RFP 2026-04 - AI Co-Pilot Sercvice

CareOregon, a nonprofit Oregon-based Medicaid-focused coordinated care organization, is issuing Request for Proposals (RFP) 2026-04 for AI Co-Pilot Services to support its end-to-end Prior Authorization and Utilization Management functions. The procurement seeks an AI-enabled, workflow-integrated co-pilot solution designed to work seamlessly with the QNXT UM platform and other enterprise infrastructure. Key deliverables include support for Prior Authorization and Appeals processes with a minimum extraction accuracy requirement of 95% across all document types (faxed, scanned, handwritten, and low-quality PDFs), confidence scoring between 0.70 and 0.84, and automated routing capabilities that maintain human authority over all final medical necessity determinations. CareOregon processes approximately 9,700 Medicaid Prior Authorization requests monthly (1,300 expedited) and 1,000 Medicare requests monthly (161 expedited). The solution must comply with HIPAA requirements, include comprehensive AI governance and security controls, bias monitoring, audit logging, and CMS audit defensibility, with integration via APIs, batch files, database extracts, event feeds, or vendor-supported connectors to be determined during Phase 1 implementation. Proposals are evaluated on a 100-point scale: Proposer's General Background and Qualifications (0-30 points), Scope of Work (0-35 points), Interviews/Presentations (0-10 points), and Fees (0-25 points). The deadline to submit clarifying questions is May 21, 2026, at 5:00 PM Pacific Time, with proposals due by May 28, 2026, at 2:00 PM Pacific Time. The anticipated contract start date is August 1, 2026, with a phased implementation targeting pilot go-live by December 31, 2026, and full enterprise rollout potentially extending into 2027.

No specific set-aside designations for disadvantaged enterprises are detailed in the available documentation, though Equity, Diversity, and Inclusion Efforts are addressed in evaluation but receive no points. All selected proposers must execute a Business Associate Agreement, comply with CareOregon's Data Security Requirements (Tier 1), and adhere to a Contracting Addendum for Software that prohibits offshore services for accessing or housing CareOregon data. Required insurance coverage includes Commercial General Liability, Professional Liability, Automobile Liability, and Cyber Liability with minimum limits of $1,000,000, $1,000,000, $1,000,000, and $3,000,000 per occurrence, respectively. CareOregon maintains a Snowflake data warehouse available for integration purposes and has committed to providing necessary internal IT, clinical, compliance, legal, and operational resources throughout implementation. Proposers must submit fees on a fixed-fee basis with sufficiently descriptive detail including implementation fees, subscription fees, hourly rates, reimbursable expenses, and maximum escalators for additional contract terms. The initial contract term is three years with options for two additional one-year renewals, subject to mutual agreement, though specific award values or budget ranges are not disclosed in the available documentation.