Utilization Review Services

The Kansas Department of Health and Environment (KDHE)-Division of Healthcare Finance (DHCF) is conducting a competitive procurement for retrospective utilization review services across the state's Fee-For-Service (FFS) Medicaid population. The solicitation seeks a qualified vendor to provide comprehensive review methods for approximately 328 hospitals and 62 ambulatory surgical centers, focusing on inpatient hospital admissions, cost outliers, inpatient psychiatric hospital services, readmissions, outpatient surgery, transfers, and DRG validation. The contractor must be a Federally Designated Quality Improvement Organization or QIO-Like Entity with a facility within five miles of Topeka, Kansas, capable of handling high-volume claim reviews. The RFP was originally posted on April 9, 2025, with an amended closing date of June 3, 2025, at 2:00 PM CST. Key deliverables include monthly and quarterly reports, with the contract running from the award date through June 30, 2029, and an option to renew for an additional 24-month period. Potential bidders must submit comprehensive documentation, including completed forms for Boycott of Israel, Sexual Harassment, and Immigration Reform, and obtain a current Tax Clearance Certificate.

The procurement includes potential preference provisions for disabled veteran-owned or certified businesses, with an emphasis on vendors that demonstrate practices to discourage human trafficking. The contract has structured fixed costs for each state fiscal year (SFY 26-30), requiring bidders to provide detailed budget supporting their proposed costs. Liquidated damages are specified for delivery delays, ranging from $1,000 to $5,000 per business day. While specific budget ranges are not explicitly detailed, the scope suggests a significant contract value given the comprehensive review requirements for hundreds of healthcare facilities. The KDHE reserves the right to accept or reject any bids, and vendors must demonstrate technical capabilities for system access and comprehensive claim review processes. Bidders are required to submit a signed amendment acknowledging the extended closing date, and all questions were to be submitted via email by April 29, 2025, to the procurement officer Lee Askew.