Prior Authorization Solution and Professional Review Services

Overview

Healthcare Services, Wellness & Biotech

Jefferson City, Missouri, United StatesPosted about 2 months agoDeadline: May 12th, 2026

Fit Score

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SUMMARY

Missouri is seeking a vendor for a five-year contract to deliver a prior authorization solution and related professional review services for a government agency in Jefferson.

KEY REQUIREMENTS

Must have at least 5 years of experience providing prior authorization solutions for state Medicaid programs
Must have at least 5 years of experience in providing prior authorization and professional review services
Must be independent from any Managed Care Organization or health care provider in Missouri
Must be FedRAMP and StateRAMP certified
Must have Software Engineering Institute (SEI), International Standards Organization (ISO), and Institute of Electrical and Electronics Engineers (IEEE) certifications
Must be registered in MissouriBUYS with 'Approved' and 'Spend Authorized' status
Must maintain E-Verify enrollment and participation
Must maintain required insurance coverage including Commercial General Liability, Umbrella, Workers' Compensation, and Cyber Liability

BUDGET

Estimate

$5,000,000 – $15,000,000

CONTRACT DURATION

60 months

TIMELINE

Pre-proposal teleconference: March 31st, 2026

Proposal due date: May 12th, 2026

QUESTION DEADLINE

May 2nd, 2026

Issuing Agency

Missouri Department of Social Services, Mo Healthnet Division

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DESCRIPTION

The state government authority in Jefferson, Missouri is seeking a vendor to provide a comprehensive prior authorization solution and professional review services. Key responsibilities include supplying a data administrator with the appropriate combination of skills and experience to manage solution data, as well as a fully dedicated operations manager during training, launch, and ongoing operations.

The selected vendor must also provide a solution architect with prior experience designing, developing, and overseeing the architecture of a prior authorization solution for either another state Medicaid agency or a similarly sized health claims processing organization. A privacy and security officer will be responsible for overseeing all solution-related privacy and security matters. The database administrator is required to hold a bachelor's degree in information technology or a closely related field. An account manager must maintain consistent, proactive communication with the state agency, including regular monthly status reports, to ensure transparency and strong customer service.

The operations manager is expected to be fully committed throughout the contract transition period. The contract term will span five years, and a pre-bid teleconference will be conducted on March 31, 2026.

Source attribution

This Settle analysis is based on the issuing organization’s public RFP listing.