Enhanced Provider Network Auditing Program

The Florida Agency for Health Care Administration (AHCA) has issued an Invitation to Negotiate (ITN 002-24/25) for an Enhanced Provider Network Auditing Program targeting Medicaid Managed Care Plans in Leon County. The procurement seeks a vendor to develop and implement a comprehensive web-based system for monitoring provider network adequacy, conducting secret shopper activities, and ensuring compliance. Specific deliverables include developing tracking systems, performing both telephonic and physical onsite secret shopper validations, analyzing network metrics, and creating remediation plans for identified deficiencies. Respondents must possess a minimum of three years of experience performing quality assurance reviews of Medicaid or healthcare programs and demonstrate capabilities across six key evaluation areas: Data and Systems (25 points), Network Analysis (20 points), Secret Shopper capabilities (25 points), Compliance/Remedies (30 points), Staffing (25 points), Respondent Qualifications (20 points), and Compliance History (20 points). Key procurement dates include written questions due January 20, 2025, responses due March 11, 2025 at 2:00 PM ET, negotiations scheduled for March 31 - May 5, 2025, and anticipated notice of intent to award on May 15, 2025. The initial contract term will run from April 1, 2025, through March 31, 2028, with potential renewal for up to three additional years.

The solicitation does not specify specific set-aside designations for disadvantaged enterprises, but requires vendors to maintain Florida office locations, provide bilingual staff, and ensure all services are performed within the United States. Vendors must complete various certification forms, including verifications of non-participation in boycotts, compliance with E-Verify requirements, and absence from scrutinized vendor lists. The contract will require a performance bond of 10% of the annual contract amount and a proposal guarantee of $500,000. Expenses will be reimbursed by managed care plans proportionate to their enrolled population, with plans required to pay the Agency within 21 days of receiving detailed charges. The anticipated contract value ranges between $5-10 million annually, totaling $15-30 million over the initial three-year term. Respondents must be prepared to provide comprehensive documentation of their compliance history, including up to 100 entries each for fines, penalties, sanctions, and Corrective Action Plans, as well as details about any contract terminations in the past five years.