Third Party Claims Data Matching

The South Dakota Department of Social Services is seeking a vendor to provide third-party claims data matching services through Request for Proposal (RFP) #13686. The primary objective is to identify third parties responsible for payment of health, medical care, and other benefits under the Department's programs, with a specific focus on HIPAA-compliant claims submissions. Key deliverables include electronic claims submissions to insurers, comprehensive identification of liable third parties, and preparation of claims for reimbursement. The procurement targets a vendor capable of processing data for approximately 148,000 Medicaid recipients and over 7.0 million annual claims. Proposal submissions are due by April 2, 2025, with a letter of intent requested by March 4, 2025. The initial contract term will span three years from June 1, 2025, to May 31, 2028, with potential for two additional one-year renewal terms. Vendors must submit cost proposals with specific rates per match and claim submission, including rates for previously unknown active resources, previously unknown terminated resources, and previously known terminated resources.

The RFP does not explicitly indicate specific set-aside designations or restrictions for disadvantaged enterprises. Vendors must demonstrate comprehensive insurance coverage, including commercial general liability, professional liability, business automobile liability, and worker's compensation insurance with specified minimum coverage amounts. The pricing structure requires vendors to incorporate all expenses into their proposal, with the Department declining to pay separate vendor expenses. While no incumbent vendor is mentioned, the successful bidder must be prepared to integrate with existing Department systems and processes. The cost proposal must include a not-to-exceed figure, with pricing structured around per-match and per-claim submission rates. Although a specific budget range is not provided, the scale of claims processing (7.0 million annually) suggests a significant contract value that would be attractive to vendors specializing in healthcare claims data matching and third-party liability recovery services.