Medicaid Billing (Annual Contract)

The Puerto Rico government is seeking a medical billing services provider for a one-year annual contract focused on Risk Management and Human Resources Medicaid billing operations. The procurement is a competitive Request for Proposal (RFP) process, designated as RFP 26-10, with proposals due by September 16, 2025. The solicitation requires comprehensive medical billing services, with specific emphasis on Medicaid billing processes and administrative support. Potential vendors must complete several mandatory forms, including the Offeror Information Form, E-Verify Affidavit, Debarment Affidavit, and Lobbying Disclosure Form. Key evaluation criteria will likely include technical expertise, billing accuracy, compliance capabilities, and cost-effectiveness. Interested vendors must carefully review the detailed solicitation document (6-RFP 26-10 Medicaid Billing Annual Contract) and submit all required documentation by the stated deadline.

While specific set-aside designations are not explicitly detailed in the provided documents, vendors should anticipate potential preferences for local or disadvantaged business enterprises typical in government contracting. The solicitation suggests a preference for vendors with demonstrated experience in Medicaid billing, healthcare administrative services, and risk management support. The contract appears to be structured as an annual engagement, potentially indicating ongoing service requirements beyond the initial one-year term. Though exact budget ranges are not specified in the available documentation, medical billing service contracts of this nature typically range from $100,000 to $500,000 annually, depending on the scope and complexity of services required. Vendors must ensure full compliance with all regulatory requirements, including federal and Puerto Rican healthcare billing regulations, and demonstrate robust technological capabilities for efficient billing and documentation processes.