Medical Claims Processing System
Overview
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SUMMARY
KEY REQUIREMENTS
TIMELINE
Questions due by June 24th, 2026.
Responses due by July 17th, 2026.
QUESTION DEADLINE
CONTACTS
Primary procurement contact — name, title, email, and phone
Additional decision-makers and their departments
Issuing Agency
Department Of Homeland Security
DESCRIPTION
A buyer in Washington, District of Columbia is seeking information on medical claims processing system solutions capable of supporting a comprehensive claims administration environment. The requested system should support claims adjudication, reimbursement, program integrity, and related operational functions for medical and dental claims submitted by community providers.
The sought solution should address both electronic and paper claim intake and provide details on functionality, compliance with federal standards, average claim adjudication time frames, timely filing practices, appeals handling, and denial rates. The buyer is also interested in the balance of automation versus manual review within the adjudication process.
Vendors should be able to demonstrate analytic capabilities that support program integrity, including the use of artificial intelligence and machine learning tools to identify duplicate claims, fraud, waste, abuse, and missing data values. The system should be scalable for large claim and user volumes, integrate with other government systems such as electronic health records, support provider network management including credentialing and enrollment, and offer reporting or dashboard tools for real-time data sharing.
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Frequently asked questions
- When is the submission deadline?
- This RFP closed on July 17, 2026 and is no longer accepting submissions.
- Who issued this RFP?
- It was issued by Department Of Homeland Security. The work is located in Washington, District Of Columbia, United States.
- Who is a good fit for this opportunity?
- Healthcare claims technology provider with medical and dental adjudication platforms
- Experience supporting federal or public sector healthcare programs
- Capability to process both paper and electronic claims submissions
- Expertise in provider network management, credentialing, and enrollment
- Strong analytics, fraud detection, and program integrity capabilities
- Scalable platform with integration experience for electronic health records and government systems
- Demonstrated use of AI and machine learning in claims review and anomaly detection
Analysis generated by Settle AI from the source RFP.
RFP Hunter shows what is open. Settle shows what is forming.
Settle pieces together buyer signals, budgets, contract activity, and the sources your team already monitors. See why an opportunity fits and what to do before the RFP posts.