Medicaid Third Party Liability (TPL), Recovery Audit Contracting (RAC), and Medicaid Estate Recovery

The Nevada Health Authority is requesting proposals for Medicaid Third Party Liability (TPL), Recovery Audit Contracting (RAC), and Medicaid Estate Recovery (MER) services under RFP 41NHA-S3818, with proposals due August 10, 2026 at 2:00 p.m. PST and questions due July 13, 2026. This is a single-award contract with an anticipated four-year initial term beginning May 1, 2027, with two optional renewal years.

The vendor must hold a Nevada business license and register on sam.gov as mandatory minimum requirements. The scope encompasses nine service areas: general program and enterprise requirements, TPL activities and revalidations (50,000 annually), managed care TPL data exchange and evaluation, managed care secondary recovery, RAC activities, MER database services, subrogation and casualty reduction, cost avoidance, and Health Insurance Premium Payment (HIPP) services (10 new applications monthly and 300 members for case management). The vendor must deposit collected funds within 24 hours of receipt, submit daily itemized deposit reports, disposition claims within 10 business days and refunds within 30 calendar days, and maintain comprehensive databases interfacing with Nevada's interChange MMIS and the Federal Data Services Hub. All systems and data must be maintained within the United States. The vendor bears all implementation and operational costs.

The vendor must comply with HIPAA and a Business Associate Addendum governing Protected Health Information handling, including breach notification within five calendar days and prohibition on artificial intelligence or machine learning on PHI without express written consent. Required insurance includes Commercial General Liability ($2 million aggregate / $1 million per occurrence), Technology Errors & Omissions/Professional Liability ($1 million per claim / $2 million aggregate), Network Security and Privacy Liability, Workers' Compensation at statutory levels, and Fidelity Bond or Crime Insurance ($5 million if handling financial accounts). The State must be named as additional insured.

Cost proposals must be submitted for fiscal years 2027–2031 with costs itemized as a percentage of collections for TPL activities, managed care secondary recovery, RAC, subrogation, and cost avoidance; monthly flat fees for 210 Program Overview and MER database; and per-application and per-member-per-month rates for HIPP. Proposal terms remain valid for 180 days after the due date.

Evaluation weighs technical factors (30%, 25%, 20%, 15%), cost (10%), and presentation (20%, 20%, 20%, 20%, 10%, 10%), with financial stability as pass/fail. Vendors must submit references from three similar projects completed within the last five years and financial statements (last two full years plus current interim). Reference questionnaires are due August 9, 2026. Estimated notice of award is December 8, 2026. Performance penalties include $5,000 per day for delayed operational deployment, $500 per day for late deliverables, $25 per file for unauthorized formatting changes, and $1,000 per data entry error, with a potential 25% invoice holdback for viability, correctness, and timeliness issues.