RFP 26-0028-5 Annual Contract for Health Claims Audit

The Chatham County Board of Commissioners issued RFP 26-0028-5 to procure health claims audit services for the county's self-funded medical and prescription drug plans covering 1,994 subscribers and 3,913 members. The contract term is one year with four optional one-year renewal periods, covering audit services for calendar year 2025 claims. Qualified proposers must conduct statistical random sampling with 95 percent confidence levels, perform 100 percent electronic screening with at least 15 targeted samples, and benchmark findings against at least 100 of the firm's most recent audits completed within the past three years. The county anticipates awarding a fixed annual contract with separate pricing options for medical claims audits, prescription drug claims audits, or combined audits, with fees required for all five potential contract years. Evaluation will occur in a two-step process: Step 1 awards points on a 100-point scale based on qualifications and experience (25 points), methodology and implementation plan (30 points), MBE/WBE participation (15 points), references (5 points), and fee proposal (25 points), while Step 2 interviews may award an additional 30 points. A pre-proposal conference is scheduled for March 12, 2026, at 11:00 a.m. via WebEx, with proposals due by 5:00 p.m. on April 2, 2026, submitted through the county's procurement portal, and potential interviews scheduled for the last week of April.

The RFP emphasizes MBE/WBE participation as an evaluation factor with 15 points allocated for minority and women business enterprise involvement. The current administrator of the county's health plans is United Healthcare, and successful proposers must integrate with this existing infrastructure. Proposers are required to maintain Professional Liability insurance with minimum limits of $1 million per claim, Commercial General Liability coverage of $1 million, Worker's Compensation at statutory limits, and Business Automobile Liability of $1 million. While the RFP does not specify an explicit budget range or award value, all fees must be submitted on a fixed annual basis with detailed pricing for each contract year. Chatham County reserves the right to reject any or all proposals and to waive technicalities and informalities at its sole discretion. The RFP does not identify an incumbent vendor, suggesting this may be a new procurement or a change in service providers.