USA | NV | CARSON CITY COUNTY | CARSON CITY | 89701 Small City
Nevadaepro - Nevada Health Authority - NV
Managed Care Secondary Recovery/ Health Insurance Premium Payment/ Managed Care Tpl Data Exchange/ Insurance Services
Medicaid Third Party Liability ( TPL), Recovery Audit Contracting ( RAC), and Medicaid Estate Recovery
Medicaid Third Party Liability ( TPL), Recovery Audit Contracting ( RAC), and Medicaid Estate Recovery ( MER) Services
AI helper
The deadline for submissions is August 10, 2026, at 2:00 PM PST. deadline submissions and opening no later than 2:00 pm on ****
Responses shall be consistently evaluated and scored based upon the following factors and relative weights. Technical factor 1 vendor demonstrates extensive experience and understanding of medicaid thirdparty liability tpl requirements including coordination of benefits, cost avoidance and payandchase. Vendor has extensive experience in supporting states with recovery activities specific to managed care secondary recovery services, recovery audit contracting rac services, medicaid estate recovery mer services, subrogation and casualty reduction services, cost avoidance services, health insurance premium payment hipp services and managed care tpl data exchange and evaluation services. 30technical factor 2 vendor demonstrates the ability to understand and comply with state and federal regulations related to tpl, subrogation, hipp, rac, and mer, specifically 42 cfr **** ssa ****, ssa ****, 42 cfr part 455 subpart f, 42 ****, and the coordination of benefits cobtpl handbook. Vendor is experienced with security controls and hipaa compliance, as well as mmis integration system requirements. 25technical factor 3 vendor demonstrates qualifications, experience, organization strengths and capacities and administrative preparedness to support and respond to evolving work requirements related to the states recovery programs. Vendor proposals describe organizational capacity, including expertise and availability of key expert personnel, firm resources, team skillsets, work approaches, including project management, and problemsolving methods it would use to support work under this rfp. 20technical factor 4 vendor demonstrates the capacity to provide expert technical assistance and support regarding recovery methodologies, datamatching processes and verification steps, subrogation workflows, use of analytics to determine compliance and cost effectiveness, as well as clinical review processes, provider engagement, appeal handling procedures, and innovation. 15cost factor 10presentation factor 1 system architecture and design vendor demonstrates overall system design and capabilities, user interface, systems ability to support data exchanges, alignment with hipaa and security standards, and ability to meet rfp system requirements. 20presentation factor 2 data integration and interoperability vendor demonstrates ability to integrate with mmis, managed care entities, pharmacy systems, and thirdparty data sources 20presentation factor 3 tpl and cost avoidance identification and verification vendor demonstrates methodologies and system capabilities for identifying commercial insurance coverage, medicare, workers comp, accident carriers, including electronic verification and automated inquiries 20presentation factor 4 post payment recovery and subrogation functionality vendor demonstrates case assignment and management workflows, document management, letter generation, and settlement tracking 20presentation factor 5 reporting and dashboard capabilities vendor demonstrates ability to produce standardized operational, financial and performance reports, and adhoc reports 10presentation factor 6 vendor demonstrates ability to customize system rules to adapt to police and regulatory changes. 10cost factor. The cost factor score will be based on the following equation. The highest proposed cost from any vendor and the lowest proposed cost from any vendor will be added together to generate a combined total. For each vendor, that proposed cost will be subtracted from the previously combined total. This number is then divided by the highest proposed cost. The resulting number is multiplied by the cost factor weight to generate a weighted cost score.
Vendors must be registered at nevadaepro. com and have an active entity registration in sam. gov. Vendor information must match nevada business license and sam. gov entity registration. Prior to contract execution, the awarded vendor must hold a state business license. pursuant to nrs ****, vendor must be registered at nevadaepro. com to respond to the solicitation.
Failure to comply with the restriction to only contact the single point of contact or use the electronic procurement system may result in disqualification. Failure to adhere to mandatory minimum requirements may also lead to disqualification. failure to observe this restriction may result in disqualification of a response per nac ****.
Bid Close Date:
