Supplemental Medical Review Services
Overview
Fit Score
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SUMMARY
KEY REQUIREMENTS
TIMELINE
June 10th, 2026: Sources Sought Notice issued.
June 23rd, 2026: Responses due by 12:00 PM Eastern Standard Time.
CONTACTS
Primary procurement contact — name, title, email, and phone
Additional decision-makers and their departments
Issuing Agency
Centers For Medicare & Medicaid Services
DESCRIPTION
The government authority in Baltimore, Maryland is requesting information regarding the provision of supplemental medical review services. The selected contractor will be responsible for performing post-payment medical reviews and related activities to support program integrity. This includes supporting the Fraud Investigations Group's mission to detect, investigate, and respond to potential fraud within Medicare, Medicaid, and related programs, with the goal of safeguarding trust funds and taxpayer resources.
Responsibilities include conducting non–medical record reviews for payment recommendations, claim re–reviews for remedial action on overpayments or underpayments, and comprehensive research based on literature, studies, policies, and coding guidelines. The contractor must also perform data analysis to support decision-making processes, as well as maintain a public website to inform and assist Medicare providers and suppliers.
Additionally, the contractor will be required to develop a secure web-based public portal for providers to access real-time updates on the status of their reviews. Effective customer service is critical, including managing a toll–free support line during standard business hours to ensure timely assistance and high satisfaction levels among stakeholders.
Similar RFPs
Frequently asked questions
- When is the submission deadline?
- Submissions are due June 25, 2026.
- Who issued this RFP?
- It was issued by Centers For Medicare & Medicaid Services. The work is located in United States.
- Who is a good fit for this opportunity?
- Experience with Medicare and Medicaid program integrity and medical review
- Proven expertise in healthcare fraud detection and data analysis
- Capability to develop secure public web portals for healthcare providers
- Adequate customer service infrastructure for high-volume inquiries
- Previous work with government healthcare authorities
Analysis generated by Settle AI from the source RFP.
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