RFP 2022-25 Prior Authorization Services

CareOregon, a public benefit nonprofit company in Oregon, issued Request for Proposals (RFP) 2022-25 for Prior Authorization Services to support their Medicaid (Oregon Health Plan) and Medicare Advantage (Dual Special Needs Plan) programs in Multnomah County. The procurement seeks a contractor to assist internal clinical staff in processing prior authorization requests for physical health, mental health, and durable medical equipment services. Key deliverables include processing assigned prior authorization requests, reviewing requests for completeness, accessing CareOregon's prior authorization systems, creating denial letter language, and performing self-audits. The contractor will be expected to handle approximately 1,000 prior authorization requests per month, with a productivity standard of 20 requests processed per day and a cycle time of 1-3 days from assignment to completion. Evaluation criteria will encompass the proposer's general background, qualifications, scope of work understanding, equity/diversity/inclusion efforts, and proposed fees. The initial contract term runs from the effective date through December 31, 2024, with options for two additional two-year renewals. Proposals were originally due by January 9, 2023, at 2:00 PM Pacific Time; however, the solicitation was subsequently cancelled.

CareOregon specifically encourages proposals from minority, women, service-disabled veteran, and emerging small businesses, indicating set-aside preferences for diverse enterprises. The RFP does not disclose the identity of any incumbent vendor or current contractor performing these services. Pricing is to be submitted on a time and materials basis with a not-to-exceed amount, with an estimated contract value of approximately $250,000 per year. The selected contractor's nursing staff will work alongside CareOregon's internal nurses, with both parties performing quality audits and participating in annual interrater reliability assessments. CareOregon remains open to flexibility in staffing, including potential use of LPNs for certain reviews. The organization will require proposers to demonstrate capabilities in accessing their prior authorization systems and integrating with existing workflows. Notably, the RFP was ultimately cancelled, with CareOregon indicating they would continue handling prior authorization services internally for the foreseeable future.