Missouri BUYS #STATE 0000000557SL

Missouri Department of Commerce and Insurance Medical Care Utilization Review Services RFP

Missouri's Department of Commerce and Insurance is seeking Medical Care Utilization Review Services through a competitive RFP. - Government Buyer: - State of Missouri, Department of Commerce and Insurance - Division of Purchasing - Services Requested: - Medical Care Utilization Review Services for insurance-related health care determinations - External medical case reviews across multiple specialties (general medicine, neurology, cardiology, oncology, psychiatry, etc.) - Expedited reviews and secure web-based case transmission - Personnel requirements: Medical Director and at least two full-time registered nurse reviewers - Pricing is per hour per person for nurse and physician reviewers - Notable Requirements: - Certified Independent Review Organization accreditation required - Strict compliance with Missouri statutes, conflict of interest policies, HIPAA, and HITECH - Quality assurance and secure handling of medical information - Vendors must be registered and authorized in MissouriBUYS - No specific OEMs or commercial vendors are named in the solicitation - Contract period is one year with up to four one-year renewal options

Description

This solicitation is a Request for Proposal (RFP) issued on behalf of the Department of Commerce and Insurance by the State of Missouri's Office of Administration, Division of Purchasing. The procurement seeks proposals for Medical Care Utilization Review Services, with a contract period effective from the date of contract through one year. Proposals must be submitted electronically through MissouriBUYS by September 16, 2026. The scope includes compliance with Missouri laws on health care utilization review and requires vendors to meet minimum experience qualifications.

View original listing