Workers Compensation Medical Bill Review Services

The State of Michigan Department of Labor and Economic Opportunity, Workers' Disability Compensation Agency is soliciting proposals for medical bill review services under RFP 260000002170, with proposals due July 17, 2026 at 3:00 p.m. Eastern. Bidders must be currently WDCA-certified or meet certification requirements by the time of bid review to avoid disqualification.

The scope covers technical bill review (coding accuracy and maximum allowable payment verification) and professional healthcare review performed by licensed healthcare professionals (RNs, MDs, DOs holding active licensure in any U.S. state, though Michigan licensure is not required). Approximately 85% of processed bills require professional healthcare review. Services span three funds: the Self-Insured Employers' Fund, the Volunteer Health Plan Fund, and the Christopher R. Slezak First Responder Presumed Coverage Fund. Historical volume data shows approximately 2,100–4,400 bills annually across the three funds, with significant fluctuation in monthly submissions. The State requires a seven-business-day turnaround time for all reviews and monthly cost-savings reporting. Bidders may propose separated pricing per bill (technical) and per case (professional healthcare review) or alternative arrangements. The contractor must reimburse the State for any late fees from processing delays and recover overpayments caused by vendor errors.

The contract runs October 1, 2026 through September 30, 2029, with up to two optional one-year renewals at the State's sole discretion. Award notification is expected no later than September 4, 2026. Contracts valued at $250,000 or greater require State Administrative Board approval.

Proposals are evaluated on a 100-point technical scale (Statement of Work weighted at 80 points, Vendor Questions Worksheet at 20 points). Only proposals scoring 80 or more points proceed to pricing evaluation. The incumbent vendor is identified as still providing services under the existing arrangement; this RFP represents full replacement. Insurance requirements include Commercial General Liability ($1,000,000 each occurrence / $2,000,000 aggregate), Professional Liability/Errors and Omissions ($3,000,000 each occurrence / $3,000,000 annual aggregate), and five additional coverage types. Federal provisions apply, including Byrd Anti-Lobbying Certification for contracts exceeding $100,000.