Self-Funded Health Plan Claims Audit Services
Multnomah County
Original Solicitation Links
RFP-12-2027
]medical claims audit
Contact
Submission Instructions
Description
Multnomah County seeks one contractor to conduct comprehensive independent audits and operational assessments of its self-funded medical, prescription, and dental health plans. The work includes a 100% electronic claims audit and targeted sample audits; methodology, quality assurance, error checking, dispute resolution, and corrective-action planning; semimonthly progress reporting; final reporting; and knowledge transfer or training for County staff. Proposals must address experience with comparable public-sector health plans, including at least three relevant case studies or references and outcomes such as error rates, recovered overpayments, and corrective actions. The contractor must describe data-security practices for protected health information, including HIPAA and HITECH compliance, encryption, access controls, breach response, and relevant certifications. Proposals must include fixed fees for each scope of service and hourly rates for additional work or extensions, as well as responses concerning subcontractor management, conflicts of interest, technology and analytics tools, risk management, innovation, performance metrics, energy conservation, equity-focused analysis, and workforce practices. The County may issue a contract not to exceed five years and may request additional projects individually not expected to exceed $10,000.
Classification Codes
Smart Codes
Specifications
Timeline
Join Google MeetRequirements
- Professional Liability (Errors & Omissions) — $1,000,000.00
- Commercial General Liability — $1,000,000.00
- Automobile Liability — $500,000.00
- Workers' Compensation — $500,000.00
- Cyber Liability — $1,000,000.00
- Minimum 3 references
Location
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