Texas DIR/ESBD #TRS000646

TRS Seeks Vendors for Comprehensive Claims Audit Services for Health Plans

The Teacher Retirement System of Texas (TRS) is seeking qualified vendors to provide comprehensive claims audit services for its health care programs. - Government Buyer: - Teacher Retirement System of Texas (TRS), Procurement & Contracts office, Austin, Texas - Services Requested: - Medical claim audit services for TRS-Care and TRS-ActiveCare plans - Prescription drug claim audit services and pharmacy rebate audit services for TRS-Care, TRS-ActiveCare, and Medicare Part D plans - Clinical validation review services, including pre- and post-payment reviews, DRG validation, medical record review, appeals management, and customer service - Optional/ad hoc audit services related to claim adjudications or operational risks, as needed - Key Requirements: - Vendors must have experience auditing large client bases and comply with HIPAA, data security, and confidentiality standards - Collaboration with TRS Internal Audit is required - Compliance with Texas Government Code Section 825.103 and dual CTCD/CTCM certification - Use of TRS Procurement and Vendor E-System (PAVES) for proposal submission - Pricing must be all-inclusive (no separate travel reimbursement) and remain flat for renewal terms - OEMs and Vendors: - No specific OEMs or named vendors are identified in the solicitation - Contract Structure: - Initial term through August 31, 2029, with two optional two-year renewals (potentially through August 31, 2033) - Estimated total contract value: $2,700,000 - Scope: - Audits cover claims from 2024 through 2033, with annual reporting cycles - Services apply to multiple locations across Texas

Description

The Teacher Retirement System of Texas (TRS) is seeking qualified vendors to provide medical claim audit services, prescription drug claim audit services, pharmacy rebate audit services, and clinical validation review services. The procurement is conducted through a Request for Proposal (RFP) process. The contract includes an initial term and optional renewal terms, with a total estimated value of $2,700,000. The solicitation involves multiple locations across Texas and requires compliance with specific certifications and statutory exemptions.

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