AI Solution

The agency is seeking a technology-enabled solution to streamline the prior authorization process using artificial intelligence. This initiative addresses a significant increase in authorization volume and complexity that currently relies on manual workflows, which delay therapies and strain existing staff. The requested solution must improve efficiency and increase throughput while reducing the need for additional staffing. The project covers authorizations for both pharmacy and medical insurance benefits, specifically including specialty and infusion therapies. The service must utilize AI to retrieve required clinical information directly from the electronic medical record system to reduce staff investigational time. The agency requires a scalable and secure platform that provides actionable analytics to support departmental growth and process improvements. Eligible bidders must be onshore organizations based in the United States. The performance of all work will occur offsite, and the agency will accept digital submissions via email or an online portal. The resulting contract will cover a performance period of five years. The agency is currently looking for proposals to establish budget parameters and costs. All formal questions regarding this opportunity must be submitted no later than June 23, 2026.