26EHSKWTPLIIRFR: RRF for Third Party Liability Health Insurance Investigations and Recovery Claims

The Massachusetts Executive Office of Health and Human Services (EOHHS) is initiating a Request for Responses (RFR) to procure third party liability (TPL) health insurance investigation and claims recovery services. The procurement seeks to contract with qualified vendors to perform two primary activities: conducting health insurance investigations for cost avoidance and identifying/recovering MassHealth claims payments from liable third parties, and performing health insurance investigations to ensure the cost-effectiveness of MassHealth Premium Assistance programs. Vendors must demonstrate expertise in health insurance investigations, claims recovery, and premium assistance health insurance modules. The RFR will be posted on COMMBUYS, the state's procurement platform, with a scheduled release in January 2026 and a response deadline of January 26, 2026. Prospective respondents are required to monitor COMMBUYS for all procurement updates and amendments, with strict instructions not to contact EOHHS directly with questions. The procurement is covered by the World Trade Organization Government Procurement Agreement, emphasizing principles of fairness, non-discrimination, and equal treatment in the government procurement process.

The RFR does not explicitly specify set-aside designations or restrictions for specific types of organizations, though standard state procurement practices often include provisions for disadvantaged business enterprises. No incumbent vendors or current contractors are mentioned in the available documentation. The procurement appears to be open to vendors with demonstrated capabilities in health insurance investigations and claims recovery services, with potential vendors needing to establish an account on www.commbuys.com to receive notifications and track the procurement. While specific award values or budget ranges are not disclosed in the provided materials, the scope suggests a potentially significant contract involving comprehensive health insurance investigation and recovery services for the MassHealth program. The procurement aims to improve cost management and recovery processes within the Massachusetts health and human services system, indicating a strategic approach to managing healthcare-related financial resources.