Federal and Postal Employee Health Benefit Independent Medical Review

The Office of Personnel Management (OPM) is seeking a contractor to provide independent medical and dental health benefits reviews for disputed claims and preservice requests under the Federal Employees Health Benefits (FEHB) and Postal Service Health Benefits (PSHB) Programs. The contractor must provide qualified medical specialists including board-certified medical doctors, dentists, and coding specialists who can conduct comprehensive reviews across over 120 medical specialties, from general internal medicine to highly specialized fields like pediatric neurosurgery and undersea medicine. Key requirements include completing standard reviews within seven business days and expedited reviews within three business days, providing detailed typewritten analyses with medical literature citations, maintaining HIPAA compliance, and possessing URAC IRO Accreditation. Offerors must submit both technical and price proposals with strict formatting requirements including a 60-page technical proposal limit using Times New Roman 11-point font, five medical review writing samples across specialized domains, and comprehensive documentation of professional staff qualifications. The proposal submission deadline is July 15, 2025, at 11:00 AM EDT, with all proposals to be submitted electronically to OPMContracting@opm.gov.

This solicitation operates under an unrestricted procurement with no set-aside designations and uses NAICS code 541611 for Administrative Management and General Management Consulting Services with a small business size standard of $30.5 million. The current incumbent contractor is J29, Inc., which provides context for the government's existing service arrangements. The contract structure is an indefinite-delivery/indefinite-quantity (IDIQ) arrangement with a base period from September 30, 2025, to September 29, 2026, followed by four potential one-year option periods extending through September 29, 2030. The pricing structure includes various review categories ranging from routine case reviews (1-150, 151-300, over 300 cases) to specialized coding specialist reviews and multi-reviewer panels, with services covering medical reviews for hundreds of health insurance plans across multiple states and regions. The place of performance is Washington, DC, and the contractor will utilize OPM's FDC centralized platform for case management while providing their own medical review processing technology.