Audit Services of Pharmacy Billings

The State of Hawaii Department of Health, specifically the Adult Mental Health Division's Hawaii State Hospital (HSH), is seeking an independent contractor to provide comprehensive auditing services for pharmacy billings through Invitation for Bids (IFB-HSH-26-02). The contractor will audit monthly pharmacy invoices involving approximately 450-550 National Drug Codes and 3,400-4,300 transactions per month, with both PDF and Excel format invoices. The audit scope requires reviewing historical invoices from April 2018 to present and continuing future monthly invoice audits to verify accurate billing rates and fees consistent with contracted pharmacy rates. Qualified bidders must demonstrate at least three years of experience in pharmacy billing audits, possess knowledge of drug pricing methodologies like Average Wholesale Price and Wholesale Acquisition Cost, and understand Medicare, Medicaid, and private insurance medication processes. Sealed bids must be submitted via the Hawaii eProcurement System (HIePRO) by December 31, 2025, at 2:00 p.m. Hawaii Standard Time, with an estimated contract award date of January 2, 2026, and a contract period from February 1, 2026, to January 31, 2027.

The contract allows potential extensions for up to five additional twelve-month periods upon mutual written agreement, provided the contract price remains unchanged. Contractors must maintain general liability insurance of $1,000,000 per occurrence and $2,000,000 aggregate, along with automobile liability insurance of $1,000,000 per person and accident. Vendor compliance requirements include obtaining a Hawaii Compliance Express (HCE) verification, a Certificate of Vendor Compliance (CVC), and an IRS Form W-9. The contractor is expected to submit monthly progress reports and a final Independent Auditors' Report upon completion of all audit work. Bid pricing must be comprehensive, including wages, fringe benefits, subscription fees, applicable taxes, and incidental costs. While no specific set-aside designations are mentioned, the detailed qualification requirements suggest a competitive procurement process targeting experienced pharmacy billing audit firms with demonstrable expertise in healthcare financial review.