Project Information

Bid Title

Dependent Eligibility Verification Audit (DEVA) Services Request for Information (RFPQHSS2025.O1)

Issuing Agency

San Francisco Health Service System

Location

California

Published Date

Jan 5, 2026

Closing Date

Jan 9, 2026

Government Level

State & Local

Status

Closed

Original Source

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Project Description

3.  Dependent Eligibility Verification Audit (DEVA) Services Request for Information (RFPQHSS2025.O1)

SFHSS has issued a Request for information (RFI) for for an experienced vendor that can perform dependent eligibility verification audit (DEVA) services. An RFI is neither binding nor does it result in a contract. SFHSS releases RFI’s to obtain the most current information from the marketplace, which may lead to a Request for Proposal. The vendors that respond may bid on a future Request for Proposal (RFP).

• RFI for Dependent Eligibility Verification Audit Services (RFPQHSS2025.O1)

Key Dates:

• RFI Issued: December 31, 2025
• Deadline for Submissions: Friday, January 9, 2026 at 5:00PM (PT)

Please see these webpages for more information:

• 2024 Dependent Eligibility Verification Audit Update, August 8, 2024 Regular Meeting of the Health Service Board, https://sfhss.org/board-meeting/2024-08-08t200000#tab-32317

• 2022 Dependent Eligibility Verification Audit Update, September 8, 2022 Regular Meeting of the Health Service Board, https://sfhss.org/board-meeting/2022-09-08t200000

• Director's Report, January 19, 2019 Regular Meeting of the Health Service Board, https://sfhss.org/board-meeting/2019-01-10t210000#tab-11931

Attachment Preview

DATE:

TO:

FROM:

RE:

Request for Information

December 31, 2025

Dependent Eligibility Verification Audit (DEVA) Vendors

Patrick Chang, San Francisco Health Service System

Dependent Eligibility Verification Audit (DEVA) Request for Information

(RFPQ#HSS2025.O1)

I.

Request for Information (RFI) Intent.

The San Francisco Health Service System (SFHSS) is soliciting information to determine

the availability and qualifications of a vendor partner capable of providing dependent

eligibility verification and auditing (DEVA) services to ensure the eligibility of dependents

enrolled in medical, dental, and vision benefits through SFHSS.

II. The San Francisco Health Service System.

SFHSS is dedicated to providing outstanding health and other employee benefits to SFHSS

Members, preserving and improving sustainable, quality health benefits, enhancing the

well-being of employees, retirees and their families, and adhering to the highest standards

of customer service. SFHSS executes all process phases related to benefit operations and

administration of non-pension benefits (including health, dental and vision) for over

130,000 individuals, including both active and retired employees of the City and County of

San Francisco, the San Francisco Unified School District, the Community College of San

Francisco, and the San Francisco Superior Court (collectively known as (or “Members”),

and their covered dependents pursuant to The City and County of San Francisco Charter §§

12.200-12.203 and A8.420-A8.432, and San Francisco Administrative Code §§ 16.700-

16.703.

Target Population: SFHSS member employees and retirees may enroll eligible dependents

on their health coverage in accordance with Section B (Eligible Dependents of Health

Service System Members) of the San Francisco Health Service System Rules.1

1 San Francisco Health Service System Rules are available at https://sfhss.org/san-francisco-health-service-system-

member-rules.

Dependent Eligibility Verification Audit (DEVA) Request for Information (RFPQ#HSS2025.O1)

Page 1 of 4

As of January 1, 2025, there were approximately 41,000 active employees and 35,000

retirees with at least one (1) dependent enrolled in benefits through SFHSS, including a

legal spouse, registered domestic partner, children, and surviving dependents.2

More information on the demographics of the population which is served can be found

under the SFHSS Demographics Report available at https://data.sfgov.org/stories/s/ppyt-

2mqw.

III. SFHSS Goals and Needs.

SFHSS seeks to conduct one or more DEVA audits to help maintain costs of healthcare

benefits. Covering ineligible dependents puts health plan administrators at financial risk

and increases overall healthcare costs for eligible members. SFHSS is seeking information

on the availability and qualifications for vendors to provide the following DEVA services,

which may include, but not limited to:

1) Population Scope: An audit conducted for:

• all covered dependents

• a sample population of covered dependents

2) Target Population: Audit population can include dependents of the following plan

participants:

• Active employees

• Retired employees

• Leave of absence employees

• COBRA enrollees

3) Benefits: An audit conducted of a participant’s enrolled dependent(s) in

accordance with eligibility requirements under the SFHSS Rules (for one plan or

several plans with the same plan rules) which may include:

• Medical

• Dental

• Vision

Dependents who are covered under a qualified medical child support order

Qualified Medical Child Support Orders (QMCSO) will not be audited.

4) Communications:

• Print and mail up to ten (10) SFHSS-created letters to be sent over a specific

time period and directed to DEVA participants as identified by SFHSS, and

where each letter will have a unique distribution list provided by SFHSS.

2 SFHSS Demographics Report available at https://data.sfgov.org/stories/s/ppyt-2mqw

Dependent Eligibility Verification Audit (DEVA) Request for Information (RFPQ#HSS2025.O1)

Page 2 of 4

• Collaborate with SFHSS to develop a cover sheet with a unique barcode or

other solution approved by SFHSS for receiving, tracking, digitizing, and

indexing DEVA participant mail responses that facilitate rapid sorting,

collating, and linking each SFHSS member’s record.

• Collect eligibility documentation via USPS mail, secure fax, secure online

document upload.3

• Notify participants of dependent(s) eligibility status.

• If needed, provide templates, sample notices, eligibility requirements,

and/or other audit materials for City’s review and approval.

5) Documentation Review and Determination:

• Provide a secure online self-service portal that complies with the United

States Department of Justice (DOJ) Web Content Accessibility Guidelines

Version 2.1 Level AA that will allow audit participants to submit

documentation; view, save, and print audit notices; review deadlines for

action and eligibility criteria; and available twenty-four (24) hours a day,

seven (7) days a week.4

• Collect, review, and qualify all received documentation required by SFHSS

from DEVA participants which establishes relationships between the

member and their dependents.5

• Provide a system for digitizing, combining, and indexing verification

documents mailed by DEVA participants to the vendor in a manner that is

compatible and readable to SFHSS’ systems.

• Determine eligibility for benefits based upon received documentation in

accordance with SFHSS Rules.

• Provide claims and appeals management resources.

6) Data and Reporting:

• Ensure that all information sharing, retention, and destruction practices are

in full compliance with HIPAA and other applicable regulations.

• Commit to maintaining and hosting City data solely on hardware residing on

data centers located in the United States, whereas no City data is

downloaded to or stored on any hardware residing on data centers not

residing in the United States.

• Provide final report and audit results.

3See Section C (Eligibility Documentation Required and Optional) of the San Francisco Health Service System Rules,

available at https://sfhss.org/san-francisco-health-service-system-member-rules.

4 Web Content Accessibility Guidelines (WCAG) 2.1 available at https://www.w3.org/TR/WCAG21/

5 Participants to provide copies (not original documents), and the vendor will not be required to return submitted

documentation to participants.

Dependent Eligibility Verification Audit (DEVA) Request for Information (RFPQ#HSS2025.O1)

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• Provide City twenty-four (24) hours a day, seven (7) days a week access to

DEVA participant data (“City data”), including but not limited to call-

recordings, chat logs, and submitted documents.

• Securely transmit all collected City data to City, including but not limited to

call-recordings, chat logs, and submitted documents, in the City’s preferred

format and in accordance with City’s encryption requirements, at a mutually

agreed upon schedule.

• Provide standard regular reporting on a weekly basis during the project.

• Provide ad-hoc reporting as-needed upon request.

7) Account Management:

• Provide an Account Manager to align with SFHSS during the DEVA project,

which may include regularly scheduled meetings.

• Provide operational updates and troubleshooting support to City as-needed.

IV. Submitting your Response.

Response Deadline. Vendors must complete the Vendor Response Form [Appendix A],

ensuring to also the RFI Product Overview (Appendix A Section 4) and submit the form in

PDF format via email to patrick.chang@sfgov.org, cc: william.kudenov@sfgov.org and

michael.visconti@sfgov.org no later than 5:00 PM (PT) on Friday, January 9, 2026. Any

attachments to the Vendor Response Form must not exceed ten (10) total pages and must

be submitted with the Vendor Response Form (Appendix A).

As a result of this RFI, SFHSS may release a request for proposals or request for bid.

Failure to respond to this RFI will not preclude an entity from responding to any

subsequent procurement requests.

V. Minimum Qualifications.

Qualified Respondents shall:

1) Respondent is a Corporation, Limited Liability Company, or Non-Profit entity in

Good Standing with the State of California (or vendor’s state of formation).

2) Respondent is licensed to do business in California.

3) Respondent has at least three (3) years of experience of providing dependent

eligibility verification services.

4) Respondent has reviewed and can meet the requirements for becoming an

Approved City Supplier (https://www.sf.gov/step-by-step--become-city-supplier).

Dependent Eligibility Verification Audit (DEVA) Request for Information (RFPQ#HSS2025.O1)

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VI. Desirable Qualifications.

1) Experience performing dependent eligibility verification and auditing (DEVA)

services for at least one (1) government or one (1) non-profit organization within the

past five (5) years.

2) Respondent has experience performing dependent eligibility verification for at least

one (1) organization in excess of 10,000 lives.

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Dependent Eligibility Verification Audit (DEVA) Request for Information (RFPQ#HSS2025.O1)

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Commodity Codes

• NAICS 541211Offices of Certified Public Accountants
• NAICS 541519Other Computer Related Services

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