S24DWC005 "Independent Medical Review"

The California Department of Industrial Relations (DIR) Division of Workers' Compensation (DWC) is issuing a Request for Proposal (RFP) to contract with an independent medical review (IMR) organization to conduct IMR services as required under California law. The 36-month contract will require the selected contractor to provide a case workflow tracking system, develop review procedures and manuals, process IMR applications, conduct reviews, and report data to DIR. Proposals must be submitted by August 8, 2024, and the contractor will be expected to bill claims administrators directly for each review performed, up to a maximum of $495 per review. DIR is seeking proposals from contractors with a minimum of 5 years' experience conducting IMR, managing high-volume medical reviews, and providing data on case status and outcomes. Proposals exceeding the $495 per review rate may be deemed non-responsive.

This RFP does not appear to have any set-aside designations or restrictions on the types of organizations that can respond. The RFP also does not mention any incumbent vendors or current contractors, nor does it indicate any existing infrastructure or technology that requires integration. The total budget for the contract is $0.00, as the contractor will bill the claims administrators directly for each review performed, up to a maximum of $495 per review.