Worker's Compensation Medical Bill Review Program

The State of Maine Department of Administrative and Financial Services, Office of Employee Health, Wellness, and Workers' Compensation is requesting proposals for medical bill review and negotiation services under RFP 202607125, with proposals due September 2, 2026 at 4:00 p.m. local time via the Vendor Self Service system. The Department anticipates one award and intends no best and final offer round.

The scope includes reviewing and down-coding facility and professional medical bills per the Maine Medical Fee Schedule, negotiating fees for specific medical services, providing quarterly training to Department staff, and delivering comprehensive reporting on audit results and cost savings. The Department processes 1,200 to 1,400 workers' compensation claims annually and requires all medical bills processed for payment within 30 days of receipt. The vendor must propose secure methods for receiving scanned bill images and electronic submissions via medical clearinghouses and demonstrate integration capabilities with the Department's Risk Management Information System.

Pricing must be submitted as a fixed fee structure covering the initial two-year performance period. Bidders must propose specific fees across eight service categories: medical bill review (estimated 8,000 bills annually), PPO network access (estimated 6,000 transactions annually), out-of-network negotiated savings (estimated 400 negotiations annually), historical document/image conversion (one-time), claims examiner portal (annual), document management implementation (one-time), customized W-9 management referral (estimated 200 annually), and additional services.

The contract runs from November 1, 2026 through October 31, 2028, with two optional renewal periods extending through October 31, 2031. Evaluation allocates 35 points to organizational qualifications and experience, 35 points to proposed services, and 30 points to cost; the lowest bid receives 30 points with higher bids scored proportionately lower. Bidders must comply with HIPAA, State IT policies, NIST standards, SOC 2 Type 2 audit compliance, vulnerability scanning, digital accessibility standards, and data protection regulations. Written questions are due August 17, 2026 at 4:00 p.m. local time.