Claims Payment and Com Srvs Part 1 & Ent Print and Fulfillment Automation Part 2

CalOptima Health, a county-organized health system in Orange County, California, has issued Request for Proposals (RFP 26-002) for comprehensive claims payment and communication services alongside enterprise print and fulfillment automation. The procurement seeks contractors capable of processing high-volume claims payments, including secure printing, mailing of payments and checks, digital delivery options, and print/fulfillment services for routine and ad-hoc materials. Proposers must demonstrate extensive experience with health plan payment processing, technological capabilities, robust data security protocols, and compliance with regulatory requirements like HIPAA. The RFP covers approximately 4+ million annual remittance records, including 510,727 printed checks, 172,684 bank ACH files, and 3,267,028 electronic payments. Evaluation criteria will assess vendors' experience with health plans, quality control procedures, technology integration, and overall service delivery approach. Key dates include a proposal submission deadline of November 3, 2025, at 2 PM Pacific Standard Time, with interviews/presentations scheduled for January 5-16, 2026, and tentative vendor selection on January 20, 2026. The contract allows vendors to submit proposals for one or both service areas, with CalOptima potentially awarding up to three contracts.

The RFP does not explicitly specify set-aside designations for disadvantaged enterprises or minority-owned businesses. The contract will have an initial duration of five years, with options to extend for up to three or five additional one-year terms. While no incumbent vendors are mentioned, the RFP requires proposers to have robust disaster recovery and business continuity plans. Existing infrastructure considerations include integration capabilities with current healthcare payment systems and support for multilingual communication materials across various healthcare program lines. Though specific budget ranges are not detailed, the comprehensive pricing sheets suggest a complex, tiered pricing model that accommodates volume-based transactions and varied service levels. Proposers must complete detailed pricing forms covering implementation costs, administrative fees, transaction charges, material expenses, and additional services like variable data printing, PDF hosting, warehousing, and document destruction. The contract appears designed to provide CalOptima with flexible, scalable claims payment and communication services that can adapt to changing healthcare communication needs.