Third-Party Medicaid Billing

The State of Texas is soliciting qualified vendors through a Request for Proposal (RFP) to provide comprehensive third-party Medicaid billing and collection services. The procurement encompasses claims submission, eligibility verification, payment posting, denial management, and revenue cycle support to enhance the state's Medicaid operations. Respondents must demonstrate substantial experience in healthcare billing, in-depth knowledge of Medicaid regulations, and technical capability to integrate with existing state systems. Key evaluation criteria include vendor qualifications, pricing competitiveness, technical capacity, and demonstrated past performance in similar healthcare billing engagements. Deliverables require vendors to submit detailed fee schedules that may include percentage-based collections fees, per-claim processing fees, or hybrid compensation models, along with comprehensive compliance and data security protocols aligned with state standards. The proposal submission deadline is May 26, 2026, with the solicitation having been posted on May 5, 2026. Vendors must address reporting capabilities and service level commitments that meet or exceed incumbent performance benchmarks established by the state.

The solicitation may include designated set-asides for certified businesses or specific vendor categories, though final determinations regarding such preferences should be confirmed within the complete RFP documentation. Incumbent vendor information and current service baseline metrics have been provided to establish performance standards and expectations for the incoming contractor. Selected vendors must demonstrate the ability to seamlessly integrate with Texas Medicaid's existing infrastructure and technology systems while maintaining compliance with state data security requirements. Funding for this contract is derived from the Texas Medicaid program budget, with specific award values and budget allocations detailed in the fiscal provisions of the RFP. The contract term and renewal options are outlined within the proposal requirements, establishing the duration of the vendor's engagement in supporting the state's Medicaid billing operations.