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Medical Necessity Independent Review Services

Active

State & Local

Response Deadline09/30/2026, 06:00:00 PM 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 Medical Necessity Independent Review Services involves performing independent clinical reviews of Medicaid cases for prime contractors supporting the Commonwealth of Kentucky Department of Medicaid Services. The primary objective is to conduct detailed clinical reviews of patient cases and provide formal determinations regarding medical necessity criteria. The project requires licensed healthcare professionals, specifically MDs or DOs with relevant specialty expertise and certified conflict-of-interest clearances. The successful provider will be responsible for delivering final clinical decisions on medical necessity cases under NAICS code 621399.

General Info

Subcontract for MDs/DOs to perform medical necessity clinical reviews for Kentucky Medicaid.

Agency

Kentucky → 275 E. Main StreetView Agency

NAICS

621399 - Offices of All Other Miscellaneous Health PractitionersView NAICS

Place of Performance

Other, KY, USA

Set-Aside

NONE

Documents

This scope was carved out of RFP-746-2700000006-2.

The full solicitation package (8 documents), including the RFP, is on the prime solicitation, not on this scope.

View the prime solicitation

RFP-746-2700000006-2 | External Independent Third-Party Review (C6102)

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Timeline

PostedSep 14

subcontract

Response DeadlineSep 30

Submission deadline

Response Deadline

09/30/2026, 06:00:00 PM UTCin 16 days

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Organization & Contact Information

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AgencyKentucky → 275 E. Main Street

ContactsNo contacts available

OfficeN/A

Organization / Agency

Kentucky → 275 E. Main Street

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Office AddressN/A

ContactsNo contact information available

Full Description

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Performs independent clinical reviews of Medicaid cases for prime contractors on Commonwealth of Kentucky Department of Medicaid Services projects. Conducts clinical reviews of patient cases and renders formal determinations on medical necessity criteria. Requires licensed healthcare professionals (MDs, DOs) with specialty expertise and conflict-of-interest certifications. Delivers rendered clinical decisions for medical necessity cases.

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