RFP 2025-04 Home Health and Skilled Nursing Facility Audit and Review Services
Closed State & local contract opportunity Posted
- Solicitation number
- S-X26083-00015254
- State
- Oregon
- Responses due
Opportunity facts
- NIGP codes
- 918 Consulting Services
- 91804 Accounting/Auditing/Budget Consulting
- 91806 Administrative Consulting
- 91869 Insurance Consulting
- 953 Insurance And Insurance Services, All Types
- 95327 Claims Processing Services
- 95348 Health/Hospitalization (Including Dental And Visual Insurance)
- 95352 Insurance And Insurance Services (Not Otherwise Classified)
- UNSPSC codes
- 81162304 Expense management process as a service
- 71161611 Technical consultant services for claim management
- 78142101 Claim management
- 64121504 Commercial multiple peril policy
- 64122202 Group dental insurance policy
- 84131520 Insurance broking fees and commission
- 92110000 Military services and national defense
- 71161612 Technical consultant services for asset integrity information and data control
- 64120000 Insurable interest contracts
- 64122007 Modified guaranteed annuity policy
Show all 38
- 64122006 Fixed annuity policy
- 64121514 Warranty policy
- 64121505 Farm owners multiple peril policy
- 84131513 Erection all risks insurance
- 84131905 Employment practice liability insurance services
- 94000000 Organizations and Clubs
- 84131613 Claims payment processing or administration
- 84131900 Insurance services for casualty lines
- 64122102 Group health insurance policy
- 64122201 Individual dental insurance policy
- 64122101 Individual health insurance policy
- 81162310 Procurement process as a service
- 93000000 Politics and Civic Affairs Services
- 81130000 Statistics
- 93100000 Political systems and institutions
- 93110000 Socio political conditions
- 93120000 International relations
- 84130000 Insurance and retirement services
- 84131602 Health or hospitalization insurance
- 64122100 Health insurance contracts
- 64122200 Dental insurance contracts
- 64121502 Boiler and machinery policy
- 64121507 Fraternal benefit society insurance policy
- 64121508 Homeowners insurance policy
- 64121509 Inland marine insurance policy
- 64121511 Ocean marine insurance policy
- 64121512 Surety policy
- 84131518 Bicycle insurance
- Point of contact
-
- Lee Reinholtz reinholtzl@careoregon.org (503) 416-1797
Opportunity details come from oregonbuys.gov. Updated .
About this opportunity
CareOregon, Inc. is issuing a Request for Proposals (RFP #2025-04) for Home Health and Skilled Nursing Facility Audit and Review Services on behalf of CareOregon Advantage and Health Share of Oregon. The procurement seeks a contractor to implement comprehensive payment integrity programs through prepayment and post-payment audits of home health and skilled nursing facility claims. The selected vendor must utilize only Certified Coding Specialists or Certified Professional Coders and maintain a medical director on staff. Proposers will be evaluated across four key areas: background and qualifications (30 points), scope of work (35 points), equity and diversity efforts (10 points), and fees (25 points), totaling 100 possible points. The project is scheduled to commence in January 2026 with an initial one-year contract and options for two additional one-year renewals. Proposals are due by December 8, 2025, at 2:00 PM Pacific Time and must be submitted electronically to vendorservices@careoregon.org. In 2024, CareOregon processes approximately 8,247,136 Medicaid claims and 852,759 Medicare claims, including 346,542 home health claims and 17,336 skilled nursing facility claims.
The RFP explicitly encourages proposals from minority-owned, women-owned, service-disabled veteran-owned, and emerging small businesses, indicating a commitment to diverse vendor participation. The contract will feature fixed pricing for the initial two years, with potential fee increases of up to 2% annually in subsequent years. While no specific budget range is disclosed, the volume of claims suggests a substantial contract opportunity. The procurement appears to be open to qualified audit and review service providers with demonstrated expertise in healthcare claims analysis and coding. The evaluation process emphasizes not only technical capabilities and fee structures but also gives meaningful weight to equity and diversity efforts, allocating 10 of 100 possible points to these criteria. The contract aims to minimize overpayments through rigorous claims review across home health and skilled nursing facility service categories, suggesting a focus on fiscal accountability and healthcare payment accuracy.
Opportunity text
REQUEST FOR PROPOSALS #2025-04 Home Health and Skilled Nursing Facility Audit and Review Services
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