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Pharmacy Claims Processing & Adjudication

Active

State & Local

Response Deadline11/19/2026, 04:30:00 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 Pharmacy Claims Processing and Adjudication supports the Texas Department of State Health Services HIV medication programs. The selected provider will be responsible for the technical processing and adjudication of medication claims for prime contractors, which includes managing copayments, deductibles, and coinsurance. A critical component of the scope involves coordinating benefits with private insurance plans and Medicare Part D to ensure accurate payment records and claims delivery. To execute these services, the contractor must utilize specialized PBM adjudication software and maintain strict adherence to security privacy inquiries and Data Use Agreements. Interested parties should note that the response deadline is November 19, 2026, and the project falls under NAICS code 541990.

General Info

Pharmacy claims processing and adjudication for Texas HIV programs, due November 19, 2026.

Agency

Texas → Department of State Health Services

NAICS

541990 - All Other Professional, Scientific, and Technical Services

Place of Performance

TX, USA

Set-Aside

NONE

Documents

This scope was carved out of HHS0017240.

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

View the prime solicitation

Pharmacy Drug Benefits

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

PostedOct 21

subcontract

Response DeadlineNov 19

Submission deadline

Response Deadline

11/19/2026, 04:30:00 PM UTCin 28 days

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Organization & Contact Information

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AgencyTexas → Department of State Health Services

ContactsNo contacts available

OfficeN/A

Organization / Agency

Texas → Department of State Health Services

Office AddressN/A

ContactsNo contact information available

Full Description

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Performs technical processing and adjudication of medication claims for prime contractors on Texas Department of State Health Services (DSHS) HIV medication programs. Coordinates benefits with primary insurers including Medicare Part D and private plans, and manages adjudication of copayments, deductibles, and coinsurance. Requires PBM adjudication software and compliance with Data Use Agreements and security privacy inquiries. Delivers adjudicated claims and payment records.

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