Kansas Supplier Systems #EVT0010856

Kansas State Employees Health Care Commission Seeks Comprehensive Audit Services for State Employee Health Plan

The Kansas State Employees Health Care Commission (HCC) is seeking a qualified audit services provider to conduct comprehensive audits of the State Employee Health Plan (SEHP) over a three-year period. - Government Buyer: - Kansas State Employees Health Care Commission (HCC), State Employee Health Plan (SEHP) - Scope of Services: - Annual audits of medical and dental claims for accuracy, timeliness, and compliance with plan provisions - Pharmacy Benefit Manager (PBM) audits, including 100% electronic review of pharmacy claims, rebate audits, and transparency audits - Targeted claims audits (e.g., high-cost or bariatric claims) - Eligibility record audits for medical, dental, and PBM plans, including full enrollment and terminated member testing - Recoupment audits for medical, dental, and PBM claims (reviewing adjustments, reversals, and provider audits) - Dependent Eligibility Verification Audits (DEVA) to confirm dependent eligibility - Premium payroll deduction and reconciliation audits to ensure accurate premium collection - Optional pre- or post-implementation audits of benefit changes or vendor setup - Hourly rate services for additional audit needs as required - Notable Requirements: - Statistically valid sampling for claims audits (e.g., 95% confidence level) - Compliance with HIPAA and data security standards; all work must be performed within the U.S. - Flat-fee pricing per vendor audited, with all travel included; separate hourly rates for additional services - Vendors must be available for up to one year after final audit report acceptance for follow-up - Timely reporting and adherence to performance guarantees; liquidated damages for non-performance - No specific OEMs or audit firms are named; opportunity is open to qualified audit service providers - Technical and cost proposals must be submitted separately, with clear compliance to Kansas Open Records Act and language standards for health documents.

Description

The Kansas Department of Administration is soliciting proposals for audit services related to the State Employee Health Benefit Plan. The contract period is from January 1, 2027, through December 31, 2029. The scope includes auditing medical, dental, and pharmacy benefit managers, eligibility records, recoupment claims, and other related audit services to ensure compliance with plan documents and contract performance guarantees. The solicitation requires submission of technical and cost proposals, with a response deadline of July 22, 2026.

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