Project Information

Bid Title

Medical Payment Claims Integrity Review and Performance Audit Services

Issuing Agency

Mississippi Division of Medicaid

Location

Mississippi

Published Date

Apr 30, 2026

Closing Date

May 29, 2026

Government Level

State & Local

Status

Closed

Original Source

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Project Description

• Medical Payment Claims Integrity Review and Performance Audit Services – QR # 20260430 – RFx # 3150006823 – 4/30/26
  • QR# 20260430
  • Attachment A – Medical Claims Quote Form
  • Attachment C – Medical Claims Subcontractor Form
  • Attachment D – Medical Claims Drug Free
  • Attachment E – Medical Claims Debarment
  • Attachment F – Medical Claims Amendment
  • Attachment G – Medical Claims Proprietary
  • Attachment H – Medical Claims BAA
  • Attachment I – Medical Claims Quote Checklist
  • Appendix 1 – Medical Claims Reference Survey Form

Attachment Preview

OFFICE OF PROCUREMENT

QUOTE REQUEST (QR) 20260430

RFX # 3150006823

MEDICAL PAYMENT CLAIMS

INTEGRITY REVIEW AND

PERFORMANCE AUDIT SERVICES

Issue Date: Thursday, April 30, 2026

Question Deadline: Thursday, May 14, 2026, by 2:00 p.m. CST

Response Deadline: Friday, May 29, 2026, by 2:00 p.m. CST

Procurement Contact:

Sharon Clark

Sharon.Clark@medicaid.ms.gov

P.O. Box 2222

Jackson, Mississippi 39225

DOM WELCOMES PARTICIPATION OF MINORITY BUSINESSES

1.0 PROCUREMENT OVERVIEW

1.1 Introduction

The Mississippi Division of Medicaid (DOM), Of ice of Procurement, is seeking a quali ied,

experienced entity specializing in professional accounting and/or auditing services to perform

Medical Payment Claims Integrity Review and Performance Audit services in support of the

agency’s Medicaid claims management system. The selected Offeror shall demonstrate

specialized expertise in Medical Payment Claims Integrity Review and Performance Auditing,

with a proven track record of delivering services directly aligned with the scope of this

procurement.

DOM requires a comprehensive analysis of 100% of medical claims payment data for a speci ied

timeframe based on dates of service, with the objective of identifying potentially incorrect

payment calculations within claims adjudication processes. In addition, the Offeror will be

expected to conduct global analyses and produce reports that highlight payment integrity trends

across both current and historical claims data.

This audit includes all claims – both fee for service claims and managed care paid encounters.

Anywhere this Quote Request uses the term ‘claim(s)’, it is meant to include fee for service and

managed care. This audit excludes all outpatient pharmacy claims but includes Physician

Administered Drug (PAD) claims.

It is understood that any resultant contract awarded pursuant to this Quote Request (QR) is

exempt from approval by the State of Mississippi’s Public Procurement Review Board (PPRB);

however, the contract will be subject to review by the Department of Finance and

Administration’s Of ice of Personal Services Contract Review (OPSCR), for the purpose of

conducting a review to ensure compliance with applicable exempt contract requirements. DOM

intends to award one contract for the services required herein. DOM further reserves the right to

reject any and all quotes provided in response to this solicitation at any point of the evaluation,

award and/or contract execution process.

1.2 Authority

Medicaid Program

This solicitation is issued under the authority of Title XIX (Medicaid) and XXI (Children’s

Health Insurance Program) of the Social Security Act, as amended, including applicable

implementing regulations, and in accordance with the Mississippi Code of 1972, as amended.

All prospective Contractors are charged with presumptive knowledge of all requirements of

the cited authorities in this Quote Request (QR). The submission of a valid executed quote

response by any prospective Contractor shall constitute admission of such knowledge on the

part of each prospective Contractor. Any quote response submitted by any prospective

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Contractor which fails to meet any published requirement of the cited authorities shall, at

the option of DOM, be rejected without further consideration.

Medicaid is a joint federal and state program providing medical assistance to eligible

individuals, funded through a combination of state appropriations and federal matching funds

under Title XIX and XXI of the Social Security Act. Section 1902(a)(30)(A) of the Act (42 U.S.C.

§ 1396a(a)(30)(A)) mandates that state Medicaid agencies implement methods and

procedures to safeguard against unnecessary utilization of services and to ensure efficiency,

economy, and quality of care.

1.3 Term of Contract

The term for the services required herein shall begin on July 1, 2026, and end on June 30, 2031.

The contract shall remain under the same prices, terms, and conditions throughout the term of

the contract.

Quotes for the required services must be received by the DOM Of ice of Procurement no later

than the deadline speci ied in this QR. Payment and performance obligations for future iscal

years will be subject to the appropriation and availability of funding.

1.4 Contract Type and Compensation

The resulting contract will be a irm ixed-price agreement, under which the Auditor’s proposed

rates shall remain constant for the entire contract term. Invoices must be submitted in the format

prescribed by DOM and shall itemize all services provided in alignment with the rates speci ied

in the Quote Form (Attachment A).

1.5 Travel

Operational costs shall include all necessary travel as it relates to the performance of this service.

Travel expenses will not be reimbursed.

1.6 Selected Vendor Requirements

The awarded vendor will be required to register with the Mississippi Accountability System for

Government Information and Collaboration (MAGIC) system. Registering with MAGIC allows

vendors to receive noti ications for upcoming RFx opportunities based on your entity’s product

categories. Businesses can search the MAGIC system for upcoming RFxs, respond electronically

to some solicitations, receive purchase orders by email and receive payments electronically. To

register, visit: https://www.dfa.ms.gov/dfa-of ices/mmrs/mississippi-suppliers-vendors/.

1.7 Eligibility and Minimum Quali ications

1.7.1 Organizations Eligible to Submit Proposals (Attachment A – Quote Form)

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1. To be eligible to submit a quote, the Offeror must submit a completed and signed

“Attachment A – Quote Form.” This form shall include all required pricing, certi ications,

and attestations. Any costs included elsewhere in the Offeror’s submission will not be

considered part of the contract and will not be paid.

2. The Offeror must submit all narrative responses and documentation required under

Sections 1.7.2 Minimum Quali ications and 1.7.3 Capability to Provide Services as

part of the proposal package.

Failure to complete and sign (1) and provide required information noted in (2) above will result

in the Offeror being deemed non-responsive.

1.7.2 Minimum Quali ications (Attachment B: Addendum 1)

(No page limit)

Note: Offerors must create this document based on the requirements below.

A template is not provided by DOM.

The following minimum requirements are mandatory and must be addressed in full. Offerors

shall fully respond to and provide any necessary documentation of how their quote response

meets or exceeds each quali ication as an addendum entitled, “Attachment B: Addendum 1:

Minimum Quali ications”.

Offerors should note:

a. Failure to provide the necessary documentation speci ied in Sections 1.7.2 will

result in the Offeror being deemed non-responsive.

b. Failure to meet or exceed any of the minimum quali ications will result in the

Offeror being deemed non-responsible.

c. Offerors deemed non-responsive and/or non-responsible will be disquali ied from

further consideration.

Please ensure that your vendor response includes the total number of years and types of

experience of your company to support how your company meets the minimum requirement.

1.7.2.1 Offeror Experience Requirement

1. The Offeror must demonstrate the ability to manage complex audit engagements,

including development and execution of detailed project management methodologies,

timelines, and deliverables. The Offeror must have experience producing comprehensive

audit reports, maintaining complete and accessible electronic records, and providing

supporting documentation (e.g., spreadsheets, methodologies, and calculations) in client-

approved formats. Experience presenting indings to executive leadership and providing

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advisory recommendations, including legislative or legal support is required. (Offeror to

provide three (3) distinct, complex audit projects of similar size and scope within the

previous ive (5) years [January 1, 2021 to present] and should include client name, scope,

and complexity of work, contractual time period and summary of activities.)

2. The Offeror must have a minimum of ive (5) years’ experience performing large-scale

medical claims audits, including high volume or up to full population (100%) electronic

claims re-adjudication. Three (3) years of this experience must be in performing audits of

Medicaid Fee-for-Service (FFS) and/or managed care claims. Experience must include

comprehensive analysis of Medicaid payment accuracy, including provider/member

eligibility validation, NCCI edits, and coordination of bene its (COB). Additionally, the

auditor must have proven expertise in verifying medical necessity and pricing accuracy

based on Medicaid State Plan methodologies. (Offeror to provide two (2) to three (3)

projects meeting the experience requirements listed above involving high-volume and/or full

population medical claims audits. Should include client name, contractual time period and

list of activities associated with each project).

3. The Offeror must agree to perform all services required in this quote in accordance with

customary and reasonable industry standards, as well as in strict conformance to all laws,

statutes, and the applicable rules, regulations, methods and procedures of all required

government boards, bureaus, of ices, and other agents whether currently in place,

updated and replaced, or newly created. The Offeror shall be responsible for the complete

performance of all work; for the methods, means, and equipment used; and for furnishing

all materials, tools, apparatus, and property of every description used in connection

therewith. No statement within this quote shall negate compliance with any applicable

governing regulation. The absence of detailed speci ications or the omission of detailed

description shall be recognized as meaning that only the best commercial practices are to

prevail, and that only irst quality materials and workmanship are to be used. Offeror must

con irm compliance.

4. References: References provided by an Offeror must be familiar with the Offeror’s

abilities in the areas involved with this solicitation and must be from the experience the

Offeror identi ied in Section 1.7.2.1 (1) – (2). DOM staff will use these references to

determine the Offeror’s ability to perform the services. The Offeror is responsible for

verifying that all reference contact information is accurate and up to date prior to

submitting its response. DOM staff will not be responsible for locating references. Client

references that cannot be contacted for veri ication will not be considered. The

determination of the length of time an entity has provided these services will be based

upon the initial date the Offeror established a contractual relationship to provide such

services.

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Commodity Codes

• NAICS 541611Administrative Management and General Management Consulting Services

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