Clarifying Questions 2 RFP Home Health and Skilled Nursing Facility Audit and Review Services.pdf
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- Solicitation number
- S-X26083-00015254
- Issued by
- Oregon
About this file
This document is a Clarifying Questions Response #2 issued by CareOregon, Inc., a Medicaid managed care organization in Oregon, in connection with RFP #2025-04 for Home Health and Skilled Nursing Facility Audit and Review Services. The RFP seeks a qualified contractor to perform prepayment and post-payment audits and reviews of home health and skilled nursing facility claims on behalf of CareOregon Advantage and Health Share of Oregon. The project is scheduled to commence in January 2026 under an initial one-year contract with two optional one-year renewal periods. Proposals were due by December 8, 2025, at 2:00 PM Pacific Time, submitted electronically to vendorservices@careoregon.org. The selected vendor must employ only Certified Coding Specialists or Certified Professional Coders and maintain a medical director on staff. Evaluation criteria include background and qualifications (30 points), scope of work (35 points), equity and diversity efforts (10 points), and fees (25 points).
CareOregon processes approximately 8,247,136 Medicaid claims and 852,759 Medicare claims annually, with 346,542 home health claims and 17,336 skilled nursing facility claims representing the audit scope. For 2025, total paid dollar amounts for claims are $36 million, with hospice outpatient spend totaling $2.1 million. CareOregon does utilize prior authorization policies for home health services but not for skilled nursing facilities. The contract features fixed pricing for the initial two years, with potential fee increases of up to 2 percent annually in subsequent years. The RFP encourages proposals from minority-owned, women-owned, service-disabled veteran-owned, and emerging small businesses, with equity and diversity considerations allocated 10 percent of total evaluation points.
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Text version
George Marlton Procurement Director
Procurement Department 503-488-7646 vendorservices@careoregon.org
315 SW Fifth Ave, Portland, OR 97204 | 800-224-4840 | TTY 711 | careoregon.org
REQUEST FOR PROPOSALS #2025-04
Home Health and Skilled Nursing Facility Audit and Review Services
RESPONSE TO CLARIFYING QUESTIONS #2
November 13, 2025
Note that these are questions submitted by interested firms to the above referenced solicitation.
The below answers are for clarification purposes only and in no way alter or amend the RFQ as published.
1. Can CareOregon please provide details on the total paid dollar amount for the claims referenced in this RFP? In addition, are there any historical recovery benchmarks or overpayment dollar amounts available for the audit programs included within the scope of this RFP?
Answer: Total paid dollar amount for the claims for 2025 is $36M. CareOregon doesn’t have any historical benchmark.
2. Can CareOregon please clarify whether documentation of a face-to-face encounter is a required component of a valid Home Health claim? Would a lack of such documentation constitute a sufficient reason to deny a claim?
Answer: This will be up to the vendor’s expertise. RFP section 3.2.2 Services, A. Home Health Audit and Review states, “Vendor sets scope for coordinating home health claim reviews with CareOregon.”
3. Please provide total annual hospice outpatient spend and claim count. Please include Calendar Year 2024 and available Calendar Year 2025 data.
Answer: 2024 total: $2.6M; 2025 total: $2.1M.
4. Please provide total annual hospice inpatient spend and claim count . Please include
Answer CareOregon does not have spend and claim count totals for this ask.
5. Please provide total annual hospice professional spend and claim count. Please include
Answer: CareOregon does not have spend and claim count totals for this ask.
6. Do you utilize prior authorization, and will you (do you) send us that data? What claim types are subject to prior authorization? Request prior authorization policy.
mailto:vendorservices@careoregon.org http://careoregon.org/
315 SW Fifth Ave, Portland, OR 97204 | 800-224-4840 | TTY 711 | careoregon.org
Answer: CareOregon does utilize prior authorization policy for home health, but not for skilled nursing facility. Please see link for details:
https://www.careoregon.org/docs/default-source/providers/careoregon-provider-manual-web.pdf?sfvrsn=53df3142_23
End of Clarifying Questions http://careoregon.org/ https://www.careoregon.org/docs/default-source/providers/careoregon-provider-manual-web.pdf?sfvrsn=53df3142_23 https://www.careoregon.org/docs/default-source/providers/careoregon-provider-manual-web.pdf?sfvrsn=53df3142_23
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