RFP Clarifying Questions 1 - Final.pdf

315 SW Fifth Ave, Portland, OR 97204 | 800-224-4840 | TTY 711 | careoregon.org

George Marlton Procurement Director

Procurement Department 503-488-7646 vendorservices@careoregon.org

REQUEST FOR PROPOSALS #2026-04

AI Co-Pilot Services

RESPONSE TO CLARIFYING QUESTIONS #1

May 11, 2026

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 RFP as published.

1. What level of QNXT integration is realistically available in scope: read-only, workflow-triggered, bidirectional updates, or external companion workflow only?

Answer: CareOregon’s tech stack supports a range of integrations, depending on use case, but not necessarily all possible use cases. CareOregon is looking for full integration but how we get there is open to discussion. We’d like to understand the proposer’s vision for how to proceed with the integration and then the implementation team would decide which level of integration to proceed with.

2. Can the solution directly integrate with InterQual in production, or must it rely on indirect reviewer-facing references and manual access patterns?

Answer: CareOregon is open to a directly integrated solution with InterQual. Currently, we use IQ in Anonymous mode and any integration would require important workflow changes, so it would be up to the proposer to suggest a sound methodology for integration.

3. When policy guidance conflicts across SharePoint, Excel repositories, and other stores, what authoritative source should govern the recommendation layer?

Answer: This would be determined in implementation and could vary by file type.

CareOregon is interested in learning about the proposer’s experience with best practices in this area and their recommendations on versioning/resolving conflicts.

4. Beyond the RFP’s no-auto-determination rule, what specific workflow actions are prohibited from any AI-triggered automation, including routing, draft generation, queue reassignment, or status updates?

Answer: Per CareOregon policy, a human is always responsible for any AI output and thus must review and approve any AI recommended decisions. Denial by AI without human input would be prohibited.

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Procurement Director

Procurement Department 503-488-7646 vendorservices@careoregon.org

5. Will Care Oregon provide a usable non-production dataset, integration sandbox, and representative document samples early enough to support validation and UAT on the stated timeline?

Answer: CareOregon’s normal process would be to provision an environment for the vendor to work with. An integration sandbox would be possible and document samples would be made available. The timeline in which these would be set up would depend on the implementation plan established with the selected proposer.

6. What exact fairness dimensions must be contractually monitored and reported beyond the examples named in the RFP, and what remediation expectation applies if disparities are detected?

Answer: CareOregon would expect demographic equity, requestor fairness, and condition-based equity to be a part of any solution. Geographic equity and workflow equity would be nice additions but are not necessarily required.

7. What is the minimum required audit package per case for acceptance: source citations, retrieved content, confidence scores, reviewer overrides, model rationale, timestamps, and user actions?

Answer: CareOregon has not established a minimum audit package requirement for this project. The proposer should specify what they can provide and what other clients have found useful.

8. What minimum acceptable extraction accuracy is required across faxed, scanned, handwritten, and low-quality PDF submissions before the solution is considered operationally viable?

Answer: The minimum acceptable extraction accuracy for the proposed solution should be 95% across all document types. A solution with higher accuracy will score better.

9. What measurable performance threshold must be achieved in parallel validation before Care Oregon would allow progression from shadow mode to assistive production use?

Answer: No minimum performance threshold for progression to production mode has been set. This would be determined by the implementation team.

10. Which integration, reporting, governance, and change-management items must be included in the base fixed fee versus treated as optional or phased expansions?

Answer: It is up to the proposer to determine what is included in their fees and how they want to break those fees down. See the published RFP, Section 3, for a full description of

Procurement Director

Procurement Department 503-488-7646 vendorservices@careoregon.org the scope of the project and the implementation schedule for what services are anticipated to be required.

11. Are QNXT-specific production references mandatory, or will comparable UM platform integrations be considered responsive?

Answer: CareOregon is not currently interested in moving to a different UM platform.

QNXT-specific solutions will be mandatory.

12. Which QNXT integration methods are available for this project, including APIs, batch files, database extracts, event feeds, or vendor-supported connectors? They should tell us what would be required.

Answer: Potentially, all of these integration methods would be available. It would be up to the proposer to suggest the solution and the best integration method for the project.

The final determination of which integration method will be used will be determined in Phase 1 of the implementation plan.

13. What are the annual and monthly PA and appeals volumes by service line, intake channel, urgency, and line of business?

Answer: CareOregon’s current PA volumes are as follows: Medicaid - ~ 9700/mo (~1300/mo are expedited), and Medicare - ~ 1,000/mo (~161/mo are expedited). The majority of our PA requests are received via our provider portal

14. What minimum accuracy, extraction, routing, confidence scoring, and turnaround-time improvement targets will CareOregon use to determine pilot success?

Answer: CareOregon will be evaluating proposals, in part, on which solution provides the highest quality in all these metrics. We are looking for at least 95% extraction accuracy and a confidence scoring of between 0.70 and 0.84. Other metrics will depend on the solution and the implementation plan.

15. What CareOregon security standards, cloud hosting restrictions, encryption requirements, identity management protocols, and audit logging formats are mandatory beyond the posted Tier 1 documents?

Answer: No standards beyond those set out in the CareOregon Data Security Agreement for Tier 1 Contractors and the Terms and Conditions for Cloud Services, referenced in the published RFP, have been established. Additional standards will be further determined as part of the implementation plan and will depend on the solution selected.

Procurement Director

Procurement Department 503-488-7646 vendorservices@careoregon.org

16. What CareOregon IT, clinical, compliance, legal, and operational resources will be available during each implementation phase, and what weekly time commitment is expected?

Answer: The resources necessary to implement this project in the required timeframe will be determined between the proposer and the implementation team as part of Phase 1.

CareOregon has committed to providing whatever internal resources will be necessary to meet the implementation plan.

17. Does CareOregon expect full enterprise rollout by December 31, 2026, or is pilot go-live by year-end acceptable with broader rollout continuing into 2027?

Answer: See Section 3.2.2 of the published RFP for the expected timeframes for implementation. Based off that timeline, it is possible that full implementation may extend into 2027.

18. How will CareOregon evaluate fees across implementation, subscription, transaction volume, support, model retraining, and optional renewal years?

Answer: See the published RFP, Section 5.6, for how a proposal’s fees are evaluated.

Fees will make up 25% of the total scoring.

19. Does CareOregon maintain an enterprise data platform or data management layer (e.g., Databricks, Snowflake, or equivalent)? If so, is this environment accessible for integration and workflow orchestration? If not, are workflow solutions expected to operate directly across the listed systems (QNXT, SharePoint, Excel) without a centralized data layer?

Answer: CareOregon has a warehouse and uses Snowflake, which would be available for use in integration for this project. The workflow solution is expected to work across QNXT, SharePoint, the warehouse, and other systems.

End of Clarifying Questions