Medical Review Services

This subcontract opportunity with the Department of Health and Human Services involves providing medical review services for prime contractors on CMS Medicare Administrative Contractor projects. The selected provider will perform clinical reviews of medical records against Medicare medical necessity guidelines to determine claim validity and deliver comprehensive clinical review reports. Due to the technical nature of the work, the contract requires personnel who are certified medical coders or licensed medical professionals, such as MDs, RNs, or LPNs. The project is managed by the Office of Acquisition and Grants Management and is centered in Baltimore. Interested parties must submit their responses by November 2, 2026. The work falls under NAICS code 621999 and focuses on the delivery of critical medical necessity determinations to ensure compliance with federal healthcare standards.