Medicare Claim, Revenue Cycle, and Insurance Eligibility Management Services

Questions due by June 11th, 2026.

Quotes due by June 26th, 2026.

Initial period of performance starts October 1st, 2026.

This RFP seeks a vendor to provide comprehensive Medicare claim management, revenue cycle management, and insurance eligibility services. The objective is to enhance and maximize third-party revenue and collection activities, streamlining the business aspects of healthcare revenue generation. The selected provider will be responsible for maintaining and creating efficient processes for claims administration and insurance eligibility verification.

The requirements include gathering comprehensive eligibility information, submitting and processing batch eligibility requests for multiple patients, and implementing a customizable dashboard that optimizes workflow by prioritizing and assigning patients, payers, and daily tasks. The solution must allow integration between eligibility and claims functions, minimize repetitive tasks, and facilitate batch imports of eligibility data files, ultimately saving time and enhancing record-keeping with full transaction history access.

Additionally, the provider must supply a secure software solution that enables connectivity to Medicare DDE (Direct Data Entry)/FISS and supports automated claims status reporting, payment details, and eligibility verification. The system must accommodate all claim types, apply rigorous claims and custom business rules, and allow self-monitoring for service usage thresholds. This bid is set aside for Indian Small Business Economic Enterprises (ISBEE).