Request for Solutions (RFS): Autonomous Coding (AC) and Automated Appeals & Denials Management (ADM)
Closed Solicitation Posted
- Solicitation number
- HT0038RFSACADM
- Agency
-
Defense Health Agency
Department of Defense
- Responses due
- Set-aside
- No set-aside
Opportunity facts
- NAICS code
- 541511 Custom Computer Programming Services
- Place of performance
- Rosslyn, Virginia, United States
Notice details come from SAM.gov. Updated .
About this opportunity
The Defense Health Agency seeks AI/ML-enabled solutions for autonomous medical coding and automated appeals and denials management across the Military Health System, with white paper submissions due August 19 and proposals due August 28. The procurement is structured as one or more prototype Other Transaction Agreements under 10 U.S.C. 4022, and vendors may propose either capability individually or both combined.
Place of performance is Rosslyn, Arlington, Virginia. The procurement processes approximately 143,000 daily encounters (4.35 million monthly) and requires solutions to integrate with the MHS GENESIS electronic health record system. Autonomous Coding must assign ICD-10, CPT, and HCPCS codes from clinical documentation without human intervention, maintaining full auditability and explainability. Automated Appeals and Denials Management must automate appeal generation and submission to third-party payers while requiring human approval for all financial dispositions and maintaining complete FFMIA-aligned audit trails.
Technical requirements include DODI 8510.01 RMF compliance, FedRAMP authorization at Moderate level minimum (DoD Impact Level 4 or higher required; DoD IL 5 preferred), HIPAA compliance, CMMC Level 2 attestation, CAC/PIV authentication capability, and data encryption. Vendors must collaborate with Leidos for MHS GENESIS integration and accept DHA Business Associate Agreements. The estimated period of performance is 13–16 months, with production delivery targeted for June 30, 2027. Performance thresholds include 60% autonomous coding coverage at 95% accuracy by Milestone 2 and 80% coverage at 95% accuracy by Milestone 4; ADM requires 80% correlation match at Milestone 2 and 90% at Milestone 4. The Government reserves the right to award multiple agreements, partial components, or make no award. Questions are due August 13, 2026 at 10:00 AM ET. The NAICS code is 541511, Custom Computer Programming Services; PSC is DA01, IT and Telecom Business Application/Application Development Support Services (Labor).
Notice text
4 versions
Update #4 · Latest ·
August 26, 2026: The remaining responses previously marked as to be provided at a later date are now available in attached ‘ACADM Phase 1 QA 082626’. The RFS and SOO have been revised accordingly; please see the yellow-highlighted sections in the attached ‘ACADM RFS Rev 1’ and ‘ACADM SOO Rev 1’.
August 21, 2026: Responses to submitted questions are now available in the attached document, 'ACADM Phase 1 QA 082126'. This document also specifies which questions will receive responses at a later date.
August 17, 2026: Revision 2, RFS has been extended to 8/28/2026 to allow the government additional time to respond to questions. Question period has not been extended.
August 5, 2025: Revision 1, to correct the SAM.gov solicitation close date to 8/19/2026
Request for Solutions (RFS): Autonomous Coding (AC) and Automated Appeals & Denials Management (ADM)
Opportunity Overview
The Defense Healthcare Management Systems Modernization (DHMSM) Program Management Office (PMO), in conjunction with the Defense Healthcare Management Systems Program Executive Office (DHMS PEO) is seeking innovative, Artificial Intelligence and Machine Learning (AI/ML) enabled solutions to enhance healthcare delivery and strengthen financial recovery operations across the Military Health System (MHS).
Pursuant to 10 U.S.C. § 4022, the Government intends to award one or more prototype Other Transaction Agreements (OTAs) through this competitive Request for Solutions (RFS) process.
Under this RFS, the DHMSM PMO is seeking solutions for two distinct capability areas. Industry partners may submit a solution for either capability individually or for both capabilities:
- Capability 1: Autonomous Coding (AC) – A solution that uses advanced, human-like AI/ML computational processes to assign medical billing codes from clinical documentation without human intervention, while maintaining full auditability and explainability.
- Capability 2: Automated Appeals & Denials Management (ADM) – A phased, automated solution designed to address backlogged aged Accounts Receivable (A/R), improve first-pass claim success, accelerate documentation release, and automate the generation and submission of appeals to third-party payers.
Important Instructions for Interested Parties
Interested parties are strongly encouraged to review the attached documents in their entirety for complete details regarding this opportunity, including submission requirements and other specific instructions.
Update #3 ·
August 21, 2026: Responses to submitted questions are now available in the attached document, 'ACADM Phase 1 QA 082126'. This document also specifies which questions will receive responses at a later date.
August 17, 2026: Revision 2, RFS has been extended to 8/28/2026 to allow the government additional time to respond to questions. Question period has not been extended.
August 5, 2025: Revision 1, to correct the SAM.gov solicitation close date to 8/19/2026
Request for Solutions (RFS): Autonomous Coding (AC) and Automated Appeals & Denials Management (ADM)
Opportunity Overview
The Defense Healthcare Management Systems Modernization (DHMSM) Program Management Office (PMO), in conjunction with the Defense Healthcare Management Systems Program Executive Office (DHMS PEO) is seeking innovative, Artificial Intelligence and Machine Learning (AI/ML) enabled solutions to enhance healthcare delivery and strengthen financial recovery operations across the Military Health System (MHS).
Pursuant to 10 U.S.C. § 4022, the Government intends to award one or more prototype Other Transaction Agreements (OTAs) through this competitive Request for Solutions (RFS) process.
Under this RFS, the DHMSM PMO is seeking solutions for two distinct capability areas. Industry partners may submit a solution for either capability individually or for both capabilities:
- Capability 1: Autonomous Coding (AC) – A solution that uses advanced, human-like AI/ML computational processes to assign medical billing codes from clinical documentation without human intervention, while maintaining full auditability and explainability.
- Capability 2: Automated Appeals & Denials Management (ADM) – A phased, automated solution designed to address backlogged aged Accounts Receivable (A/R), improve first-pass claim success, accelerate documentation release, and automate the generation and submission of appeals to third-party payers.
Important Instructions for Interested Parties
Interested parties are strongly encouraged to review the attached documents in their entirety for complete details regarding this opportunity, including submission requirements and other specific instructions.
Update #2 ·
August 17, 2026: Revision 2, RFS has been extended to 8/28/2026 to allow the government additional time to respond to questions. Question period has not been extended.
August 5, 2025: Revision 1, to correct the SAM.gov solicitation close date to 8/19/2026
Request for Solutions (RFS): Autonomous Coding (AC) and Automated Appeals & Denials Management (ADM)
Opportunity Overview
The Defense Healthcare Management Systems Modernization (DHMSM) Program Management Office (PMO), in conjunction with the Defense Healthcare Management Systems Program Executive Office (DHMS PEO) is seeking innovative, Artificial Intelligence and Machine Learning (AI/ML) enabled solutions to enhance healthcare delivery and strengthen financial recovery operations across the Military Health System (MHS).
Pursuant to 10 U.S.C. § 4022, the Government intends to award one or more prototype Other Transaction Agreements (OTAs) through this competitive Request for Solutions (RFS) process.
Under this RFS, the DHMSM PMO is seeking solutions for two distinct capability areas. Industry partners may submit a solution for either capability individually or for both capabilities:
- Capability 1: Autonomous Coding (AC) – A solution that uses advanced, human-like AI/ML computational processes to assign medical billing codes from clinical documentation without human intervention, while maintaining full auditability and explainability.
- Capability 2: Automated Appeals & Denials Management (ADM) – A phased, automated solution designed to address backlogged aged Accounts Receivable (A/R), improve first-pass claim success, accelerate documentation release, and automate the generation and submission of appeals to third-party payers.
Important Instructions for Interested Parties
Interested parties are strongly encouraged to review the attached documents in their entirety for complete details regarding this opportunity, including submission requirements and other specific instructions.
Update #1 ·
Request for Solutions (RFS): Autonomous Coding (AC) and Automated Appeals & Denials Management (ADM)
Opportunity Overview
The Defense Healthcare Management Systems Modernization (DHMSM) Program Management Office (PMO), in conjunction with the Defense Healthcare Management Systems Program Executive Office (DHMS PEO) is seeking innovative, Artificial Intelligence and Machine Learning (AI/ML) enabled solutions to enhance healthcare delivery and strengthen financial recovery operations across the Military Health System (MHS).
Pursuant to 10 U.S.C. § 4022, the Government intends to award one or more prototype Other Transaction Agreements (OTAs) through this competitive Request for Solutions (RFS) process.
Under this RFS, the DHMSM PMO is seeking solutions for two distinct capability areas. Industry partners may submit a solution for either capability individually or for both capabilities:
- Capability 1: Autonomous Coding (AC) – A solution that uses advanced, human-like AI/ML computational processes to assign medical billing codes from clinical documentation without human intervention, while maintaining full auditability and explainability.
- Capability 2: Automated Appeals & Denials Management (ADM) – A phased, automated solution designed to address backlogged aged Accounts Receivable (A/R), improve first-pass claim success, accelerate documentation release, and automate the generation and submission of appeals to third-party payers.
Important Instructions for Interested Parties
Interested parties are strongly encouraged to review the attached documents in their entirety for complete details regarding this opportunity, including submission requirements and other specific instructions.
Files
| File | Type | Posted |
|---|---|---|
| ACADM RFS Rev 1.pdf | ||
| ACADM Phase 1 QA 082626.pdf | ||
| Draft SOO ACADM Rev 1.pdf | ||
| ACADM Phase 1 QA 082126.pdf | ||
| Request for Solution ACADM.pdf | ||
| Draft SOO ACADM.pdf |
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