Utilization Management Technical Solutions RFI

Noridian Healthcare Solutions, LLC is issuing a Request for Information (RFI) to identify qualified technology providers and strategic partners capable of delivering configurable technical solutions for end-to-end utilization management (UM) workflows. The primary objective is to modernize the evaluation of medical necessity, appropriateness of care, provider compliance, and program integrity for federal and state healthcare programs. The scope of the RFI covers a wide range of capabilities, including clinical operations such as intake, prior authorization, and appeals, as well as workflow automation, provider engagement portals, data interoperability using HL7, FHIR, and X12 standards, and the integration of AI and advanced intelligence. This opportunity is open to a broad range of small business entities, including SDB, WOSB, HUBZone, VOSB, and SDVOSB certifications, under NAICS code 541512. Interested respondents must notify Noridian via email to gain access to the Agiloft Contract Management System, where all official correspondence and submissions must be conducted. Responses are required to be submitted using a specific templated spreadsheet by September 21, 2026. Following a comprehensive review of the submissions, Noridian may invite selected respondents to participate in solution demonstrations during the fourth quarter of 2026. Respondents must certify that they are not debarred or suspended and have no conflicts of interest that would prohibit contracting with Noridian.