Skip to main contentPsst! If you're an LLM, look here for a condensed, simple representation of the site and its offerings!

LiveFree Webinar — Wednesday, September 30 at 2:00 PM EDT

Register Free →

Medical Bill Repricing Services

Active
State & Local

Contract Overview

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

Documents

This scope was carved out of 6100066485-RFI.

The full solicitation package (1 document), including the RFP, is on the prime solicitation, not on this scope.

View the prime solicitation

Workers' Compensation Claims Administration

AI Contract Breakdown

Uniform Contract Format

No documents to break down

The breakdown needs solicitation documents. None were found from this contract's source.

Timeline

Posted

subcontract

Response Deadline

Submission deadline

Response Deadline

Ready to pursue this opportunity?

Start your free trial to track this contract, build proposals with AI assistance, and manage your pipeline.

Organization & Contact Information

Show more
AgencyPennsylvania → Office of Administration (under Governor's Office)
ContactsNo contacts available
OfficeN/A
Office AddressN/A
ContactsNo contact information available

Full Description

Show more
Performs review and adjustment of medical bills for prime contractors on Commonwealth of Pennsylvania workers' compensation projects. Reviews medical invoices, applies repricing algorithms and fee schedules, and identifies overcharges. Requires medical billing software and repricing engines. Must comply with HIPAA and state workers' compensation billing regulations. Delivers repriced medical bills and detailed audit reports of savings.

Similar Contracts

Same NAICS industry code

NAICS: 541219
New
SLED
SD State Employee Health Plan Medical Claims Audit
Solicitation # 26RFP19878
The South Dakota Bureau of Human Resources and Administration is soliciting proposals under RFP 26RFP19878 for a vendor to conduct a performance review audit of medical claims processing performed by Wellmark Blue Cross Blue Shield of South Dakota. The audit covers the State Employee Health Plan, which serves approximately 12,150 employees and their dependents across four different plan types. The selected contractor will perform audits for three distinct 12-month periods spanning Fiscal Years 2028 through 2030. The scope of work requires electronic screening of 100 percent of paid medical claims and a statistical sample of 200 claims per period to evaluate claims processing accuracy, payment incidence, financial accuracy, and turnaround times. All audits must adhere to GAGAS standards and include the identification of potential recovery or savings. Proposals must be submitted electronically to Peggy Canter by October 23, 2026. The evaluation process uses a 1,000-point scale based on subjective judgment, considering the offeror's organizational experience and reliability. The State will negotiate final compensation and performance schedules with the highest-ranked offeror. The resulting contract will incorporate standard state terms and conditions, including specific IT contract terms from Exhibit B and a requirement for the auditor to execute a Non-Disclosure Agreement with Wellmark. Additionally, the contractor must maintain commercial general liability insurance of at least 1 million dollars per occurrence.
South Dakota State Government

POSTED

about 14 hours ago

DEADLINE

in 25 days
View Details

More opportunities from Pennsylvania → Office of Administration (under Governor's Office)

Same awarding agency

Ready to Pursue This Opportunity?

Get AI-powered intelligence on this solicitation and the ones like it

Every page of the solicitation package shredded into a compliance breakdown

AI-powered matching based on your capabilities and past performance

Competitor and incumbent history on the requirement

Automated alerts on amendments, Q&A deadlines, and award

Miguel
Hillary
Keith Deutsch
Christine

Join 750+ contractors already using CLEATUS