Revenue Integrity, Managed Care Contract Performance & Patient Financial Platform

Roswell Park Comprehensive Cancer Center is requesting proposals for a single, integrated revenue integrity and patient financial software platform supporting automated workflows across hospital revenue cycle functions, with proposals due August 28, 2026. The RFP carries no MWBE set-aside or participation goals.

The scope encompasses underpayment reporting and recovery based on modeled contract terms, payer contract management and performance analytics with scenario modeling, patient financial estimates and projections with financial assistance workflows, eligibility verification and payer/product matching with coverage discovery, and authorization management. Roswell Park strongly prefers a single-vendor platform delivered under one master agreement with integrated implementation and support, demonstrating automation, data integration, audit readiness, and measurable financial impact with minimal manual process reliance. Roswell Park currently uses Altera Sunrise EHR and Athena IDX patient accounting platform. The organization processes approximately 520,947 annual patient encounters (5,636 institutional claims and 515,311 professional claims) across one hospital and five clinic/ambulatory locations in Western New York, with payer concentration in regional commercial and Medicare Advantage plans, New York State Medicaid and managed care plans, and Medicare fee-for-service. Roswell Park utilizes multiple non-DRG reimbursement methodologies including percent of charges, case rates, bundled payments, per diem arrangements, and fee schedules varying by payer and service type.

The initial contract term is three years with two successive one-year renewal options, automatically renewing unless Roswell Park provides written non-renewal notice at least 30 days prior to expiration. Pricing must remain firm and fixed for the initial three-year term, with any annual increases thereafter limited to no more than 2% requiring at least 60 days' prior written notice. Vendors must provide complete pricing transparency across all costs including implementation, integration, training, support, maintenance, hosting, licensing, transaction-based, usage-based, and third-party costs, with optional modules clearly identified.

Evaluation criteria are weighted as: Financials (40%), Platform and Functional Capability (30%), Integration, Architecture, and Technical Fit (10%), Implementation, Support, and Operational Fit (10%), and Vendor Experience and Qualifications (10%). Vendors must demonstrate healthcare client experience with hospitals and health systems, proven experience with PPS-exempt and NCI-designated cancer centers, and provide at least three client references for similar services within the last three years, including at least one from an NCI-designated cancer center. Post-bid evaluations may include Phase II presentations, interviews, and demonstrations for shortlisted vendors.

Vendors must comply with comprehensive security requirements including NIST Cybersecurity Framework, HITRUST, ISO 27001, and CSA Cloud Controls Matrix; HIPAA and Business Associate Agreement obligations; FIPS 140-3 validated encryption for data in transit and at rest; multi-factor authentication and role-based access controls; annual penetration testing; and strict prohibition on offshoring data outside the United States. New York Executive Order No. 16 certification addressing Russian business operations is required. Questions were due July 17, 2026. Proposal narratives are limited to 20 pages, excluding checklists, pricing, case examples, company background, required forms, and optional appendices.