Procuring auditing services or health care claims processing and related activities for t

The Commonwealth of Massachusetts Group Insurance Commission (GIC) is procuring auditing services or health care claims processing and related activities for its self-insured and fully-insured health plans, including the prescription drug carve-out with CVS/Caremark. The successful bidder will be responsible for conducting claims processing and financial accuracy reviews, as well as operational assessments of customer service and related functions. The contract will cover an initial two-year period with optional two-year renewals, and the GIC expects the audit to be completed on a compressed timeline. Bidders must have substantial experience in auditing large health insurance carriers and pharmacy benefit managers. The GIC is seeking proposals by October 7, 2015, and plans to award the contract by November 20, 2015, with the first year of audits to be conducted from December 2015 to June 2016. The maximum allowable contract value is $2 million over the four-year period.

The GIC encourages participation from Minority and Women Business Enterprises (M/WBEs) and Service-Disabled Veteran-Owned Business Enterprises (SDVOBEs), and bidders are required to develop initiatives to foster new business relationships with such entities. The current incumbent provider is Claim Technologies Incorporated, whose contract expired in June 2015. Funding for this contract will come from the GIC's overall budget of approximately $2.6 billion in fiscal year 2015 to provide health care benefits to its 435,000 members across the Commonwealth of Massachusetts and other public entities.