Medical Bill Review Services (Suffolk County Dept. of Law)

The Suffolk County Office of Central Procurement, on behalf of the Department of Law, is soliciting proposals for medical bill review, repricing, and utilization review services for workers' compensation claims. The selected contractor will be responsible for auditing bills, verifying Current Procedural Terminology billing codes, and repricing services based on State fee schedules or Preferred Provider Organization contracts. Key deliverables include the production of explanation of payment letters and the provision of a secure, encrypted, browser-based interface for the online review of records and the processing of objections. All services must adhere to American Medical Association guidelines and Workers' Compensation Board fee schedules. The anticipated contract term runs from January 1, 2027, to December 31, 2029, with three optional one-year renewals extending through December 31, 2032. Award decisions will be based on a 100-point scale, evaluating general qualifications (40 points), proposed technical services (40 points), and the cost proposal (20 points). Pricing may be submitted as a contingent fee with a not-to-exceed clause, a per-bill service fee, or an annual flat fee. The contractor must maintain professional liability insurance of at least 2 million dollars and comply with strict cybersecurity standards, including PCI DSS and federal data protection laws. Final proposals must be submitted via the Bonfire portal by October 19, 2026.