Utilization Review Clinical Criteria Software
United States of America > HEALTH AND HUMAN SERVICES, DEPARTMENT OF > INDIAN HEALTH SERVICE > NAVAJO AREA INDIAN HEALTH SVC
Original Solicitation Links
75H71026Q00297
]utilization review software
Contact
Submission Instructions
Description
The Indian Health Service, through the Gallup Indian Medical Center, seeks a contractor to provide a site-hosted, evidence-based clinical criteria software license for hospital utilization review. Required capabilities include evaluating inpatient admissions and continued stays, observation status, discharge planning, ambulatory surgical procedures, imaging, obstetrical and newborn care, rehabilitation and skilled nursing transitions, substance-use-disorder care transitions, durable medical equipment needs, and retrospective risk-management and quality-of-care issues. The software must support searches by keywords, CPT codes, and ICD-10 codes; provide source documentation and clinical notations supporting medical-necessity decisions; generate utilization-review reports, including variance days and medical-necessity results; and include a length-of-stay application. The contractor must provide a non-transferable license for at least 12 simultaneous users at the site, maintain current evidence-based criteria throughout the contract, provide initial onsite training and self-paced training resources, and furnish technical support and application-administrator support. The solution must comply with applicable HIPAA, Section 508, WCAG 2.1 Level AA, and federal information-security requirements. A cloud-based solution must have current FedRAMP certification at the time of submission and include documentation confirming its certification status and class. The base period runs from October 1, 2026, through September 30, 2027, with four one-year option periods.
Classification Codes
Smart Codes
Specifications
Timeline
Requirements
Documents
| Title | Date Posted |
|---|---|
| Sol_75H71026Q00297.pdf | Sep 09, 2026 12:00 PM |
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