days beyond the expiration date to ensure uninterrupted service. The District's point of contact for this solicitation is the Assistant Director, June McMahon. Responses must be submitted by June 16, 2026, and the opportunity is open to all vendors interested in providing these specialized Medicaid-related services in Texas.

General Info

LISD seeks vendors for Medicaid claims processing, training, and consultation from Aug 2026 to 2031.

Agency

Texas → Lewisville ISD

NAICS

524292 - Pharmacy Benefit Management and Other Third Party Administration of Insurance and Pension Funds

Place of Performance

TX, USA

Set-Aside

NONE

Documents

Lewisville ISD Vendor Insurance Requirements 091523

insurance-requirements

High

LISD Terms and Conditions 071725

terms-and-conditions

High

RFP F1052A-23 Medicaid Claims Processing Services

rfp

High

TX NDPA v1r6 Student Data Privacy Agreement Lewisville ISD

23 pages · contract-document

High

Conflict of Interest Questionnaire (CIQ Form 2015)

2 pages · conflict-of-interest-questionnaire

Low

Form 1295 - Certificate of Interested Parties for Lewisville ISD Contract

1 page · certificate-of-interested-parties

Low

IRS Form W-9 Request for Taxpayer Identification Number and Certification Rev 2024

6 pages · tax-form

Low

Lewisville ISD Sample Certificate of Insurance (COI)

1 page · other

Low

Lewisville ISD Vendor Insurance Acknowledgment

2 pages · vendor-insurance-acknowledgment

Low

LISD Public Records Agreement

2 pages · public-records-agreement

Low

Pre-Employment or Pre-Service Affidavit for Educational Entities TEC-22A055

3 pages · pre-employment-affidavit

Low

Vendor Insurance Coverage Terms Reference

other

Low

AI Contract Breakdown

Uniform Contract Format

Timeline

PhaseClosed

PostedMay 22

Solicitation

Response DeadlineJun 16

Deadline has passed

Submission Closed

06/16/2026, 08:00:00 PM UTC

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Organization & Contact Information

AgencyTexas → Lewisville ISD

Contacts1 person available

OfficeTX, USA

Organization / AgencyTexas → Lewisville ISD

Office AddressTX, USA

Contacts

June McMahonAssistant Director

contact@example.gov

+1 (555) 000-0000

Full Description

Lewisville Independent School District, (LISD or DISTRICT) is accepting supplemental proposals and pricing for the processing of School Health and Related Services (SHARS) Medicaid claims, annual training of all Medicaid providers, on-going technical consultation on Medicaid regulations and requirements for submissions. Other departments and functionalities may be included at any time. All interested vendors, including sole source providers, are encouraged to respond to this request for proposal in its entirety and should submit all required bid attachments regardless of sole source status to be considered. Missing or incomplete information will have a negative impact on vendor evaluations. RFP #F1052A-23 shall be awarded at District discretion, to multiple Proposers supplying comparable products or services, also known as a multiple award schedule, or award the Contract to a single Proposer. The District's decision to make multiple awards or a single award will be based upon the District's sole discretion regarding the type of products and/or services that provides best value to The District. If vendor does not notify the District 90 days before any renewal date(s), the District will auto-renew the bid under the existing terms and conditions. Lewisville ISD has the option to extend this RFP at the end of the performance period for up to 90 days if determined to be in the best interest of the district to ensure availability of products and/or services. The initial term of this proposal shall be from August 2026 - August 2027. Dependent on the long-range needs of the District, this bid will automatically renew for the terms listed below. If vendor does not wish to renew, or wishes to renew with new terms and conditions, please contact LISD within 90 days of the renewal term. There will be four successive renewals, each consisting of a one year term. Initial Anticipated Contract Term: August 2026 - August 2027 Second Term: August 2027 - August 2028 Third Term: August 2028 - August 2029 Fourth Term: August 2029 - August 2030 Fifth and Final Term: August 2030 - August 2031