Annual Contract for Health Claims Audit

Chatham County Board of Commissioners is soliciting proposals for an annual health claims audit contract covering the County's medical and prescription drug plans administered by United Healthcare for approximately 1,994 subscribers and 3,913 members. The contract term is one year with four optional one-year renewal periods through 2029, with the audit period covering calendar year 2025. Proposers must submit annual fixed-fee pricing for three service options: medical claims audit only, prescription drug claims audit only, or combined audits, with all costs to be inclusive. Required qualifications include demonstrated experience auditing health claims for public entities with direct United Healthcare experience preferred, and proposers must provide at least five current or past government client references. Technical requirements mandate statistical confidence of at least 95% in random sampling, 100% electronic screening with at least 15 targeted samples, benchmarking against at least 100 recent audits, and operational assessments. The evaluation criteria allocates 100 points across proposal submittal components including qualifications and experience (25 points), methodology and implementation plan (30 points), MBE/WBE participation (15 points), references (5 points), and fee proposal (25 points), with an additional 30 points possible if interviews are required. A mandatory Pre-Proposal Conference is scheduled for March 12, 2026, at 11:00 a.m. via WebEx, and proposals must be submitted online through the County's procurement portal at https://chathamcountyga.bonfirehub.com/portal by 5:00 p.m. on April 2, 2026.

Proposers must comply with Georgia's drug-free workplace requirements, E-Verify work authorization provisions, and immigration eligibility verification under the SAVE program. Minority and Women Business Enterprise (M/WBE) participation is required, with bidders obligated to make good faith efforts to achieve participation goals and provide detailed documentation including solicitation of certified M/WBE firms, contract work breakdown, information sharing, and good faith negotiation records. All proposals must include completed certifications and affidavits covering non-discrimination statements, E-Verify compliance for both contractors and subcontractors, debarment certifications, immigration status verification, and lobbying affidavits. Standard insurance requirements include general liability of $1,000,000, workers' compensation of $500,000 per accident, and professional liability of $1,000,000 per claim. The RFP does not specify a budget range or incumbent vendor information, and Chatham County reserves the right to reject any or all proposals and waive technicalities at its discretion.