Medical Invoicing Review Services

The Washington State Department of Transportation (WSDOT) is soliciting proposals through Request for Qualifications and Quotations (RFQQ 2025 0131) for Medical Invoicing Review Services specifically for Washington State Ferries (WSF) Jones Act claims. The procurement seeks a qualified firm to review, negotiate, and reduce medical invoices for maritime employees who become injured on the job, with an anticipated initial contract term of three years and potential for three additional one-year extensions. Key deliverables include reviewing approximately 1,696 medical bills annually, verifying medical procedure codes, repricing invoices to reflect reasonable rates, and uploading completed reviews to WSDOT's FTP site within 10 business days of receipt. Vendors must demonstrate capabilities in reducing medical bills, processing high volumes, and pre-negotiating fees for complex procedures, with a required 48-hour turnaround for pre-authorization negotiations. The solicitation timeline includes a pre-bid conference on February 10th, 2025, at 11:00 AM Pacific Time, with questions due by February 11th and bids due by March 17th, 2025. The evaluation will consider both technical capabilities and cost factors, with 80 points for non-cost factors, 53 points for cost factors, and additional preference points for compliance with various state business initiatives.

The RFQQ includes voluntary goals for diverse business participation, with targets of 10% Minority-Owned Businesses, 6% Women-Owned Businesses, 5% Veteran-Owned Businesses, and 5% Washington Small Businesses. Bidders can earn additional evaluation points for compliance with Executive Order 18-03, Washington Small Business certification, and Certified Veteran-Owned Business status. The current incumbent vendor is PMSI, LLC (doing business as Optum Managed Care Services), and the program has historically achieved an average savings rate of 40.6% on medical invoices. The estimated annual contract value is approximately $90,000, with a potential total contract value of $540,000 over six years if all extensions are exercised. Bidders must provide comprehensive documentation including client references, business certifications, and demonstrate compliance with strict data security requirements outlined in the Data Sharing Agreement, which mandates adherence to HIPAA regulations for handling sensitive medical and personal information. The contract includes requirements for multiple insurance coverages, including Commercial General Liability, Cyber Liability, Workers' Compensation, and Professional Liability Insurance.