Federal and Postal Employee Health Benefit Independent Medical Review

The Office of Personnel Management (OPM) is seeking a contractor to provide independent medical review services for federal and postal employee health benefits. The primary objective is to review disputed medical and dental claims, preservice requests, and conduct specialized consultation services. OPM will determine the appropriate medical specialist category for each disputed claim, and the contractor will be responsible for assigning qualified professionals such as Coding Specialists, Medical Doctors, Dentists, or Dental Specialists to evaluate case documentation. The contractor must prepare comprehensive typewritten review analyses and provide paper or electronic copies of all referenced supporting materials. The pre-solicitation notice indicates the solicitation is scheduled for release on June 9, 2025, with the contract falling under the Administrative Management and General Management Consulting Services NAICS category (541611).

The current pre-solicitation notice does not specify a small business set-aside, meaning the opportunity is unrestricted and open to all qualifying businesses. No specific award value or budget range is currently disclosed in the notice, nor are any incumbent contractors identified. The contract will be administered by a civilian agency (OPM) and classified under the Professional Support: Other PSC category (R499). While precise service quantities are not specified, the contract appears focused on providing flexible medical review capabilities for employee health benefit claim disputes. The opportunity is categorized as a pre-solicitation notice, suggesting potential contractors should prepare for a formal solicitation release in early June 2025 and be ready to demonstrate expertise in medical claims review and analysis.