T3110 Bid Amendment 4 4.17.2026.docx

MIKIE SHERRILL

Governor State of New Jersey

DEPARTMENT OF THE TREASURY

DIVISION OF PURCHASE AND PROPERTY

PROCUREMENT BUREAU

33 WEST STATE STREET

P. O. BOX 230

TRENTON, NEW JERSEY 08625-0230

AARON BINDER

State Treasurer

DR. DALE G. CALDWELL

Lt. Governor

AMY F. DAVIS, ESQ.

Acting Director https://www.njstart.gov

April 17, 2026

To: All Interested Bidders

Re: Bid Solicitation # 26DPP01218 T3110 - Medical and Pharmacy Claims Reviewer, Data Management and Technical Services

Quote Submission Due Date: May 15, 2026 (2:00 p.m. Eastern Time) 2nd Electronic Question and Answer Period: April 24, 2026 (2:00 p.m. Eastern Time)

Bid Amendment #4

The following constitutes Bid Amendment #4 to the above referenced Bid Solicitation:

· A list of attendees who attended the optional Pre-Quote Conference that was held on Wednesday, October 22, 2025;

· Answers to electronic questions submitted during the first electronic Question and Answer period;

· Please note that for all additions, deletions, clarifications and modifications to the Bid Solicitation, please refer to the Revised Bid Solicitation entitled “REVISED T3110 Bid Solicitation 4/17/2026.” The following revisions are included in the Revised Bid Solicitation:

· Section 4.1.1, Medical Claims Reviewer Services Requirements, Revised;

· Section 4.1.2, Medical Claims Reviewer Guidance and Support, Revised;

· Section 4.1.3, Invoicing for Medical Claims Reviewer, Revised;

· Section 4.2, Scope 1: Medical Claims Data Management – Aggregation and Analytics, Revised;

· Section 4.2.1, Data Aggregation, Revised;

· Section 4.2.3, Data Collection and Quality Control, Revised;

· Section 4.2.5, Ongoing Medical Claims Data Management, Revised;

· Section 4.3.1.7, Deployment Plan, Revised;

· Section 4.6.4.3, Deployment Plan, Revised;

· Section 4.7, Account Management, Revised;

· Section 5.7, Liquidated Damages, Revised;

· Section 5.7.1, Notification of Liquidated Damages, Revised; and,

· Section 9.3, Contract-Specific Definitions, Definition added.

· The second electronic Question and Answer period will be received until 2:00 p.m. Eastern Time on April 24, 2026. Questions that will be considered will be limited to subject matter related to the following:

· The revisions to the Revised Bid Solicitation Sections listed above. Refer to “REVISED T3110 Bid Solicitation 4/17/2026.”

· It is the sole responsibility of the Bidder to be knowledgeable of all of the additions, deletions, clarifications, and modifications to the Bid Solicitation and/or the New Jersey Standard Terms and Conditions relative to this Bid Solicitation as set forth in all Bid Amendments.

All other instructions, terms, and conditions of the Bid Solicitation shall remain the same.

Bid Solicitation # 26DPP01223 T2551 Credit Card Payment Processing

Optional Pre-Quote Conference Attendee List

Bid Solicitation # 26DPP01218 T3110 - Medical and Pharmacy Claims Reviewer, Data Management and Technical Services Answers to Questions

Where applicable, each question references the appropriate Bid Solicitation section.

Section Reference Question (Bolded) and Answer

A: Please be advised that all Quotes shall be submitted electronically through NJSTART.

A: Yes. Prior to the Quote Opening Deadline, a Bidder should review the documents comprising the submitted Quote to ensure that all of the required documents have been completed and attached. Oftentimes a Quote is deemed non-responsive because a Bidder fails to attach a required form or attaches a blank form. To review a submitted a Quote, a Bidder should log into NJSTART and review each document attached to the Quote submission. Instructions on how to review a submitted Quote can be found in the Quick Reference Guide entitled How to Review a Submitted Quote, which is available on the NJSTART Vendor Support Page under Vendor Reference Guides.

A: It is recommended that users utilize Microsoft Edge to view PDFs. Certain PDF forms cannot be opened in the Chrome or Firefox built in PDF viewers that are enabled by default. If using Chrome or Firefox it is recommended that the file is downloaded instead by clicking the download button in the upper right-hand corner of the browser after an error message is received. An alternative option is to disable the built in PDF viewers in Chrome or Firefox.

A: As stated in Bid Solicitation Section 2.2, Exceptions to the State of NJ Standard Terms and Conditions (SSTC): “Questions regarding the State of New Jersey Standard Terms and Conditions and exceptions to mandatory requirements MUST be posed during the Electronic Question and Answer period and shall contain the Bidder’s suggested changes and the reason(s) for the suggested change(s).” Moreover, as stated in Bid Solicitation Section 3.11, Bidder proposed terms or conditions that conflict with those contained in the State of New Jersey Standard Terms and Conditions will render a Quote non-responsive.

A: Yes, the State could award only one (1) Scope to a Bidder, even if the Bidder submitted Quotes for both Scope 1 and Scope 2.

A: Scope 2 applies to Contractor’s review of the PBM contracted for the SHBP/SEHBP. MCO PBM vendors are not included in Scope 2.

A: No, the State will award an entire Scope to one (1) Bidder.

A: a. The current approximate numbers are: Active Employees: 426,000 Early Retirees: 91,700 Medicare: 233,600 COBRA: 700.

b. Individual plan spend is not available at this time. Total commercial medical spend for FY25 was $5.4 billion.

c. Annual spend, including claims and all fees, for FY25 was $5.6 billion.

A: The Contractor for T3110 is Health Management Systems Inc. The Contractor for G3077 is Truveris. Under the current T3110 contract, the value of savings after refunds from medical claims reviews from 2020 to 3/1/2026 are $385 million.

Under G3077, over seven years (2019-2025), on a performance basis, approximately 13.4M claims were reviewed annually. Savings on a linear annualized basis were approximately $13M (from aggregated identified plan and contract variances and contractual financial or rebate guarantees owed).

A: The current pricing per claim reviewed is $0.33. Bidders interested in reviewing the current Contract’s full specifications and pricing information may do so by submitting an OPRA Records Request. This may be done online using the following link: https://www-njlib.nj.gov/NJ_OPRA/department.jsp, with “Treasury” selected under Department, and “Purchase and Property ” selected under Agency/Division.

A: The State cannot provide this information at this time as this is confidential information.

A: Approximately 8,116,000 commercial pharmacy claims are processed annually subject to enrolled population.

A: Approximately 8,693,000 EGWP pharmacy claims are processed annually subject to enrolled population.

A: The current approximate numbers are: Active Employees: 426,000 Early Retirees: 91,700 Medicare: 233,600 COBRA: 700.

A: Yes, the State will offer a second round of Electronic Question and Answers. Questions that will be considered will be limited to subject matter related to the revised Bid Solicitation sections stated on the cover page of this Bid Amendment.

A: This is not a question and cannot be answered as posed. Please see response to Question #4.

A: It is recommended not to attach a file exceeding the size of 500MB due to upload slowness.

A: In addition to any mandatory submission requirements, the Bidders should include any information in their Quote that the Bidders determine is responsive to the Bid Solicitation requirements and also demonstrates to the Evaluation Committee that the Bidder understands the objectives that the Contract is intended to meet, the nature of the required work, and the level of effort necessary to successfully complete the Contract.

Bidders are reminded that, as provided in Bid Solicitation Section 3.11, Bidder Additional Terms Submitted with the Quote, any proposed terms or conditions that conflict with those contained in the Bid Solicitation or the SSTCS will render a Quote non-responsive. It is incumbent upon the Bidder to identify and remove its conflicting proposed terms and conditions prior to Quote submission.

Any Bidder questions with regard to conflicting proposed terms and conditions shall only be considered if submitted and agreed to pursuant to the electronic question and answer procedure.

A: The Bid Solicitation Checklist is simply a guide to assist Bidders in the submission of their Quotes. Bidders remain responsible for reading the Bid Solicitation and complying with all the requirements as set forth therein. As stated on the Bid Solicitation Checklist:

“THIS CHECKLIST WAS CREATED AS A GUIDE TO ASSIST BIDDERS AND MAY NOT IDENTIFY ALL OF THE DOCUMENTS, FORMS OR OTHER INFORMATION REQUIRED FOR SUBMITTING A COMPLETE AND RESPONSIVE QUOTE. IT IS THE BIDDER’S RESPONSIBILITY TO ENSURE THAT ALL REQUIREMENTS OF THE BID SOLICITATION HAVE BEEN MET.”

In the Bid Solicitation, if an item is designated as “shall” or “must,” it is a mandatory requirement and failure to comply can result in the Bidder’s Quote being deemed non-responsive. Where an item is designated as “should,” it is not mandatory for the Bidder to submit with the Quote but is strongly recommended. Please note that while “should” does not denote a mandatory requirement, technical scoring may be impacted if requested information is not provided.

A: The State requires the submission of a full non-redacted Quote in order to be considered for award. If a Bidder wishes to additionally provide a redacted version together with the completed signed Confidentiality/Commitment to Defend Form, they may do so. However, any Quote having required information which is not visible will be considered non-responsive.

A: Pursuant to REVISED T3110 Bid Solicitation 4/17/2026, Section 3.13.8, Subcontractor Utilization Plan, the Subcontractor Utilization Plan is submitted by a Bidder to designate its intended Subcontractors. The Bid Solicitation does not seek or permit quotes directly from Subcontractors.

Please refer to the Optional Pre-Quote Conference Attendee List on page 3 of this Bid Amendment for the list of attendees who attended the optional Pre-Quote Conference that was held on Wednesday, October 22, 2025.

A: No, Bidders are not required to subcontract. However, this Contract is subject to set-aside subcontracting for New Jersey Small Business Enterprises. That is, if a Bidder does intend to subcontract, it must submit a Subcontractor Utilization Plan and shall take the actions listed in REVISED T3110 Bid Solicitation 4/17/2026, Section 3.13.8.1, sections (A)-(E), to show that they’ve made a good faith effort to solicit and hire eligible New Jersey Small Business Enterprises.

A: Please see response to Question #22.

A: As indicated in the Bid Solicitation and in accordance with N.J.S.A. 52:32-44(b), a Bidder and its named Subcontractors must have a valid Business Registration Certificate (“BRC”) issued by the Department of the Treasury, Division of Revenue and Enterprise Services prior to the award of a Contract.

No substitute documentation can be accepted in lieu of a Business Registration Certificate.

A: For a Bidder to be responsive and considered for award of Scope 1, all requirements for Scope 1 that are outlined in Bid Solicitation Section 4, Scope of Work, must be included in the Bidder’s Quote.

A: The State cannot give a precise date. The State wishes to make an award(s) in Calendar Year 2026.

A: The State has not established specific educational or experience requirements for key personnel positions. Bidders shall ensure all personnel assigned to perform the work have the requisite education, training, and professional experience.

A: Please refer to Section 3, Quote Submission Requirements, which identifies the materials and draft plans to be submitted with the Technical Quote. Post-award deliverables are addressed throughout Section 4, Scope of Work, with timeframes noted in Section 4.3.1, Scope 1: Additional Plans, and Section 4.6.4, Scope 2: Additional Plans. Bidders are responsible for identifying deliverables and reports referred to within the Bid Solicitation. Due dates or cadences not specified will be developed during or after implementation.

A: Yes, the State has an agreement to do a prepayment review.

A: Please refer to REVISED T3110 Bid Solicitation 4/17/2026, Section 4.1.1, Medical Claims Reviewer Services Requirements for specific expectations and scope requirements for prepayment claims review.

A: Please refer to REVISED T3110 Bid Solicitation 4/17/2026, Section 4.1.1, Medical Claims Reviewer Services Requirements for specific scope requirements for medical claims reviewer and data management.

A: Yes, the State currently has a payment integrity Vendor.

A: Bidders interested in reviewing the current Contract’s specifications may do so by submitting an OPRA Records Request. This may be done online using the following link: https://www-njlib.nj.gov/NJ_OPRA/department.jsp, with “Treasury” selected under Department, and “Purchase and Property ” selected under Agency/Division.

A: The Bid Solicitation does not specify defined KPIs. Performance expectations are described in Bid Solicitation Section 4.1, Scope 1: Medical Claims Reviewer and Data Management. Bidders are encouraged to describe metrics and reporting methods used to demonstrate performance in their Quote.

A: This requirement has been removed from the Bid Solicitation. Please refer to REVISED T3110 Bid Solicitation 4/17/2026, Section 4.1.1, Medical Claims Reviewer Services Requirements.

A: Yes, if the provider and/or medical Vendor do not make available medical records then the State permits the Contractor to conduct a “technical denial” and initiate recovery.

Please note that Item M is now Item L. Please refer to REVISED T3110 Bid Solicitation 4/17/2026, Section 4.1.1, Medical Claims Reviewer Services Requirements

A: In most cases, the Contractor will be able to mail providers directly to maintain independence.

Please note that Item M is now Item L. Please refer to REVISED T3110 Bid Solicitation 4/17/2026, Section 4.1.1, Medical Claims Reviewer Services Requirements

A: Currently, the Medical Vendor makes the final determination regarding instances when the Contractor disagrees with the Medical Vendor. This may change in the future.

Please note that Item O is now Item N. Please refer to REVISED T3110 Bid Solicitation 4/17/2026, Section 4.1.1, Medical Claims Reviewer Services Requirements

A: There are a mix of payment methods depending on the service. The State cannot provide more detailed information at this time.

A: There is a mix of payment methods depending on the service. The State cannot provide more detailed information at this time.

A: No, the State is not willing to split prepayment and post payment claims verifications between multiple Vendors.

A: This is a TPA process in which the Division of Pension and Benefits is not involved. All identified overpayments were successfully recovered.

A: No, the State does not require the Vendor to facilitate recovery from the provider.

2) Also, will DPB update the bid sheet to reflect a contingency fee for DPB/TPA recovery via offset and a separate fee for recovery via vendor collection lock box services?

A: No, the State will not update the Bid Solicitation to reflect a contingency fee for recovery.

A: The State cannot commit to a fixed monitoring period. Monitoring will need to extend throughout the Contract period to continue to account for new activity and/or adjustments. Claim revisions that result in changes to paid amounts must be accounted by adjusting vendor fees.

A: Appeals granted requirement has been removed from 4.1.3(D). Please refer to REVISED T3110 Bid Solicitation 4/17/2026, Section 4.1.3, Invoicing for Medical Claims Reviewer for revisions to this section.

A: Appeals granted requirement has been removed from 4.1.3(D). Please refer to REVISED T3110 Bid Solicitation 4/17/2026, Section 4.1.3, Invoicing for Medical Claims Reviewer for revisions to this section.

A: The Contractor will be responsible for active data integration and issue resolution.

A: Division of Pension and Benefits staff will utilize the interface described.

A: Division of Pension and Benefits staff will require access to the interface. The Contractor is encouraged to describe the self-service analytics their solution can provide and how it will best benefit the State.

A: Turnaround times will vary depending on the request.

A: An appropriate framework and confidentiality agreement will be developed and shared as needed.

A: Division of Pension and Benefits will control the authorization for Contractor to share data. Please refer to REVISED T3110 Bid Solicitation 4/17/2026, Section 4.2, Scope 1: Medical Claims Data Management - Aggregation and Analytics.

A: Bidders, with their Quote submission, should describe the specific capabilities of their proposed platform.

A: Integration requirements will include the sharing of certain files, such as the files of claims selected for audit, audit status, and audit outcomes. The exchanges are anticipated to involve standard file transfers rather than complex system integration. DPB will provide formatting and transmission requirements.

A: The State expects no more than 15 concurrent users on the platform.

A: If work outside the scope of this Contract is required, a Contract Amendment would be necessary.

A: Current Medical Vendors are Horizon Blue Cross Blue Shield and Aetna. The current PBM Vendor is OptumRx.

A: At most, daily.

A: While we are not aware that any current Vendors lack mature interfaces or APIs, their systems are not currently integrated with State systems. However, this may change in the future.

A: Horizon and Aetna process dental claims.

A: Contractor should propose external enrichment sources with their Quote submission for review and consideration.

A: The State cannot provide this information at this time.

A: All information related to record retention can be found in REVISED T3110 Bid Solicitation 4/17/2026, Section 4.4, Record Retention.

A: The State is in the process of procuring a vendor for the data warehouse. Division of Pension and Benefits (DPB) anticipates standard file transfers between the Bidder and DPB Data Warehouse. At a minimum, SFTP protocols are expected.

A: The State does not currently have a data warehouse. However, if a data warehouse is put in place during the term of this Contract, the State expects the vendor to comply with all of the requirements of the Bid Solicitation with respect to the data warehouse and the transmission/storage of data.

A: The State requires the Claims Data Management Platform to have immediate functionality with dashboards and preset queries for the analyses the Division of Pension and Benefits needs to run immediately and often. It needs to be user friendly for those without statistical training.

A: The State is in the process of procuring a Vendor for the data warehouse and cannot provide this information at this time.

A: The State is unable to determine the number of point solutions for integration at this time.

A: Criterion W. and X. were added to Bid Solicitation Section 4.2.1, Data Aggregation. Please refer to REVISED T3110 Bid Solicitation 4/17/2026.

A: The State would like reporting on at least a monthly basis and require access to produce ad-hoc extracts. Formatting and frequencies will be discussed with the awarded Contractor for Scope 1 during implementation.

A: Data aggregation will be overseen by Division of Pension and Benefits, the awarded Contractor for Scope 1 and vendors that send claims data, i.e. primarily the TPAs.

A: All encryption standards and identity and authentication requirements can be found in REVISED T3110 Bid Solicitation 4/17/2026, Section 6.10, Cryptographic Protections, and Section 6.6, Privacy.

A: The performance requirement for a 5% variance has been removed and has been changed to 1%. Additionally, this performance requirement’s reference has been revised and moved from Section 4.2.4 to Section 4.2.3, Data Collection and Quality Control. Please refer to REVISED T3110 Bid Solicitation 4/17/2026, Section 5.7, Liquidated Damages, addressing the new performance requirement for Section 4.2.3, Data Collection and Quality Control.

A: Data extracts are anticipated to occur on a monthly basis, with corrected historical resubmissions provided as needed. The cadence and format may change based on business needs. Please refer to REVISED T3110 Bid Solicitation 4/17/2026, Section 4.2.5, Ongoing Medical Claims Data Management.

A: “24/7 reporting” is for system availability for self-service access.

A: Established cross-region cloud redundancy best practices are acceptable.

A: Data migration will be done on an as-needed basis per request from Division of Pension and Benefits.

A: Authorized entities beyond DPB include carriers, the data warehouse vendor, actuaries, as well as any additional entities that may be designated in the future. The Contractor may be expected to share data directly with authorized entities.

A: Turnaround time will be determined as needed per ad-hoc extract. Delayed ad-hoc extracts will not be subject to liquidated damages.

A: SHBP/SEHBP finds analytic tools to be useful that permit analysis of single or multiple simultaneous fields, including provider, member, code, specialty area, member group, dates of service, and paid and billed amounts, in addition to population health dashboards and tools to identify potential fraud/waste/abuse.

A: The Contractor will be expected to assist the State with data interpretation and recommendations.

A: Ad-hoc reporting is based on business needs. The State anticipates one per quarter.

A: Training is expected to be ongoing, depending on the needs of the State.

A: The State expects the Contractor to provide both pre-built models and tooling for DPB staff.

A: DPB will provide the user role hierarchy and the data field restrictions after Contract award.

A: The State currently uses Medical Intelligence and FraudCapture.

A: The Bidder, in their Quote submission, should describe how they define, identify, and analyze gaps in care, based on their proposed methodology and analytic capabilities.

A: This includes compliance with recommended disease screening, such as for cancer and chronic illnesses.

A: DPB and the awarded Contractor will develop collaboratively after Contract award.

A: The State anticipates pricing will be based off of the Bidder’s pricing for Part 2 – Implementation (Price Line 2) from T3110 Attachment 3 – State-Supplied Price Sheet, Tab “Price Sheet, Scope 2 Update.”

A: Bidders have the option to bid on either Scope 1, Scope 2, or both Scopes. If a Bidder intends to utilize Subcontractors, they are to follow the requirements set forth in Bid Solicitation Section 3.13.8, Subcontractor Utilization Plan. The Bidder should also explain, with submission of their Quote, how the intended Subcontractor will meet all of the requirements as outlined in this Bid Solicitation.

A: Whichever entity is performing the work would have to meet the minimum requirements of the Bid Solicitation.

A: The per script fee is intended to cover both the automated claim review and the supporting analytics/reporting infrastructure.

A: For publicly available information for T2679, go to www.njstart.gov. In the search bar, select “Contracts” from the drop-down menu. Enter T2679 and click the search icon. The T2679 Contract will appear under “Results.”

A: Combination virtual and in-person depending on the meeting. Notice will be provided by the State in advance.

A: The Bidder is permitted to combine key staff for both Scopes if the Bidder intends to submit a Bid for both Scopes.

A: This is not a question and cannot be answered as posed. No attachments were received by NJSTART or reviewed by the Division.

As stated in Bid Solicitation Section 2.2, Exceptions to the State of NJ Standard Terms and Conditions (SSTC): “Questions regarding the State of New Jersey Standard Terms and Conditions and exceptions to mandatory requirements MUST be posed during the Electronic Question and Answer period and shall contain the Bidder’s suggested changes and the reason(s) for the suggested change(s).” Moreover, as stated in Bid Solicitation Section 3.11, Bidder proposed terms or conditions that conflict with those contained in the State of New Jersey Standard Terms and Conditions will render a Quote non-responsive.

A: Bid Solicitation Section 5.4, Ownership of Material, and Bid Solicitation Section 7.1, Indemnification, do not conflict and the terms of each shall be enforceable as drafted.

A: The data management system should be available 24/7 with the exceptions noted. Please refer to REVISED T3110 Bid Solicitation 4/17/2026, Section 4.2.6, Data Hosting and Access.

A: 100% of data domains onboarded. During implementation Division of Pension and Benefits and the awarded Contractor for Scope 1 will agree upon planned dashboards and a launch date for each, with other dashboards to be requested as needed. By the Platform Deployment Effective Date, staff training using dummy data should be complete, further staff training using actual data should begin, and the agreed-upon initial high priority dashboards should be fully populated and functional for staff training with the actual State data.

A: State personnel will be present at all implementation meetings attended by the awarded Contractor(s) and Medical Vendors and will record all discussed causes of delays and their subsequent impacts that could affect implementation. Contractor is responsible for its own actions, not those of Medical Vendors and/or State.

A: Liquidated Damages Category for Post-Implementation Quality Assurance has been updated to Bid Solicitation Section 4.2.3. Please refer to REVISED T3110 Bid Solicitation 4/17/2026.