Workers Compensation Medical Bill Review Services

Project Release Date: February 25th, 2026

Question Submission Deadline: March 11th, 2026, 2:00pm

Proposal Submission Deadline: March 25th, 2026, 2:00pm

Initial Contract Term: 5 years from execution date

The vendor is required to provide comprehensive workers compensation medical bill review services. Each medical bill must be examined for compliance and reconciled with California's fee schedule for medical services. The service involves identifying all unauthorized charges to ensure billing does not exceed the injured worker's treatment plan, utilization review certifications, and managed care service parameters. The vendor must also provide a brief summary of their experience and capabilities in delivering workers compensation bill review services, particularly for public agencies.

Quarterly reports are expected detailing bill review activity, realized savings and costs, program trends, and performance. The workflow should integrate medical bill review with lien resolution payment processes. In addition, month-end reconciliation reports are needed that correlate fees to bills, liens, and claims. Providers must receive prompt responses to bill reduction inquiries within 24 hours. Duplicate billing must be identified and prevented from resulting in duplicate payments, and an Explanation of Benefits (EOB) must be provided for every bill reviewed.

Questions regarding this RFP must be submitted no later than March 11, 2026. The contract period will span five years.