Project Information

Bid Title

Informal Request for Information (RFI) for Independent Health Care Advocacy and Navigation Services (RFPQHSS2026.E1)

Issuing Agency

San Francisco Health Service System

Location

California

Published Date

May 22, 2026

Closing Date

May 29, 2026

Government Level

State & Local

Status

Closed

Original Source

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Project Description

1. Informal Request for Information (RFI) for Independent Health Care Advocacy and Navigation Services (RFPQHSS2026.E1)

SFHSS is exploring contracting with an independent health care advocacy and navigation services to support members with complex claims, access, billing, care-navigation, provider-search, prior-authorization, transition-of-care, and unresolved carrier-service issues, with clear escalation protocols, case tracking, reporting, and coordination across SFHSS, our carriers ( links to pages ), providers, and our diverse member population.

SFHSS Health Care Advocacy Navigation Request for Information (RFPQHSS2026.E1)

Key Dates:

• RFI Issued: May 22, 2026
• Deadline for Responses: May 29, 2026 at 12:00PM (PT)

Attachment Preview

REQUEST FOR INFORMATION (RFI) FOR

Health Care Advocacy and Navigation Services PY2028

RFPQHSS2026.E1

CONTACT: patrick.chang@sfgov.org; cc: william.kudenov@sfgov.org and

michael.visconti@sfgov.org

Purpose of this RFP: SFHSS is conducting a brief market scan to understand available health care

advocacy and navigation services. This is not an RFP and will not result directly in an award.

Responses may be brief. Please respond within one (1) week.

Nature of Request: This is a Request for Information only. This RFI is not a Request for Proposals,

does not constitute a solicitation for award, and will not result in the selection of a vendor or

execution of an agreement. Responses will not be considered in any future Request for Proposals

or procurement.

Potential Populations: Active employees, retirees, Medicare retirees, eligible dependents, and

other covered populations served by SFHSS and the four participating employers.

See https://data.sfgov.org/; and/or SFHSS Demographics Reports, i.e.,

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

https://sfhss.org/resource/march-12-2026-sfhss-2026-demographics-summary/download,

https://sfhss.org/sites/default/files/2025-

02/February%2013%2C%202025%20SFHSS%202025%20Demographics%20Report%20Summary.

pdf.

Potential Plans: Self-funded and fully insured medical, dental, vision, Medicare, and related

benefit arrangements. SFHSS is specifically seeking information on models that can function

where full claims, authorization, clinical, or provider data may not be available to SFHSS or the

advocacy vendor (flex funded/fully funded models). Currently only less than 3% of SFHSS

population is in a self-funded ASO-PPO plan. See SFHSS BENEFITS at https://sfhss.org/.

Estimated Population: Over 139,000 covered individuals, including active and retired employees

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and their eligible dependents.

Pricing: Respondents are requested to provide non-binding PEPM pricing ranges, including fully

insured, self-funded, eligibility-only, implementation, reporting, and optional module assumptions.

Pricing may be marked confidential/proprietary and will be treated as confidential/proprietary to

the extent permitted by law.

Deadline for RFI Responses: Friday May 29, 2026, 12:00 PM PT via email to

patrick.chang@sfgov.org; cc: william.kudenov@sfgov.org and michael.visconti@sfgov.org.

1. INTRODUCTION

1.1 Overview

The San Francisco Health Service System (SFHSS) is issuing this Request for Information (RFI) to

gather information from firms that provide independent health care advocacy, navigation, and

complex case-resolution services. SFHSS is interested in understanding current market

capabilities, implementation models, data requirements, limitations, pricing ranges, and practical

approaches for supporting members in a multi-carrier, public-sector benefits environment.

SFHSS is particularly interested in services that can help members resolve complex claims, billing,

prior authorization, provider access, care navigation, transition-of-care, retiree/Medicare, out-of-

area, and carrier-service issues before they escalate externally. SFHSS is not seeking general

wellness-only services, app-only engagement tools, or narrow second-opinion-only services unless

they are part of a broader, live, case-resolution advocacy model.

1.2 The San Francisco Health Service System (SFHSS)

SFHSS administers non-pension health and welfare benefits for more than 139,000 covered

individuals, including active and retired employees of the City and County of San Francisco, San

Francisco Unified School District, City College of San Francisco, San Francisco Superior Court, and

their eligible dependents. These entities are commonly referred to as SFHSS participating

employers.

SFHSS reports to the Health Service Board (HSB), the governing and policy-making body for SFHSS

benefits. SFHSS conducts an annual rates and benefits process and works with health plans,

administrators, consultants, City departments, labor, retirees, and other stakeholders to preserve

and improve sustainable, quality health benefits.

1.3 SFHSS Plan Environment

SFHSS offers benefits through a mix of self-funded and fully insured arrangements, including

medical, dental, vision, Medicare, and related benefit programs. The plan environment includes

health maintenance organizations (HMOs), preferred provider organizations (PPOs), Medicare

Advantage arrangements, and other benefit programs. The availability of claims, authorization,

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provider, clinical, and utilization data may vary by plan type, funding arrangement, carrier, and

applicable law or contract.

Because of this environment, SFHSS seeks specific information regarding how

advocacy/navigation vendors function where SFHSS does not own or receive full claims data and

where carriers may provide limited or no direct data access to an external advocacy vendor.

1.5 Market Context and Public-Sector Comparables

SFHSS is using this RFI to understand whether current market offerings can meet public-sector,

multi-carrier, retiree, Medicare, fully insured, and limited-data needs. Recent public-sector

procurements and materials show that similar services may be described as health care advocacy,

health navigation, member/provider advocacy, benefits concierge, or care navigation. Appendix C

includes an optional internal market-scan table that may be removed before public release.

2. RFI Questionnaire

A. Organization and Experience

1. Please briefly describe your organization and the services you provide.

2. Do you currently provide health care advocacy, navigation, concierge, or member-support

services to public-sector employers, unions, trusts, or large multi-plan employers?

3. Do you have experience supporting active employees, dependents, retirees, Medicare

retirees, and out-of-area members?

4. Please identify similar clients or populations you support, if available.

B. Services Provided

1. What member issues can your organization help resolve?

2. Can you assist members with claims, denied claims, billing issues, balance bills, prior

authorizations, appeals, provider access, appointment scheduling, care navigation, and

transitions of care?

3. Which issues can you directly help resolve, and which issues can you only advise or refer

back to the carrier, provider, employer, or member?

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4. How does your model differ from older advocacy, second-opinion, or concierge models

such as Accolade-style navigation or Best Doctors-style expert medical opinion services?1

C. Carrier and Plan Environment

1. Can you support members across multiple carriers and plan types, including HMO, PPO,

Medicare Advantage, MAPD, and fully insured plans?

2. Can you provide meaningful support in fully insured plan environments where SFHSS may

not have access to full claims, authorization, provider, or clinical data?

3. What data do you need to operate effectively?

4. What can you do with eligibility-only data?

5. What requires claims, authorization, provider, or clinical data from the carrier?

6. Can you work case-by-case using member authorization or consent if full data feeds are not

available?

7. What are the main limitations of your model if a carrier does not provide data or does not

agree to participate?

D. Member Access and Escalation

1. How do members access your services? Phone, web, app, email, live advocate, or other

channels?

2. Do members work with live advocates, clinical staff, benefits specialists, or care

coordinators?

3. What are your standard hours of operation?

4. Do you provide multilingual support?

5. Do you support low-tech, older, disabled, or limited-English-proficiency members?

6. How do you escalate unresolved carrier, provider, claims, or access issues?

1 https://www.sfhss.org/sites/default/files/2018-12/RM_41218_Best_Doctors_Annual_Report.pdf; May

13, 2021 Regular Virtual Board Meeting available at https://sfhss.org/board-meeting/2021-05-13t200000

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7. Can you help prevent member issues from escalating to SFHSS leadership, elected officials,

unions, or Board members?

E. Reporting and Oversight

1. What reporting would you provide to SFHSS?

2. Can you report on case volume, issue type, carrier, plan, resolution status, turnaround time,

repeat issues, and member satisfaction?

3. Can you provide trend reporting without disclosing unnecessary PHI?

4. Can you identify recurring carrier, provider, claims, access, or communication problems?

F. Implementation

1. How quickly could your organization implement services after contract execution?

2. What would you need from SFHSS to implement?

3. What would you need from carriers to implement?

4. What communication support would you provide to help members understand and use the

service?

5. What are common reasons implementation fails or underperforms?

G. Pricing

1. Please provide estimated PEPM pricing, at least in ranges.

2. Please identify any minimum annual fees, implementation fees, data-integration fees,

reporting fees, communication fees, or optional service fees.

3. Does pricing differ for active employees, dependents, retirees, Medicare retirees, or fully

insured populations?

4. Does pricing change if only eligibility data is available?

5. Are performance guarantees, fee-at-risk arrangements, or outcomes-based pricing

available?

6. Please identify any assumptions that would materially change your PEPM estimate.

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Commodity Codes

• NAICS 541511Custom Computer Programming Services
• NAICS 541611Administrative Management and General Management Consulting Services
• NAICS 541690Other Scientific and Technical Consulting Services
• NAICS 541990All Other Professional, Scientific, and Technical Services
• NAICS 624120Services for the Elderly and Persons with Disabilities

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