RFP-746-2700000006-2 | External Independent Third-Party Review (C6102)

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 Review (EITPR) services. The contractor will be responsible for conducting independent clinical reviews, including medical necessity, administrative, and pharmacy reviews, for approximately 7,200 cases per year. Key deliverables include issuing final decisions within 30 calendar days of receiving appeal materials, providing detailed review summaries, and maintaining a comprehensive Standard Operating Procedure for the credentialing and assignment of qualified clinicians. The contract covers fiscal years 2027 and 2028, with payment based on an all-inclusive rate per rendered decision. Proposals are evaluated on a 1,600-point scale, focusing on technical approach, reporting, monitoring, and personnel specifications, with a minimum technical score of 600 required for further consideration. The selected vendor must adhere to strict regulatory standards, including HIPAA compliance via a Business Associate Agreement and adherence to federal and state Medicaid statutes. Mandatory requirements include maintaining cyber insurance or a performance bond, complying with non-discrimination laws, and ensuring that all personnel are not ineligible persons under federal healthcare program exclusion lists. Proposals must be submitted electronically via the Kentucky Vendor Self Service System by September 15, 2026.