T2691 - NJFamilyCare Utilization Review Audits, DMAHS

The State of New Jersey Department of the Treasury, Division of Purchase and Property, awarded Contract 25-PROS1-133684 to Permedion, Inc., a Texas-based company, on July 1, 2026, for a four-year term extending through June 30, 2030. The contract encompasses utilization review audits, quality of care audits, Diagnosis Related Groups (DRG) validation audits, and ad-hoc audits of inpatient hospital services provided to NJ FamilyCare clients under the Medicaid program. Permedion will audit medical records from 134 healthcare facilities across New Jersey—including 66 acute care general hospitals, 34 special hospitals, 8 private psychiatric hospitals, 4 hospital-based rehabilitation facilities, and 8 freestanding rehabilitation hospitals—against approved historical claim data maintained in the Medicaid Management Information System for both Fee-For-Service and Encounter Claims. The contract also includes development and maintenance of a web-based user interface for audit management and reporting.

Permedion's service delivery will be structured on a firm fixed-price basis, with pricing established at $150,000 for the web user interface and unit prices per audit or task ranging from $27 to $925 across the four contract years. The contractor must obtain Quality Improvement Organization certification from the Centers for Medicare and Medicaid Services, establish electronic data interchange submitter approval with the State's fiscal agent within 120 days of award, and achieve full operational capability within 120 calendar days. Services are expected to encompass approximately 35,000 to 50,000 claims annually, with remote delivery of audits and meetings permitted through State-approved platforms. The contract includes a 20 percent retainage provision and carries two optional one-year extensions available by mutual agreement.