Third Party Medical Reviews

The Kansas Department of Health and Environment is seeking proposals from qualified vendors to establish an external, independent third-party review process for healthcare providers who have had services denied. The contract, anticipated to commence on July 1, 2026, with a three-year base period ending June 30, 2029, includes options for two additional one-year renewals. The scope involves conducting medical reviews of denied claims, providing annual reports, and ensuring compliance with all applicable standards and regulations. The procurement emphasizes transparency, requiring detailed technical and cost proposals, separate submission formats, and certifications such as tax clearance, immigration compliance, sexual harassment policies, and certifications related to Boycott of Israel and disabled veteran preferences. The contract value ranges from 500,000 to 2 million dollars, with the primary contact being Lara J. Williams, and proposals are due by September 23, 2025. The contractual framework incorporates the State of Kansas’s standard provisions, notably the Contractual Provisions Attachment (Form DA-146a, Rev. 07/19), which governs legal terms and precedence. The contract mandates compliance with Kansas statutes, environmental laws, and federal statutes like IRCA, emphasizing contractor integrity, confidentiality, and conflict of interest restrictions. While the contract does not specify federal FAR clauses, it incorporates state-specific clauses on debarment, environmental protection, and data security, along with provisions for amendments, change requests, and performance monitoring. The work is to be performed within Kansas, with inspection at destination, where the State retains authority to reject non-conforming deliverables. Payment procedures involve submission of invoices post-approval, with no explicit federal invoicing systems required. The proposal evaluation will consider cost, completeness, understanding of the scope, experience, and methodology, with awards made in the best interest of the State, primarily to the lowest responsive bidder. Overall, the contract emphasizes rigorous compliance, detailed documentation, and adherence to industry standards to ensure impartial, timely review services for healthcare denials.