Medicare Claim Management/Revenue Cycle Management (RCM) Service

The Indian Health Service (IHS), under the Department of Health and Human Services, is seeking a contractor to provide Medicare Claims Management and Revenue Cycle Management (RCM) services for the Fort Peck Service Unit in Poplar, Montana. The required solution must be a cloud-based software platform that delivers real-time eligibility verification for Medicare and commercial insurance payors, batch eligibility checking, customizable workflow dashboards, and integration capabilities with Medicare's Direct Data Entry (DDE) and Fiscal Intermediary Standard System (FISS). The contractor must support all claim types including Emergency, Inpatient, Outpatient, and Specialty claims, process claims by close of business the next day, provide rejected claims reports within four hours, and deliver toll-free technical support from 7 AM to 7 PM Monday through Friday with a minimum two-hour response time. All deliverables must comply with HIPAA, Section 508 accessibility standards, WCAG 2.0 Level AA standards, and Privacy Act requirements. The current Sources Sought notice was posted on April 7, 2026, with responses due by April 14, 2026 at 2:00 PM to Nikki.ferguson@ihs.gov.

This procurement is designated as a set-aside for Indian Small Business Economic Enterprises (ISBEEs) and Indian Economic Enterprises (IEEs), requiring that prospective vendors certify their eligibility under the Buy Indian Act and maintain at least 51 percent ownership and management control by Indian individuals throughout the contract period. The Statement of Work indicates the current service provider reference is Inovalon Provider Inc., though the actual incumbent status is not confirmed in the pre-solicitation notice. The contract period runs from April 1, 2026 through March 31, 2027, with four option years available, though no specific contract value or budget range is disclosed in the pre-solicitation materials. Vendors must submit detailed capability statements demonstrating relevant experience with Medicare Claim Management and RCM services, along with a list of past relevant contracts and proper Indian Economic Enterprise Representation Form documentation to be considered in the forthcoming formal solicitation.