Multnomah County #RFP-12-2027

Multnomah County Medical Claims Audit for Self-Insured Health Plans

Multnomah County, Oregon is seeking a qualified vendor to perform a comprehensive Medical Claims Audit of its self-insured health plans. - Government Buyer: - Multnomah County, Oregon - Scope of Work: - Comprehensive audit of self-insured medical, prescription, and dental health plans - Operational assessments to ensure fiscal accountability and compliance - Identification of cost recovery and process improvement opportunities - Stakeholder engagement, quality assurance, dispute resolution, and knowledge transfer - Option for additional projects not exceeding $10,000 each - Plan Details: - County administers benefits for nearly 6,000 employees - Approximately 2,300 enrolled in self-funded PPO medical plans - Approximately 2,600 enrolled in self-funded dental plans - Vendor Requirements: - Demonstrated independence and significant experience auditing public sector health plans of similar size and complexity - Robust data security protocols compliant with HIPAA and HITECH - Insurance coverage (professional liability, general liability, cyber liability, etc.) - Registration to do business in Oregon - Encouragement of Minority-Owned, Women-Owned, and Emerging Small Businesses - Contract Details: - Term not to exceed five years - Proposals must include fixed fees and hourly rates for additional work - Notable Requirements: - Innovative approaches such as predictive analytics and benchmarking are encouraged - Additional projects may be proposed and billed separately

Description

Multnomah County is seeking a qualified vendor to conduct a comprehensive Medical Claims Audit of its self-insured health plans. The project involves conducting medical, prescription, and dental audits to ensure fiscal accountability, verify compliance with plan documents, and identify opportunities for cost recovery and process improvement. The selected contractor must demonstrate independence and significant experience auditing public sector health plans of similar size and complexity. The contract term may not exceed five years, and proposals must include fixed fees and hourly rates for additional work. The County encourages participation from Minority-Owned, Women-Owned, and Emerging Small Businesses.

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