Request for Information (RFI) for Surveillance Utilization Review (SUR) Claims Review Management and Tracking System

This Request for Information (RFI) is being issued by the Texas Health and Human Services Commission (HHSC), on behalf of the Office of Inspector General (OIG), seeking information from qualified Respondents regarding a claims review management and tracking system for its Surveillance Utilization Review (SUR) unit. The SUR unit conducts retrospective claim and medical reviews across various health and human services programs, including acute care, hospital, and nursing facility utilization. The goals of this RFI are to discover best-in-class claims review management and tracking solutions that will centralize all SUR activities into one platform, increase operational efficiencies, and promote innovation and prioritization of utilization review activities. The RFI outlines detailed requirements for the claims review management and tracking solution, including the ability to pull samples of provider claim/MCO encounter data, sort and categorize samples, display and track review progress and outcomes, provide timekeeping functionality, generate reports, store and review PHI information, support a tiered user base, and generate provider notices. Respondents are also asked to provide information on support services, advancements in claims review management software, and their company's qualifications and experience with similar projects. Responses are due by August 28, 2024, at 10:30 a.m. Central Time, and must be submitted via email to the designated point of contact. This RFI is not a procurement opportunity, and no contract will be developed as a result of the submission of a response.

There are no set-aside designations or restrictions on the types of organizations that can respond to this RFI. The RFI does not identify any incumbent vendors or current contractors, nor does it provide any information on existing infrastructure or technology that requires integration. Additionally, the RFI does not include any details on possible award values or budget ranges.