When is the submission deadline?

Submissions are due July 2, 2026. Questions must be submitted by June 5, 2026.

It was issued by Department Of Health And Human Services. The work is located in Concord, New Hampshire, United States.

Who is a good fit for this opportunity?

CMS-certified Enhanced Direct Enrollment (EDE) entity. Experience with medical claims management for public health programs. Expertise in HIPAA-compliant web portal design and integration. Proven ability to manage call center operations with regulatory compliance. Familiarity with the healthcare needs of HIV-positive populations.

Insurance Benefit and Medical Claims Management Services (Due July 2, 2026)

Overview

Healthcare Services, Wellness & Biotech

Concord, New Hampshire, United StatesPosted: May 27th, 2026Deadline: July 2nd, 2026

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SUMMARY

New Hampshire seeks a CMS-certified vendor to provide insurance benefit and medical claims management services for HIV clients, including a HIPAA-compliant portal, claims processing, and outreach support.

KEY REQUIREMENTS

Must hold an active license issued by the New Hampshire Insurance Department
Must be a CMS-certified Enhanced Direct Enrollment (EDE) entity
Must provide a secure, integrated Insurance Benefit and Medical Claim Management System
Must comply with HIPAA requirements
Must comply with WCAG 2.1 AA accessibility standards
Must maintain adequate staffing levels to meet program demand
Must operate a toll-free call center during regular business hours
Must perform criminal background checks on all employees, volunteers, interns, and subcontractors assigned to the contract
Must provide a CMS-certified EDE solution and an accessible web portal for clients, providers, and case managers

CONTRACT DURATION

72 months

TIMELINE

RFP Released: May 22nd, 2026

Vendor Inquiry Period Ends: June 5th, 2026

Final State Responses to Vendor Inquiries: June 26th, 2026

Final Date and Time for Proposal Submission: July 2nd, 2026

Anticipated Governor and Council Approval: January 2027

QUESTION DEADLINE

June 5th, 2026

Issuing Agency

Department Of Health And Human Services

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DESCRIPTION

The selected vendor will provide comprehensive insurance benefit and medical claims management services for clients living with human immunodeficiency virus (HIV). The vendor must be a Centers for Medicare and Medicaid Services (CMS)-certified Enhanced Direct Enrollment (EDE) entity and securely integrate the EDE pathway in adherence to all CMS guidelines and certification requirements.

The vendor will be responsible for developing and maintaining a secure, HIPAA-compliant web portal. This portal will enable clients, providers, and case managers to submit paper-based insurance premiums and medical claims for payment. The vendor's solution should also handle the conversion of current paper-based forms into electronic format, supporting digital storage, search, retrieval, and processing.

Additionally, the vendor must ensure timely payment processing, with initial binding premium payments made within five business days of receiving the invoice, excluding weekends and state holidays. The vendor must conduct outreach to inform clients of health insurance marketplace and CMS changes, collect and manage medical claims and supporting documents, and provide assistance in resolving denied or incomplete claims. Call center operations must comply with state and federal HIPAA requirements, including obtaining caller consent before recording communications.

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Frequently asked questions

When is the submission deadline?: Submissions are due July 2, 2026. Questions must be submitted by June 5, 2026.
Who issued this RFP?: It was issued by Department Of Health And Human Services. The work is located in Concord, New Hampshire, United States.
Who is a good fit for this opportunity?: CMS-certified Enhanced Direct Enrollment (EDE) entity
Experience with medical claims management for public health programs
Expertise in HIPAA-compliant web portal design and integration
Proven ability to manage call center operations with regulatory compliance
Familiarity with the healthcare needs of HIV-positive populations

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