Claims Editing Software Solution
Inland Empire Health Plan
Original Solicitation Links
26-07372
]claims editing software
Contact
Submission Instructions
Description
Inland Empire Health Plan is soliciting proposals for a comprehensive post-adjudication, pre-payment claims editing solution. The solution must provide clinical, coding, contractual, and regulatory edits; standard rule-based and complex logic editing; historical claims review and data mining; specialty-focused editing for areas such as hospice and laboratory services; configurable custom edits; analytics to identify improper payments, fraud, waste, abuse, coding inaccuracies, and missed savings opportunities; and continuous optimization and maintenance. The selected vendor must integrate with IEHP’s MediTrac and HealthEdge HRP claims platforms through real-time API connectivity and nightly batch processing. The scope includes implementation, configuration, training, technical support, provider-facing explanations and remittance advice mapping, operational workflow support, and security and data-sharing assessments. Proposals must include extensive company, staffing, financial, technical, security, pricing, past-performance, and demonstration materials, including a pre-recorded demonstration of no more than 30 minutes. The anticipated term is one year with up to four additional one-year renewal periods.
Classification Codes
Smart Codes
Specifications
Timeline
Requirements
- Workers' Compensation
- Employers' Liability — $1,000,000.00
- Commercial General Liability — $1,000,000.00
- Vehicle Liability — $1,000,000.00
- Professional Liability — $1,000,000.00
- Cyber and Privacy Liability - Privacy & Network Liability — $1,000,000.00
- Cyber and Privacy Liability - Internet Media Liability — $1,000,000.00
- Cyber and Privacy Liability - Business Interruption & Expense — $1,000,000.00
- Cyber and Privacy Liability - Data Extortion — $1,000,000.00
- Cyber and Privacy Liability - Regulatory Proceeding — $1,000,000.00
- Cyber and Privacy Liability - Data Breach Notification & Credit Monitoring — $1,000,000.00
- Minimum 3 references
- Within the last 3 years
- Client point of contact required for each reference
Location
Documents
'Custom Computer Programming Services' Opportunities
The South Coast Air Quality Management District is seeking qualified contractors for software system...
The New York State Division of Criminal Justice Services intends to make a single-source award to Ca...
The Texas Department of Agriculture is seeking Intranet Quorum licensing, support services, engineer...
Retraite Québec is seeking information technology professional services for organic architecture, de...
The State of Vermont is seeking IT vendors for prequalification under a retainer contract covering n...
Providence Health Care Society is seeking to amend an existing agreement with Navidata for expanded ...
The Foothill/Eastern Transportation Corridor Agency and San Joaquin Hills Transportation Corridor Ag...
Indigenous Services Canada is seeking qualified TBIPS supply arrangement holders to provide developm...
Fort Vancouver Regional Library District is seeking proposals for a staff intranet platform serving ...
The Fédération québécoise des municipalités, through the Fonds d’assurance des municipalités du Québ...
The Government of Alberta is seeking application services and base services focused on continuous im...
The Government of Alberta is seeking application maintenance, base support, continuous service impro...
York University is seeking a contractor to design, develop, implement, launch, support, and maintain...
The U.S. Army is seeking innovative commercial information technology solutions and services to enha...
NOLA Public Schools is requesting proposals for web design professional services.
Miami-Dade County is planning a competitive solicitation for a stormwater billing and customer servi...
The U.S. Census Bureau is issuing a special notice updating the CenTAM acquisition framework and pri...
Loto-Québec is seeking consulting firms to provide on-demand information technology professional ser...
The U.S. Air Force is seeking market information from eligible SBA 8(a) vendors capable of providing...
The State of Alabama, through the Alabama Examiners in Counseling, is seeking a licensing database u...
The U.S. Air Force Sustainment Center is seeking Zuken E3.cable Enterprise software licenses, update...
The Arizona Department of Health Services is seeking ongoing maintenance, operations, enhancement, q...
The Canadian Department of National Defence is seeking temporary computer application support servic...
The Canadian Nuclear Safety Commission is seeking Level 3 technology architect services to design, d...
Opportunities Near Riverside, California
The City of Riverside is requesting proposals for comprehensive landscape and outside maintenance se...
Eastern Municipal Water District is seeking a contractor to install three communication towers (40' ...
Eastern Municipal Water District is seeking proposals for cleaning, dewatering, hauling, and legal o...
Riverside County is requesting quotations for the purchase and delivery of heavy-duty equipment part...
Eastern Municipal Water District is seeking a contractor to apply WeatherWeld roofing systems to fiv...
Coachella Valley Water District is seeking multiple consultants for on-call soil compaction and conc...
The California Department of Transportation is seeking bids for highway construction involving struc...
Riverside County is requesting quotations for five years of scheduled preventive maintenance, repair...
Helendale School District is seeking sealed bids to provide and install approved relocatable classro...
The San Bernardino County Transportation Authority is seeking a contractor to provide Freeway Servic...
Western Municipal Water District is seeking a contractor to repair and stabilize the eroded slopes o...
Riverside County Flood Control and Water Conservation District is requesting quotations for delivery...
The City of Riverside is seeking a contractor to replace obsolete underground HMPE and CIC electrica...
San Bernardino County is requesting proposals to lease approximately 49,888 square feet of commercia...
Desert Sands Unified School District is seeking a licensed contractor to install owner-furnished met...
The City of Riverside is seeking contractors for 2025/2026 CDBG-funded street paving maintenance and...
The California Highway Patrol is seeking a contractor to provide as-needed, 24-hour evidence impound...
The County of Riverside is seeking a contractor to provide recurring janitorial services, supplies, ...
San Bernardino County Department of Public Health is seeking contractors to administer an online foo...
San Bernardino County is seeking proposals for on-call blood collection and forensic sexual assault ...
San Bernardino County is seeking dental benefits vendors to provide DPPO and DHMO coverage and admin...
The California Department of Transportation is seeking a prime contractor for highway rehabilitation...
The City of Riverside is seeking a qualified entity or individual to provide Emergency Ambulance Ser...
The City of Riverside is seeking a consultant to develop an evacuation assessment and plan, update e...
The City of Riverside is seeking to pre-qualify up to five companies per service area for on-call co...