IFB #SD25-00049 - Pre-Payment Claim Review (PPCR) and Post Payment Audit and Recovery Services (PPAR)

California Department of Corrections and Rehabilitation (CDCR) and California Correctional Health Care Services (CCHCS) are requesting bids on Pre-Payment Claim Review (PPCR) and Post-Payment Audit and Recovery Services (PPAR) under IFB #SD25-00049, with bids due August 25, 2026 at 3:00 p.m. Bidders may submit proposals for both services or independently for either PPCR or PPAR; CDCR/CCHCS intends to award either one contract covering both services or two separate contracts, each to the lowest responsive, responsible bidder.

Small Business and DVBE incentive preferences apply: a 5% preference is available to certified small businesses or to non-small businesses committing to 25% subcontractor participation. Disabled Veteran Business Enterprise incentives ranging from 1% to 5% apply based on confirmed DVBE participation levels.

Bidders must be U.S.-based with active California Secretary of State business registration, documentation of at least 12 consecutive months of complex medical record audit experience, fraud detection expertise, and a secure web portal. Staff must hold current valid licenses as a licensed physician, medical review registered nurse, or advanced practice practitioner. Two references for similar services performed within the last five years are required.

For PPCR services, bidders submit rates per claim for estimated volumes ranging from 200 to 5,000 claims across contract periods. For PPAR services, bidders specify a percentage of recovery amount (not to exceed 20%) to be paid to the contractor, with estimated recovery amounts ranging from $5 million to $10 million per fiscal period. Contract term runs October 1, 2026, through September 30, 2029, with an option for five additional one-year extensions at rates specified in the rate sheet. Services are performed at the contractor's U.S. place of business with availability required Monday through Friday, 8:00 a.m. to 5:00 p.m. Pacific Standard Time. The contractor must maintain commercial general liability, automobile liability, workers' compensation, and professional liability insurance at specified minimums and comply with HIPAA requirements. Public bid opening is scheduled August 26, 2026, at 2:00 p.m., with a notice of intent to award on August 28 and proposed award date of September 8, 2026. Bids must be submitted electronically as a single combined PDF to Maggie Villucci at Maggie.villucci@cdcr.ca.gov, with the Rate Sheet submitted separately.