Secondary Review for Medically Necessity Hospital Admission

El Paso County Hospital District, doing business as University Medical Center, is seeking proposals for a secondary medical necessity review service for hospital inpatient admissions. The procurement involves a comprehensive medical review process that will occur after an initial InterQual criteria review, with the primary objective of providing a physician-driven second-level compliance review of failed inpatient cases. Vendors must demonstrate capabilities in performing robust denials and appeals management, including physician peer-to-peer and Administrative Law Judge level appeals. The Request for Proposals (RFP) requires vendors to provide certification documentation supported by evidence-based medical literature, with a focus on defensible hospital admissions. Key evaluation criteria will include evidence-based medical literature validation, appeals program effectiveness, reporting capabilities, physician staffing qualifications, and value-added services. The RFP was issued on November 10, 2025, with proposals due by December 8, 2025, at 2:00 p.m. Mountain Time, to be submitted through the Bonfire procurement portal. Vendors must be compatible with the Cerner platform and capable of supporting the hospital's comprehensive medical review requirements.

While specific set-aside designations are not explicitly detailed in the provided documentation, the procurement appears to be open to qualified medical review service providers. The contract will be with University Medical Center of El Paso, a 354-bed teaching hospital and the region's only Level 1 Trauma Center, which handles approximately 16,000 patient admissions annually. The selected vendor must maintain strict HIPAA compliance and demonstrate high standards of medical review and documentation integrity. Though specific contract value or budget range is not specified, the evaluation will consider overall cost, service quality, and organizational capabilities. The hospital expects the vendor to integrate seamlessly with existing case management workflows and provide comprehensive medical necessity review services. Technology requirements include compatibility with the Cerner electronic health record platform, and vendors must have experienced physician advisors capable of conducting thorough medical record reviews and supporting complex appeals processes.