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Medical and Pharmacy Claims Audit Subject Matter Experts (SMEs)

Active

State & Local

Response Deadline10/24/2026, 04:59:00 AM 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 for the South Dakota State Government seeks subject matter experts to perform performance review audits of medical and pharmacy claims processing for prime contractors on Bureau of Human Resources and Administration projects. The selected provider will analyze 108 million dollars in claims data using statistically valid sampling methods in accordance with GAGAS Yellow Book standards. The contract requires the delivery of performance review audit reports across three 12-month periods. Qualified candidates must hold professional medical auditing certifications and agree to the execution of a non-disclosure agreement. The solicitation is categorized under NAICS code 541211 and has a response deadline of October 24, 2026.

General Info

Medical and pharmacy claims audit services for South Dakota government, deadline October 24, 2026.

Agency

South Dakota State Government

NAICS

541211 - Offices of Certified Public Accountants

Place of Performance

SD, USA

Set-Aside

NONE

Documents

This scope was carved out of 26RFP19878.

The full solicitation package (2 documents), including the RFP, is on the prime solicitation, not on this scope.

View the prime solicitation

SD State Employee Health Plan Medical Claims Audit

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Timeline

PostedSep 28

subcontract

Response DeadlineOct 24

Submission deadline

Response Deadline

10/24/2026, 04:59:00 AM UTCin 25 days

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Organization & Contact Information

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AgencySouth Dakota State Government

ContactsNo contacts available

OfficeN/A

Organization / AgencySouth Dakota State Government

Office AddressN/A

ContactsNo contact information available

Full Description

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Performs a performance review audit of medical and pharmacy claims processing for prime contractors on South Dakota Bureau of Human Resources & Administration (BHRA) projects. Conducts audits per GAGAS (Yellow Book) standards using statistically valid sampling to analyze $108 million in claims data. Requires professional medical auditing certifications and execution of an NDA. Delivers performance review audit reports for three 12-month periods.

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