This Solicitation opportunity from Kentucky was posted on August 7, 2026. The submission period has ended. Browse the details below for market research, or find similar active opportunities.
RFP-746-2700000006-1 | External Independent Third-Party Review (C6102)
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The Commonwealth of Kentucky Cabinet for Health and Family Services, Department for Medicaid Services, is soliciting proposals for a Personal Service Contract to provide External Independent Third-Party Reviews (EITPR) for fiscal years 2027 and 2028. The selected contractor will perform administrative, medical necessity, and pharmacy reviews of adverse final decisions made by Managed Care Organizations regarding Medicaid provider appeals. Key deliverables include issuing final decisions within 30 calendar days for administrative cases, 3 calendar days for pharmacy cases, and 24 hours for expedited requests. The contractor is also required to develop a comprehensive Standard Operating Procedure for clinician credentialing and provide regular monthly, quarterly, and annual reports. Proposals must be submitted electronically via the Kentucky Vendor Self Service System by September 15, 2026, and must be divided into three distinct parts: a technical proposal, a cost proposal based on an all-inclusive rate per rendered decision for approximately 7,200 annual cases, and proprietary information. Evaluation is based on technical merit, with a minimum score of 600 points required to avoid elimination, and cost. The contract mandates strict adherence to HIPAA and HITECH Act compliance through a Business Associate Agreement, as well as the maintenance of cyber insurance or a performance bond for the full contract amount. Additionally, the contractor must comply with various Kentucky Revised Statutes regarding taxes, labor laws, and lobbying prohibitions, and ensure all personnel are not ineligible for federal health care programs.
General Info
Agency
NAICS
Place of Performance
Other, KY, USASet-Aside
Timeline
Submission Closed
Organization & Contact Information
Full Description
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