Medical Claims Audit and Health Plan Assessment
Multnomah County
Original Solicitation Links
RFP-12-2027
]MEDICAL CLAIMS AUDIT
Original Notices
MULTNOMAH COUNTY, OREGON MEDICAL CLAIMS AUDIT Proposals due: September 23, 2026 @ 4:00 PM REQUEST FOR PROPOSALS Request for Proposal (RFP) Sourcing Event No: RFP-12-2027 Sourcing Event Name: Medical Claims Audit Proposals due by 4:00 P.M. on: September 23, 2026 Pre-Proposal Conference: September 02, 2026 at 1:30PM PT Google Meet joining info Video call link: https://meet.google.com/hxf-iozj-xnf Or Call (US) +1 405-358-3143 PIN: 404 556 057# Medical Claims Audit SUMMARY: Multnomah County seeks proposals from qualified contractors to conduct comprehensive claims audits and operational assessments for its self-funded health plan. The selected contractor will perform independent audits at the discretion of the County, the scope to be determined at the discretion of the County. RFP AVAILABILITY: To access the RFP, visit https://multco.us/purchasing/bids-proposal-opportunities then scroll down for new business opportunities. Proposals must be submitted electronically thro
Contact
Submission Instructions
Description
Multnomah County seeks a qualified contractor to conduct comprehensive medical, prescription, and dental claims audits and operational assessments for its self-funded health plans. The work includes a 100% electronic claims audit and targeted sample audit; verification of fiscal accountability and compliance with plan documents; identification of overpayments, cost-recovery opportunities, and process improvements; quality-assurance and error-checking procedures; dispute resolution with the health plan; corrective-action-plan development and monitoring; semimonthly progress reporting; and knowledge transfer through training or documentation. Proposals must address methodology, relevant public-sector experience with at least three case studies or references, fixed fees and hourly rates, subcontractor management, conflicts of interest, follow-up reporting, HIPAA and other data-security compliance, technology and analytics tools, risk management, innovation, performance metrics, energy conservation, equity-focused analysis, and workforce practices. The contractor may use disclosed subcontractors but remains responsible for all services. The County may issue a contract not to exceed five years, with one contract awarded. Insurance requirements include professional liability, commercial general liability, automobile liability when applicable, workers' compensation, and cyber liability.
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
Documents
| Title | Date Posted |
|---|---|
| rfp082426t | Aug 24, 2026 11:00 AM |
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