RFI Comprehensive Medical Review & Audit Support

Demonstrate your organization's core capability to fulfill the functional areas outlined in the draft PWS. b. Medical Review Experience: Outline your firm's high-level experience in conducting large-volume medical claims reviews for audits and evaluations and inspections; and support services for medical expert consultants and witnesses specifically across the following five domains (as referenced in the attached PWS): 1. Audit Medicare Parts A/B/D and Medicaid 2. Audit Medicare Part C 3. Evaluations and Inspections 4. Office of Investigations 5. Office of Counsel to the Inspector General c. Geographic Reach: Describe your prior experience managing and executing nationwide or multi-jurisdictional medical claim reviews. d. Capacity & Scalability: State your organization's maximum monthly claim review capacity, including your approach to scaling operations between normal workloads and surge conditions. e Teaming & Subcontracting: Identify potential subcontracting partners or specialized vendors you would anticipate utilizing, including an estimated percentage breakdown of work performed by the prime contractor versus subcontractors. Section 2: High-Level Technical Approach & Operations a. High-Level Technical Methodology: Describe your conceptual approach to fulfilling the core tasks in PWS. Please limit this narrative to no more than 5 pages total, organized by the 5 PWS sections. Focus on your overarching claims review methodology, general sampling plan frameworks, documentation standards, and typical project timelines rather than a granular, step-by-step solution. b. Quality & Accuracy Frameworks: Outline your corporate quality assurance processes, internal review protocols, and standard strategies used to reduce error rates and ensure consistency across large volumes. b. Staffing & Key Qualifications: Provide a conceptual staffing structure or organizational chart. Identify the typical roles, credentials (e.g., MD, RN, CPC), and qualifications of the key personnel required to successfully support a PWS of this nature. Please identify whether these staff will need to be hired or if they are current employees/contractors. Also, indicate staffing availability for physicians with specialties (i.e. hospice, vascular surgeon, nephrologist, physical medicine and rehabilitation or physiatrists). c. Risk & Mitigation: Identify the primary technical or operational challenges anticipated with a medical review scope of this size and outline your high-level mitigation strategies. Section 3: Past Performance & Market Pricing a. Relevant Past Performance: Provide up to three examples of similar Federal medical review contracts performed within the last five years. Also, provide up to three examples of similar Federal support services for medical expert consultants and witnesses within the last five years. b. Performance Outcomes: Summarize the high-level outcomes of those past contracts, focusing on standard metrics such as timeliness, accuracy rates (including rate at which findings were overturned during the appeals process), and a history of successful audit findings. c. Cost Drivers & Efficiencies: Provide a general overview of your commercial pricing structure and the primary cost drivers (e.g., specific labor categories, specialized technology/AI tools, administrative overhead). Highlight any built-in efficiencies or innovative workflows in your approach that typically yield cost savings for the government. Section 4: Industry Feedback & PWS Refinement a. Clarity & Feasibility Review: Identify any requirements, metrics, or tasks within the draft PWS that appear ambiguous, overly restrictive, or technologically infeasible based on current commercial market capabilities. b. Recommendations for Improvement: Suggest specific enhancements, industry standard metrics, or structural changes to the PWS that would improve the clarity, feasibility, and competitiveness of the final solicitation. Submission Instructions: Email responses by November 13, 2026, 12:00 PM Eastern Time to the Points of Contact below. Mark proprietary information clearly; the Government may use non proprietary information to refine its acquisition approach. Points of Contact: a. Contracting Officer: Shavonda Jamison ¿ [email protected] b. Contracting Specialist: Dorothy Royster ¿ [email protected] Attachments: a. Draft PWS (for market research and feedback only; subject to change). Disclaimer: This RFI is for market research; it does not commit the Government to any acquisition. The Government will not reimburse costs for responding. Not responding does not preclude participation in any future solicitation. No proposals or quotes will be accepted in response to this notice.