Real-Time Eligibility Verification Services

The contract seeks contractors to provide real-time eligibility verification services for Medicare Part D beneficiaries, ensuring accurate confirmation of coverage status, formulary alignment, and cost-sharing details prior to claim submission. This service is critical to minimizing claim rejections, reducing administrative burden, and improving beneficiary experience by verifying eligibility instantaneously through secure, integrated systems. Contractors must deliver reliable, low-latency access to up-to-date Medicare Part D data, adhering to federal privacy and security standards while maintaining high availability and accuracy during peak usage periods. The solicitation is classified as a subcontract under NAICS code 518210, issued by the Health and Human Services Commission in Texas, with responses due by August 17, 2026. The work is performance-based and likely requires seamless integration with existing federal and state healthcare data infrastructures. While the physical place of performance is unspecified, services must be accessible nationwide to support providers across all jurisdictions. Contractors must demonstrate proven experience in real-time healthcare data exchange, compliance with HIPAA and CMS requirements, and the technical capability to handle high-volume transaction loads without disruption.