Second Pass Claims Editing System

Overview

Software, Web & Mobile Development

Portland, Oregon, United StatesPosted about 2 months agoDeadline: April 9th, 2026

Fit Score

Settle Intelligence

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SUMMARY

Oregon seeks a configurable second pass claims editing system to improve payment accuracy, detect prepay issues, and ensure support for fraud, waste, and abuse identification.

KEY REQUIREMENTS

BUDGET

Estimate

$1,500,000 – $4,500,000

CONTRACT DURATION

36 months

TIMELINE

Request for Proposals Issued: March 12th, 2026

Deadline to Submit Clarifying Questions: March 26th, 2026

Request for Proposals Closing Date and Time: April 9th, 2026

Anticipated Contract Start Date: June 2026

Proposer implementation of the solution: June 2026 through October 2026

Solution Go-Live: November 2026

Proposer to provide comprehensive training to CareOregon staff members: November 2026 through January 2027

QUESTION DEADLINE

March 27th, 2026

Issuing Agency

Careoregon, Inc.

Organization overview and procurement intelligence available on paid plans.

See Issuer Research

DESCRIPTION

The State of Oregon is seeking proposals for a second pass claims editing system. The required software solution will enhance payment accuracy and integrity by ensuring claims are properly coded and processed. The system must be able to edit various claim types, identify prepay issues not flagged by the current system, and support multiple edit outcomes, such as denial, pending, and informational notices.

Further requirements include applying multiple procedure payment reductions, customizability for configuring edits and logic, and provider billing detection to monitor excess utilization at the provider level. The solution should support seamless data migration for members, providers, claim histories, and prior authorization data. Advanced functionalities for detecting fraud, waste, and abuse are essential, as is a clinical validation approach with quality assurance, audit processes, and credentials relevant to clinical/coding development. The platform must also support appeals and reconsideration procedures.

Source attribution

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