Recovery Audit Contractor Services

The Texas Health and Human Services Commission, on behalf of the Office of Inspector General, is soliciting a qualified Recovery Audit Contractor to identify Medicaid underpayments and overpayments, known as improper payments, within the Texas Medicaid program. This scope of work includes Fee for Services and Managed Care Organizations under the Medicaid state plan and any associated waivers. The services must comply with federal regulations under 42 U.S.C. § 1396(a)(42)(B) and 42 CFR Part 455 Subpart F, as well as Texas Government Code Section 544.0504 and 1 TAC § 354.1451. The anticipated contract effective date is April 2027, with an initial term of three years and the option for two additional one-year extensions. The selection process is based on best value, with evaluation weights distributed across qualifications (30%), experience (30%), project work plan (20%), and technical proposal (20%). Pricing is not considered during the initial evaluation; instead, a contingency fee percentage will be negotiated with the highest-scoring respondent. Qualified candidates must have been in business for at least two years, be financially solvent, and provide key personnel with specific credentials, including a certified coder and a medical director or physician panel with active licensing. Submission requirements are strict, requiring a Statement of Qualifications not exceeding 25 pages and a mandatory VetHUB Subcontracting Plan. Responses must be submitted via the HHS Online Bid Room or on labeled USB drives by the September 9, 2026, deadline. Additionally, contractors must maintain specific insurance coverages and adhere to the Texas Risk And Authorization Management Plan (TX-RAMP) Level 2 certification standards.