T3110 Bid Amendment 7 6.17.26.docx
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- Solicitation number
- 26DPP01218
- Issued by
- New Jersey
About this file
This Bid Amendment #7 pertains to Bid Solicitation #26DPP01218 issued by the State of New Jersey's Department of the Treasury, Division of Purchase and Property for Medical and Pharmacy Claims Reviewer, Data Management and Technical Services. The amendment extends the quote submission due date from June 30, 2026 to July 14, 2026 at 2:00 p.m. Eastern Time and provides answers to electronic questions submitted during the second question and answer period. The amendment incorporates revisions to Section 4.1.1 (Medical Claims Reviewer Services Requirements) and Section 4.2.3 (Data Collection and Quality Control) from the Revised Bid Solicitation dated June 17, 2026. Key clarifications address medical records request procedures for both pre-payment and post-payment claims reviews, including required documentation standards, appeal processes for technical denials, fee allocation when multiple parties contribute to claim adjustments, and definitions of incremental savings for contingency fee purposes. Additional guidance covers data submission arrangements between the state and medical vendors, data format standardization responsibilities, acceptable database architectures and data engineering platforms, machine-readable file refresh cadences and retention requirements, and data validation reporting protocols.
The amendment provides detailed responses regarding the contractor's responsibilities in managing carrier relationships with state oversight, data quality reconciliation procedures expected to persist throughout the contract term, and the absence of limits on historical reprocessing frequency or depth. Clarification is provided that sample-based approaches are acceptable for data validation rather than full claim reviews, and that differences should be calculated based on claim counts and total dollar volume. The state confirms it will direct medical vendors (Horizon, Aetna, and OptumRx) to provide data directly to the contractor and that the contractor must handle varying data structures from different vendors. Several questions regarding liquidated damages thresholds, secondary data center redundancy requirements, FedRAMP certification versus SOC 2 compliance, and specific claim volume estimates were deemed ineligible for response as they fell outside the scope of revisions made in response to the first round of questions and answers.
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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
June 17, 2026
To: All Interested Bidders
Re: Bid Solicitation # 26DPP01218 T3110 - Medical and Pharmacy Claims Reviewer, Data Management and Technical Services
| Current Quote Submission Due Date: June 30, 2026 (2:00 p.m. Eastern Time) |
| Revised Quote Submission Due Date: July 14, 2026 (2:00 p.m. Eastern Time) |
Bid Amendment #7
The following constitutes Bid Amendment #7 to the above referenced Bid Solicitation:
· The Quote Submission Due Date has been extended from Tuesday, June 30, 2026 to Tuesday, July 14, 2026; and
· Answers to electronic questions submitted during the second electronic Question and Answer period, limited to subject matter related to revisions to the Revised Bid Solicitation Sections in REVISED T3110 Bid Solicitation 4/17/2026 and REVISED T3110 Bid Solicitation 4/22/2026;
· 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 6/17/2026.” The following revisions are included in the Revised Bid Solicitation:
· Section 4.1.1, Medical Claims Reviewer Services Requirements, Revised; and,
· Section 4.2.3, Data Collection and Quality Control, Revised.
· 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 # 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.
| # |
| Bid Solicitation |
Section Reference Question (Bolded) and Answer
| 137 |
| Section 4.1.1 Medical Claims Reviewer Services Requirements |
| Q: Please clarify the documentation standard and appeal requirements that apply when a Provider does not provide the requested medical records. Specifically (a) what documentation of outreach attempts is required to support a technical denial |
A: For Pre-Payment Claims Reviews, the Contractor shall electronically send the medical record request letter to the provider and document the date. If the medical record is not received after a mutually agreed upon time frame, the Contractor shall notify the medical vendor and document the date of notification. Contractor shall wait at least 390 Calendar Days from the date of first sending the medical record request before invoicing the Division of Pension and Benefits (DPB) for a fee resulting from the associated savings.
For Post-Payment Claims Reviews, the Contractor shall send the initial electronic request for medical records and document the date. If no record is received after at least 30 Calendar Days, the Contractor shall send an electronic reminder letter, document the date, and wait at least another 30 Calendar Days. If there is still no response, the Contractor shall send a second reminder letter and document the date, followed by at least a 60-Calendar Day waiting period. If records are still not received after these intervals, the Contractor shall send an update file to the medical vendor to deny the Claim for non-receipt of records (“technical denial”). The medical vendor processes the denial and sends the Contractor the savings information. The Contractor may then invoice DPB for a fee associated with the savings. For clarification, unlike Pre-Payment Claims Reviews, there is not a 390-Calendar Day wait before invoicing DPB. As with Pre-Payment Claims Review, the Contractor shall accept records indefinitely and shall review them, without applying timely filing limits.
Q: and (b) if a Provider challenges the denial what standard will be used during appeal review.
A: For both Pre-Payment and Post-Payment Review, in response to a technical denial, the Provider may submit the medical record. The medical record shall be accepted for review at any time during the term of the contract.
Please refer to REVISED T3110 Bid Solicitation 6/17/2026, Section 4.1.1, Medical Claims Reviewer Services Requirements, for revisions to this section.
| 138 |
| Section 4.1.3 Invoicing for Medical Claims Reviewer |
| Q: Please clarify how savings will be credited when more than one party such as the Contractor a TPA and DPB contribute to the same claim adjustment or recovery. Specifically (a) how credit will be allocated and (b) whether the Contractor receives a full fee a partial fee or no fee when its work is only one contributing factor. |
A: If the Contractor indicates to the medical vendor that the Claim was selected for review, issues a medical record request letter to the provider, receives and reviews the medical record, and submits a finding of an incorrect Claim before the provider rebills the Claim at a different amount, the Contractor will receive the full fee. If all of the above conditions are not met, the Contractor will receive a reduced fee. If the Contractor did not contribute to the adjustment, no fee will be awarded. Further details will be developed during implementation.
| 139 |
| Section 4.1.3 Invoicing for Medical Claims Reviewer |
| Q: Please define incremental savings for this contract and confirm whether the contingency fee applies only to savings that would not have occurred without the Contractor or to the full savings amount even when other parties also contributed. |
A: Incremental savings are defined as savings that are reduced because the Contractor has selected the Claim for review and informed the medical vendor, but may not have requested the medical record yet, or may not have received and reviewed the medical record. If this occurs during prepayment review, the medical vendor automatically “pends” the Claim (doesn’t pay it), which is visible to the provider. This may alert the provider that the Claim will be reviewed, which may prompt the provider to rebill the Claim even before receiving the medical record request or sending the medical record. Alternatively, the medical provider may have reviewed the billing and rebilled the Claim without noticing that the Claim has been pended. Thus, it is possible but not certain that the Contractor’s selection in and of itself resulted in the rebill. The contingency fee will not be reduced if the Contractor can show that they requested and reviewed the medical record and issued their finding before the Claim was rebilled. The contingency fee will be partially reduced if the Contractor selects the fee for review, but hasn’t requested the medical record, or if they have requested but not reviewed the medical record. The percentages of reduction for Pre- and Post-Payment Claim Review will be negotiated during implementation.
| 140 |
| Section 4.2 Scope 1: Medical Claims Data Management - Aggregation and Analytics |
| Q: Please confirm whether the State will direct carriers to provide data directly to the Contractor or whether the Contractor must establish and maintain individual data submission arrangements with each carrier without a State mandate. |
A: The State will direct the medical vendors to provide data directly to the Contractor.
| 141 |
| Section 4.2 Scope 1: Medical Claims Data Management - Aggregation and Analytics |
| Q: Please confirm whether all data including historical claims eligibility coordination of benefits fee schedules and out of network allowed amounts will be provided in complete and consistent formats at contract start or whether data will be received in different formats that require additional processing. |
A: The State cannot provide this information at this time.
| 142 |
| Section 4.2 Scope 1: Medical Claims Data Management - Aggregation and Analytics |
| Q: Please confirm whether the Contractor alone must handle differences in data structure field definitions and coding or whether the State will require carriers to follow a standard data submission format before sending data. |
A: The Contractor must be prepared to handle different data structures from the different medical vendors.
| 143 |
| Section 4.2 Scope 1: Medical Claims Data Management - Aggregation and Analytics |
| Q: The solicitation mandates a "Customized SaaS" intelligence infrastructure. Does the State allow for a solution built upon a custom-developed database architecture (e.g., PostgreSQL or SQL Server) and proprietary data engineering pipelines in lieu of a branded big-data platform (like Databricks), provided all functional and performance requirements are met? |
A: Provided all functional and performance requirements are met, the State does not require any particular database architecture or proprietary data engineering platforms.
| 144 |
| Section 4.2.1 Data Aggregation |
| Q: For the Machine Readable Files: 1) What is the expected refresh cadence? |
A: Centers for Medicare & Medicaid currently require that insurance carriers refresh these files monthly. The Contractor should anticipate following the same cadence.
Q: 2) How long do these files need to be retained?
A: Once downloaded, the files should be maintained for the same period as all Contract-related data. Specific record retention requirements can be found in Section 4.4, Record Retention.
Q: 3) Is the expectation that the files would be used to ensure all claims are priced appropriately, or just as a tool to run other data mining concepts?
A: The files should be used to ensure correct pricing and for data mining purposes.
Q: 4) What, if any, duration of historical files will need to be backloaded
A: Historical data will need to be backloaded starting with the most recent file for each medical vendor before the Contract start date.
Q: 5) What would the state like to do if rates in the Machine readable files cannot be validated for properly paid claims??
A: DPB asks that the Contractor coordinate with the medical vendors towards developing a workable solution. DPB should be copied on all correspondence and included in meeting invitations.
| 145 |
| Section 4.2.3 Data Collection and Quality Control |
| Q: Please provide a definition of carrier and list all entities considered carriers for purposes of data validation reporting and coordination. |
A: The term carrier is often used to mean medical vendor or third-party administrator. DPB’s current medical and pharmacy vendors are Horizon, Aetna, and OptumRx. These are contractual relationships that are subject to change.
| 146 |
| Section 4.2.3 Data Collection and Quality Control |
| Q: Please describe the required activities deliverables time periods covered and how often the full validation process must be performed. |
A: Details will be negotiated during implementation. Please refer to REVISED T3110 Bid Solicitation 6/17/2026, Section 4.2.3, Data Collection and Quality Control, for revisions to this section.
| 147 |
| Section 4.2.3 Data Collection and Quality Control |
| Q: Please confirm whether this means every claim must be fully re reviewed or whether a sample approach is acceptable. If full review is required please confirm how often it must occur and which claim elements must be reviewed. |
A: Sample periods are recommended, and should include total number of Claims and total volume, after mutual agreement with medical vendors on the fields to be included and precise field definitions and values.
| 148 |
| Section 4.2.3 Data Collection and Quality Control |
| Q: Please describe how differences must be calculated including whether they are based on claim counts dollar amounts or individual claim values and how often reports must be submitted. |
A: Differences should be calculated based on Claim counts and total dollar volume. Report submission will be negotiated during implementation.
| 149 |
| Section 4.2.3 Data Collection and Quality |
| Q: Does the State require medical and pharmacy vendors and other data suppliers to provide control files (including record counts, paid amount totals, corrected submissions, and rebill indicators) with each data submission and is this contractually enforced by the State? |
A: DPB requires the Contractor and medical and pharmacy vendors to work together to rerun files to provide control data including paid amount totals and corrected reruns of breakouts when necessary to identify subsets which may be driving the errors. While the Contractor is required to coordinate these requests, DPB is included in all correspondence and reinforces the requests with the medical and pharmacy vendors.
| 150 |
| Section 4.2.3 Data Collection and Quality |
| Q: If required control files or corrected submissions are not provided timely or completely by carriers or TPAs, how is the Contractor expected to validate data completeness and financial accuracy? |
A: DPB should be included in all correspondence between Contractor and carriers or TPAs and included in all meeting invitations. DPB will reinforce Contractor’s efforts and asks that Contractor communicates with DPB if files or resubmissions are not provided timely or correctly.
| 151 |
| Section 4.2.3 Data Collection and Quality |
| Q: Does the State anticipate that the intensive data quality reconciliation and carrier variance management effort will decrease once data definitions and reconciliation methodologies are stabilized, and should steady state support expectations differ from implementation year effort? |
A: DPB anticipates the reconciliation and variance management to persist throughout the Contract. After addressing initial data variances, it will remain a consistent effort to resolve any data quality issues that arise.
| 152 |
| Section 4.2.5 Ongoing Medical Claims Data Management |
| Q: Are there limits on the frequency, depth, or historical lookback period for corrected historical resubmissions, and if extensive historical reprocessing is required, should that effort be treated as out of scope and addressed under Time & Materials pricing? |
A: There are no limits on the frequency, depth or historical lookback periods. Any reprocessing is expected to be included in the Bidder’s proposal.
| 153 |
| Section 4.7 Account Management |
| Q: Please clarify whether the Contractor is expected to manage working relationships directly with each carrier including meetings data exchanges and issue resolution or whether DPB will serve as the main contact and direct all carrier interactions. |
A: The Contractor is expected to manage the working relationships across the carriers with DPB copied or present during the interactions.
| 154 |
| Section 5.7 Liquidated Damages |
| Q: Please clarify (a) whether the penalty applies only to the fixed data management fee or also to other Scope 1 fees and (b) whether the penalty is based on a single quarterly review or ongoing measurement. |
A: This question is unclear and cannot be answered as posed.
| 155 |
| Section 5.7 Liquidated Damages |
| Q: Please identify the specific performance measures timeframes and conditions that would result in liquidated damages so the Contractor can clearly understand performance expectations. |
A: It is unclear which liquidated damage this question references, and therefore, this question cannot be answered as posed.
| 156 |
| Section 5.7 Scope 1 Liquidated Damages - Data Consolidation 4.2.4 |
| Q: The contract mandates a 1% data variance threshold between the Contractor and Carrier systems. If the Contractor's ingestion engine identifies structural errors or missing data fields in the source files provided by the TPAs (Horizon/Aetna), will the State provide a formal mechanism to waive liquidated damages for that period? |
A: The State expects that the Contractor will inform the medical vendor(s) that sent the data with the errors or missing fields and ask for a correction. The State should be included in any such correspondence. To the degree that the Contractor can show persistent efforts to obtain corrected data, Liquidated Damages may be waived.
| 157 |
| State of New Jersey Standard Terms & Conditions Section 5.7 Termination of Contract |
| Q: State's response to question number 130 was cut-off. Please respond with the language that must be reviewed. |
A: The complete response to Question #130 from Bid Amendment #4 is:
"A: The State declines the proposed modification. The provisions of SSTC Section 5.7, Termination of Contract, apply to all State contracts. With regard to transition terms, Bidders are directed to review the language in REVISED T3110 Bid Solicitation 4.22.26, Section 5.2, Contract Transition."
| 158 |
| Section 4.2.6 Data Hosting and Access / Section 6.32 Contingency Planning |
| Q: Does the requirement for a "fully functional secondary location" necessitate a physically distinct, geo-redundant data center, or is cross-region cloud redundancy within a single CSP (e.g., Azure or AWS) sufficient to satisfy the State's continuity of operations requirements? |
A: Pursuant to Page 1-2 of Bid Amendment #5, only questions related to the revisions made in response to the first round of Q&A can be addressed at this time. Please be advised that this question is unrelated to any first round Q&A revisions, and is ineligible to be answered at this time.
| 159 |
| Section 4.5 New Third Party Administrator |
| Q: For Scope 1, If DPB selects a new/additional Medical vendor, the Contractor will be required to implement the medical claims review process and accept a new data feed as part of the data management scope. Please confirm the implementation costs associated with this change should be included under the Part 4 - All-inclusive Hourly Rates on the Price Sheet Scope 1. If not, please provide guidance on the State's preferred approach for including these implementation fees. |
A: Pursuant to Page 1-2 of Bid Amendment #5, only questions related to the revisions made in response to the first round of Q&A can be addressed at this time. Please be advised that this question is unrelated to any first round Q&A revisions, and is ineligible to be answered at this time.
| 160 |
| Section 6.6.A (Data Residence) p 42 |
| Q: For a custom-built SaaS solution utilizing US-based cloud infrastructure, does the State require a FedRAMP-certified environment, or is SOC 2 Type II compliance within a US-based AWS/Azure region sufficient for the hosting of PII/PHI data? |
A: Pursuant to Page 1-2 of Bid Amendment #5, only questions related to the revisions made in response to the first round of Q&A can be addressed at this time. Please be advised that this question is unrelated to any first round Q&A revisions, and is ineligible to be answered at this time.
| 161 |
| Section 8.9.2 Price Evaluation Attachment 3 - State-Supplied Price Sheet Scope 1 |
| Q: Section 8.9.2 of the RFP states "For Scope 1 evaluation purposes, Bidders will be ranked from lowest to highest according to the total contingency percent proposed on the State-Supplied Price Sheet accompanying this Bid Solicitation." The price sheet contains 5 parts. Please confirm that only Part 5 - Recovery/Shared Savings will be ranked for evaluation purposes. |
A: Pursuant to Page 1-2 of Bid Amendment #5, only questions related to the revisions made in response to the first round of Q&A can be addressed at this time. Please be advised that this question is unrelated to any first round Q&A revisions, and is ineligible to be answered at this time.
| 162 |
| Pricing |
| Q: Please confirm whether pricing should assume that the State will coordinate all carrier data and communication or whether the Contractor must independently manage all carrier relationships and data coordination. This information affects staffing timelines and pricing. |
A: Pursuant to Page 1-2 of Bid Amendment #5, only questions related to the revisions made in response to the first round of Q&A can be addressed at this time. Please be advised that this question is unrelated to any first round Q&A revisions, and is ineligible to be answered at this time.
| 163 |
| Pricing |
| Q: To support accurate pricing please provide estimated annual claim volumes including (a) claims subject to pre payment review (b) claims subject to post payment review and (c) the portion of claims expected to require medical records. |
A: Pursuant to Page 1-2 of Bid Amendment #5, only questions related to the revisions made in response to the first round of Q&A can be addressed at this time. Please be advised that this question is unrelated to any first round Q&A revisions, and is ineligible to be answered at this time.
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